When we exercise too much

Nearly 20% of the population meet or exceed physical activity guidelines and the World Health Organisation suggests that we should be aiming to do more exercise for additional health benefit. While exercise is good for us, and great for the heart, sometimes too much exercise may lead to heart problems. As a result, we must understand what the impact of endurance exercise is on the heart.

Systematic review and meta-analysis results

Holsworth Research Initiative researcher, Dr Dan Wundersitz and his team of international and La Trobe Rural Health School researchers firstly investigated the effect of endurance cycling on the heart.

Dan and his team diligently sifted through the research and found that endurance cyclists have larger hearts relative to body size than non-athletes, and even when compared to participants in other active sports such as kayakers, canoeists, runners, swimmers, body builders and wrestlers this difference remained.

In addition, they found that endurance cyclists have an increased incidence of cardiac problems compared to non-athletes, but no more than other sport athletes.

MADRIDE results

When the team worked with participants in the MADRIDE, they found that recreational cyclists had a ten-fold increase in the rate of heart arrhythmias after this 21-day endurance cycling event.

Next they wanted to understand how endurance cycling influenced the heart and if this had any lasting effect (over multiple days).

Endurance exercise and abnormal arrhythmias

Recently, they completed a study assessing how heart arrhythmias change in response to a bout of high-volume exercise and to identify factors associated with abnormal arrhythmias.

This was the first study to monitor participants for nine days straight. Over this time they found 68% of participants displayed abnormal arrhythmias.

In addition, they found the proportion of participants with abnormal ventricular arrhythmias was higher on the exercise day (study under review). Now they want to understand how endurance exercise influences heart health by screening ~350 recreationally active adults. Once complete, they will look for ways to improve the hearts ability to handle the stress of endurance exercise so that people can perform physical activity safer.

You can read a promotional snippet about this work here Endurance exercise and heart health, News, La Trobe University

A call for volunteers

Dan and his team are recruiting volunteers for their next study. Are you a recreationally active adult who would like to have a FREE heart health assessment and VO2peak test as part of our next study? You will be asked to visit us once at the La Trobe University Flora Hill campus physiology clinic located in Bendigo Victoria. 

If you are interested in participating, please read this flyer to confirm your eligibility and to find out to get in touch with us.

Want to read more?

Endurance exercise and abnormal arrhythmias – Bendigo Advertiser and ABC News

Could too much cycling cause heart problems? A world-first study in Bendigo aims to find out – ABC News

Wundersitz, Gordon, Lavie, et al., Impact of endurance exercise on the heart of cyclists: A systematic review and meta-analysis, Progress in Cardiovascular Diseases (2020)

Wundersitz, Williamson, Nadurata, et al., The impact of a 21-day ultra-endurance ride on the heart in young, adult and older adult recreational cyclists, International Journal of Cardiology (2019)

Wundersitz, Nadurata, Lavie, et al., Response: Arrhythmias 72 hour post strenuous exercise at a time when cardiac troponin was not elevated, International Journal of Cardiology (2019)

Collins, Kingsley, Gordon, et al., Coagulation activity and thrombotic risk following high-volume endurance exercise in recreationally active cyclists. Journal of Applied Physiology (2024)

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In the episode ‘Run Before You Can Walk’, Jenny and Frank discuss the physical activity tests that they undertook under the guidance of the HRI team when they visited the La Trobe University Flora Hill campus in September this year. Brett, Blake and Dan were able to provide Frank and Jenny with an overall assessment of their health and function after their body composition was examined, aerobic and anaerobic fitness measured and their muscular strength, endurance and power determined.

Using state of the art equipment within the La Trobe Rural Health School Exercise Physiology laboratory, Frank and Jenny undertook a Dual Energy X-Ray Absorptiometry (DEXA) scan, blood glucose test, isokinetic dynamometry, Wingate Anaerobic Test and Maximal Aerobic Test (V̇O₂ max). See below footage of Frank performing a Maximal Aerobic Test and listen to the podcast episode ‘Run Before You Can Walk’ in full on Spotify and Apple.

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# How does sport participation contribute to total physical activity, health, function and wellbeing in regional Victoria?

