Marathoner’s Heart?

Abstract

Efforts to evaluate the risks and benefits of exercise, especially prolonged endurance exercise, are almost as old as scientific medicine itself. Hippocrates, the father of scientific medicine, included a chapter on athletic training in his book Regimens in Health and suggested that exercise should be moderate and only part of a healthy lifestyle.1 Hippocrates was a near contemporary of Pheideppides, an Athenian who, in 490 BC, reportedly died after running 40 km (24 miles) from Marathon to Athens to announce the Athenians’ victory. Unfortunately, this often-quoted story is probably only partly true. The runner was unlikely to have been named Pheidippides. The distance was likely much greater and probably extended from Athens to Sparta to recruit more soldiers, back to Athens to announce that the Spartans were not coming, and, finally, from Athens to Marathon and back—a total distance of approximately 500 km.1 Furthermore, the exhausted runner probably did not die, because his death is not noted by Herodotus, the major historian of the event. There is an element of truth to the legend, however, because 50 years later, Eucles did die after running to Athens,1 providing at least some support for the dangers of prolonged exertion. Article p 2325 Competitive athletics thrived in Victorian England because they were thought to build moral and ethical fitness, and the concept of an “athlete’s heart” was more a moral than a physiological concept.1 The emergence of such sports as the Oxford–Cambridge boat race, endurance cycling, and running was accompanied by concern for the cardiac dangers of prolonged exercise. F.C. Skey, a London physician, suggested that “the hard exercise in rowing” was one of the most common causes of heart disease.2 These concerns about rowers’, bicyclists’, and runners’ hearts persisted into the 20th century and were only dispelled …