A NEW study reports that marathon runners do not appear to develop long-term ventricular damage, with cardiac changes seen after a race reversing within days and remaining stable after ten years. The findings challenge assumptions about the strain of endurance exercise.
Cardiac Adaptation and Recovery in Marathon Runners
Growing public interest in endurance sport has intensified medical scrutiny of how repeated strenuous exercise affects the heart. For recreational marathon runners, concern has centred on transient postrace changes in ventricular function and the potential association with troponin T release. This study sought to clarify whether these temporary shifts translate into lasting structural or functional impairment across a decade of regular participation.
Ten-Year Follow-Up Using Echocardiography and Biomarkers
The longitudinal Pro-MagIC cohort study included 152 male marathon runners with a mean age of 43 years. Participants underwent assessments prerace, immediately after finishing, then at one, three days, and ten years postrace. Right ventricular ejection fraction declined from a prerace median of 52.4 percent (IQR 50.0 to 55.1 percent) to 47.6 percent immediately postrace (IQR 44.7 to 51.5 percent; P < .001) and 50.7 percent one day later (IQR 48.4 to 53.0 percent; P = .001). Recovery was observed by day three, with a median of 51.3 percent (IQR 50.4 to 53.0 percent; P = .18), and values remained stable at the ten-year follow-up with 51.9 percent (IQR 49.6 to 54.5 percent; P = .15). Importantly, troponin T release after the marathon showed no association with long-term right or left ventricular ejection fraction (Pearson r = −0.10, P = .35 and r = −0.09, P = .35). Left ventricular ejection fraction and diastolic function demonstrated small but statistically significant changes that remained within normal physiological ranges.
Implications for Clinical Practice and Athlete Monitoring
For clinicians advising recreational endurance athletes, these findings provide reassurance that repetitive long-distance training does not appear to cause progressive right ventricular dysfunction in marathon runners. Postrace biomarker elevations should be interpreted as transient physiological responses rather than indicators of chronic damage. Future work may help refine risk assessment, guide tailored monitoring for older athletes or those with comorbidities, and support evidence-based recommendations for safe long-term participation in endurance sport.
Reference
Schindler MJ et al. Long-term changes in ventricular function in recreational marathon runners. JAMA Cardiol. 2025;DOI:10.1001/jamacardio.2025.4456.