# The effect of endurance exercise on cardiovascular function and movement efficiency in community level cycling

# Efficacy of e-Bike use for improving health and function

Efficacy of e-Bike use for improving health and function

The benefits of active travel, and cycling, on health have been well researched with a recent systematic review and meta-analysis demonstrating the lowest risk of CVD mortality with 130 minutes per week of cycling at an average, self-selected pace (Zhao et al., 2021). In terms of e-biking, studies have reported that e-biking enables people to achieve moderate levels of physical activity (Sperlich et al., 2012) in addition to reducing travel time when compared to push bikes (Fishman & Cherry, 2016) however, the impacts on health are less clear.

Led by Dr Rodrigo Bini, the E-biking for Human Health project incorporates three individual studies that aim to assess the efficacy of e-bike use for improving health and function in sedentary people. The project consists of an observational study identifying if current health and functional status impacts e-bike uptake in sedentary people as well as an intervention study that will assess changes in physical fitness following a short, unsupervised e-bike aerobic training program. A final randomised control study will build on these research outcomes by comparing the differences between e-bikes, walking and education in health and fitness outcomes of sedentary people.

Progress

Three e-bikes were purchased by the Holsworth Research Initiative for the project in mid-2022. This enabled pilot trials to commence followed by participant recruitment and subsequent data collection. Participants were required to attend La Trobe University Bendigo campus for physical fitness and health assessments as well as a series of familiarity trials before being provided with an e-bike for use for a period of four weeks. Data collection is almost complete with the remaining three participants currently completing their four-week block of unsupervised aerobic training. Following this, analysis of the data will take place and a draft manuscript will be prepared. The expected project completion date for both study one and two is January 2024. The final study in the E-biking for Human Health project is contingent on external funding with a projected start date of January 2024.

We are so pleased to be contributing to the literature on e-biking for human health and can’t wait to report on the findings of these studies in 2024.

Zhao, Y., Hu, F., Feng, Y., Yang, X., Li, Y., Guo, C., … & Hu, D. (2021). Association of Cycling with Risk of All-Cause and Cardiovascular Disease Mortality: A Systematic Review and Dose–Response Meta-analysis of Prospective Cohort Studies. Sports Medicine, 51, 1439-1448.

Fishman, E., and C. Cherry. 2016. E-bikes in the Mainstream: Reviewing a Decade of Research. Transport Reviews 36: 72–91.

Sperlich, B., C. Zinner, K. Hebert-Losier, D.P. Born, and H.C. Holmberg. 2012. Biomechanical, Cardiorespiratory, Metabolic and Perceived Responses to Electrically Assisted Cycling. European Journal of Applied Physiology 112: 4015–4025.

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The HRI Director and Stream Leaders have had the privilege of supervising a number of higher degree by research students since the Holsworth Research Initiative began in 2019. These students now work across a broad range of industries including academia, applied sports science and clinical practice.

In this new series, we will update our subscribers on where our past HDR students are now and how their research degree with the La Trobe Health School and the Holsworth Research Initiative helped shape their career.

Part 8: Mr Jake Jennings, Sport Scientist, Brisbane Broncos NRL team

Part Eight of our Where Are They Now blog series features Jake Jennings, a PhD candidate with the HRI and a Sport Scientist with the Brisbane Broncos NRL team. Mr Jennings is currently in the final stages of his PhD with a likely submission date early in 2023. Jake’s supervisory team consists of HRI Director Professor Michael Kingsley, HRI Stream Leader Dr Daniel Wundersitz, HRI Research Coordinator Dr Courtney Sullivan and Lecturer at La Trobe University, Dr Stephen Cousins. This PhD was made possible due to an industry scholarship involving both AFL Victoria and the Bendigo Pioneers. An industry PhD connects industry partners to La Trobe’s world-leading research capabilities, while addressing a problem that is of direct relevance to the organisation. This saw Mr Jennings embedded within the Bendigo Pioneers NAB League football team where he provided high-performance services to the team while also collecting data for each study within his thesis.

Draft success in junior Australian Rules Football

Mr Jennings and his supervisory team are investigating match-play demands, and characteristics associated with draft success in male elite-junior Australian Rules football players. Although his thesis has not yet been submitted for review, an original study from his thesis has been published in a peer-reviewed journal with a further three papers currently under review.

Physical testing characteristics better explain draft outcome than in-game movement profile in junior elite Australian rules football players

A dream to work in elite sport

In the final year of his PhD and at the end of 2021, Mr Jennings was offered the full-time role of Sport Scientist at the Brisbane Broncos NRL team which required him to relocate to Brisbane. Additionally, Mr Jennings made the decision to convert his PhD to part-time to enable sufficient time to dedicate to his role in elite sport. Throughout this year, Mr Jennings has continued to refine his thesis and submit completed manuscripts to peer-reviewed journals with the aim of thesis submission in the first quarter of the new year. In regards to his current role, Mr Jennings reports utilising many of the skills that he has developed throughout his PhD studies in the everyday operations of the Sport Science department. When asked about his career aspirations, Mr Jennings stated that he hoped to continue his journey in professional sport with a view to high-performance management.

And that’s a wrap! After 8 weeks we have finally come to the end of our Where Are They Now mini-blog series. Missed our previous posts in this series? Read them at the HRI blog using the links below and while you’re there, don’t forget to subscribe to our newsletter so you can stay informed of all the latest HRI news.

Bendigo local GP Dr Stephen Bovalino

Post-Doctoral Research Fellow at Mid-Sweden University Dr Craig Staunton

Allied Health Education & Research Manager at Goulburn Valley Health, Dr Emma Macdonald

Allied Health Research and Knowledge Translation Lead, Bendigo Health, Dr Stephen Barrett

High Performance Manager at Old Scotch Football Club, Dr Jodie Palmer

Teaching-Focused Lecturer at La Trobe University, Dr Paul Xanthos

Sport and Exercise Medicine Registrar, Dr Samantha May

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The HRI Director and Stream Leaders have had the privilege of supervising a number of higher degree by research students since the Holsworth Research Initiative began in 2019. These students now work across a broad range of industries including academia, applied sports science and clinical practice.

In this new series, we will update our subscribers on where our past HDR students are now and how their research degree with the La Trobe Health School and the Holsworth Research Initiative helped shape their career.

Part 5: Miss Jodie Palmer, High Performance Manager Old Scotch Football Club and Strength and Conditioning Coach Camberwell Grammar School

Part Five of our Where Are They Now blog series features Miss Jodie Palmer, a current PhD candidate of the HRI and the current High Performance Manager at Old Scotch Football Club.

Miss Palmer is a current PhD student of the HRI and is supervised by HRI Director Professor Michael Kingsley and Human Performance stream leaders Dr Rodrigo Bini and Dr Daniel Wundersitz. Miss Palmer completed her pre-submission review presentation in July this year and expects the conferral of her doctorate degree in the coming months. A unique aspect of Miss Palmers research has been her involvement with the Bendigo Basketball Association. Thanks to an industry partnership between La Trobe University and the Bendigo Spirit and Braves, Miss Palmer was embedded with the teams in a mutually beneficial arrangement that saw Miss Palmer provide Sport Science services while collecting data for her PhD.

Exercise intensity in professional basketball

Miss Palmers PhD is investigating on-court exercise intensity in professional basketball and how basketball performance can be improved using 3D Microtechnology. Although her thesis is not yet available publicly, Miss Palmer has published a number or original studies from her thesis in peer-reviewed journals.

Criterion validity of an automated method of detecting live play periods in basketball

Effect of player role and competition level on player demands in basketball

On-Court Activity and Game-Related Statistics during Scoring Streaks in Basketball: Applied Use of Accelerometers

Residual neuromuscular fatigue influences subsequent on-court activity in basketball

So far, Miss Palmer and her supervisory team have published a paper establishing the criterion validity of an automated method using accelerometry technology to detect the start and end of live play periods in professional basketball matches. Once this was established, Miss Palmer was then able to use the live play detection technique to further investigate factors that influence on-court activity in professional basketball including player role, competition level, scoring streaks and neuromuscular fatigue. Conclusions from these studies include;

# In regard to player role, professional basketball players should prepare for the greatest match demands they could encounter during a season to improve performance and reduce injury risk.

# Basketball players might need their training volume managed when transitioning from a semi-professional to a professional season to reduce the injury risk from sharp increases in training demands.

# Maintaining high levels of exercise intensity in professional and semi-professional basketball matches assists in reducing the chance that an opposing team will engage in a scoring streak (when a team scores three times in a row)

# To maximise the probability of a scoring streak, a basketball team should aim to shoot more 2-point shots, at a 3:1 2-point to 3-point ratio.

# Residual neuromuscular fatigue can influence the amount of supramaximal activity players perform in a subsequent training session or match.

# Practices should be implemented to minimise residual neuromuscular fatigue carried into matches while maintaining a sufficient training volume to elicit physiological adaptations.

A passion for women’s sport

Miss Palmer is very much looking forward to receiving her doctorate degree and stated that she needs a break from academia, a sentiment expressed by many higher degree by research students at the conclusion of their PhD journey. Miss Palmer has transferred the skills she learnt during her PhD studies and her time embedded within the Bendigo Braves and Spirits teams, to her current roles as the High-Performance Manager of the Old Scotch Football club in Melbourne, Victoria and the Strength and Conditioning Coach at Camberwell Grammar School. When asked about her career aspirations, Miss Palmer reiterated her passion for women’s sport and her desire to work at the elite level in a Sports Science or High-Performance role.

Up next week is Part six of our 8-part blog series. We will be following up with Dr Paul Xanthos, ateaching-focused Lecturer in the discipline of Sport and Exercise Science at La Trobe University.

Missed our previous posts in this series? Read them at the HRI blog using the links below and while you’re there, don’t forget to subscribe to our newsletter so you can stay informed of all the latest HRI news.

Bendigo local GP Dr Stephen Bovalino

Post-Doctoral Research Fellow at Mid-Sweden University Dr Craig Staunton

Allied Health Education & Research Manager at Goulburn Valley Health, Dr Emma Macdonald

Allied Health Research and Knowledge Translation Lead, Bendigo Health, Dr Stephen Barrett

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Recent research published by HRI affiliated researcher, Miss Jodie Palmer, has found that maintaining high levels of exercise intensity in professional and semi-professional basketball matches assists in reducing the chance that an opposing team will engage in a scoring streak (when a team scores three times in a row). To maximise the probability of a scoring streak themselves, the findings suggest that a team should aim to shoot more 2-point shots, at a 3:1 2-point to 3-point ratio.

Partnership with the Bendigo Basketball Association

This research formed part of Miss Palmer’s PhD which was supervised by HRI Director Professor Michael Kingsley and HRI Stream Leads Dr Rodrigo Bini and Dr Daniel Wundersitz. The research was made possible due to the collaborative partnership between the Bendigo Basketball Association and La Trobe University, whereby Miss Palmer was embedded within the Bendigo Braves and Bendigo Spirit teams as the High Performance Manager throughout her studies. This enabled Miss Palmer to both offer High Performance services to the Bendigo Braves and Bendigo Spirit teams and collect the data required to fulfil the requirements of her degree.

Using novel methods to identify activity intensity

Miss Palmers research was unique in that it utilised a novel method of identifying activity intensity during basketball game-play. The method known as accelerometry-derived net force or AvFNet was previously validated by Dr Craig Staunton, a former PhD Candidate for the HRI. Additionally, although previous research has investigated individual-based scoring streaks or so called ‘hot hand’, Miss Palmers research was the first to determine the technical and physical activity factors that contribute to team-based scoring streaks in semi-professional and professional basketball.

You can access the full article here. If you find Miss Palmers research particularly interesting, be sure to subscribe to the HRI newsletter to receive the new 8-part blog series celebrating the success of our past HRI graduates, including Miss Palmer.

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This study was made possible as a result of funding received from the Holsworth Research Initiative Small Grant Scheme. Holsworth Research Initiative Stream Leaders Associate Professor Brett Gordon and Dr Daniel Wundersitz co-authored the paper with Associate Professor Gordon recently highlighting the importance of such research to regional and rural areas.

It is important to identify potential treatments for obesity as we know that regional and rural areas have greater rates of obesity and more commonly poorer health outcomes. 

Dr Van Schaik is quick to understate the findings in terms of weight loss and caffeine and capsicum annuum fruit powder supplementation as a potential treatment for obesity but does suggest that the results provide a basis for pharmacologically targeting the receptors on adipose tissue that caffeine and capsicum annuum fruit powder act upon.

Dr Van Schaik isn’t trying to minimise his findings, he is acknowledging the preliminary nature of the investigation and that although supplementation in the present study resulted in a large effect on glucose metabolism, it is still unknown what drives this response. He suggests that the reduction in blood glucose levels due to caffeine and capsicum annuum fruit powder supplementation could be due to changes in insulin signalling and that this is a logical direction for future research. Dr Van Schaik also proposes that the study should be replicated in different cohorts including women, overweight individuals and those experiencing metabolic dysfunction to determine if caffeine and capsicum annuum fruit powder supplementation has the same outcomes on energy metabolism, fat oxidation and glucose homeostasis.

Congratulations to Dr Lachlan Van Schaik and his research team on contributing to the literature on such an important topic! You can read the full article published in Frontiers in Physiology here.

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World-leading expert in cardiac rehabilitation and disease prevention, Dr Carl “Chip” Lavie, presented a seminar titled Exercise is Medicine to La Trobe staff, students and alumni and members of our industry partner organisations on Tuesday August 16. Dr Lavie presented his body of research supporting the use of exercise as medicine including specific information around the efficacy, dosing, adverse effects and toxicity.

Dr Lavie has been involved with the HRI since 2020, contributing as a co-author on two papers alongside the Initiative’s Director, Professor Michael Kingsley and Stream Leads Associate Professor Brett Gordon and Dr Daniel Wundersitz. An initial systematic review reporting on heart health and endurance exercise was published in 2020 with a follow up intervention study completed earlier this year.

We at the Holsworth Research Initiative are very grateful to Dr Lavie for his time and look forward to continuing to work alongside him in future research endeavors.

If you missed the seminar or would like to watch it again, please use the links below.

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Daniel Wundersitz has always loved sport. Growing up he played football, basketball, netball, cricket and tennis, but when he left school he studied horticulture. His dad was an avid gardener and Daniel wanted to follow in his footsteps. It was only later that he realised that his real passion was sport.

Sports Scientist

Dan returned to study as a mature-age student to become a sports scientist. He discovered his research interest lay in bio-mechanics, learning how muscles, bones, tendons, and ligaments work together to create human movement.

Daniel worked with the Eastern Ranges football club as a fitness conditioning coach and researched the physical demands of team sports and looked at how wearable technology (like GPS and accelerometers) help athletes perform at their peak by monitoring physical demands during team sports. He dreamed of being a sports scientists with the AFL prescribing training to ensure the footballers were at peak fitness.

The Call to Research

But the call to research was too strong. Up north, medical staff at Bendigo Health Cardiology had noticed a worrying trend– a lot of cyclists from the Bendigo community were turning up in the cardio clinics with arrythmias – abnormal heart patterns. The cyclists were all ‘weekend warriors’, that is they enjoyed endurance cycling during their leisure time.

Professor Michael Kingsley thought this was a great research project for the Holsworth Research Initiative. He knew of Dan’s work and persuaded him to join the team. As Dan says:

‘It was definitely the right decision. Exercise physiology research into the health of the cardiovascular system gives me a real chance to make an impact on people’s lives.’

The Mad Ride

Daniel found that heart rate abnormalities were surprisingly common in endurance cyclists but he needed some real world data. One of his La Trobe Bendigo colleagues was helping plan an endurance charity ride (the Mad Ride 2019), so Daniel persuaded the cyclists to volunteer for a pilot study.

The findings from the field confirmed the research – the cyclists had a higher rate of heart irregularities during and after the multi-day ride.

What happens next?

Daniel plans to study the intensity and duration of exercise on the heart so he can find the right balance between ‘too much’ and ‘not enough’ allowing us to exercise in a way that keeps us healthy.

He wants to find out if there is a volume or amount of endurance exercise that leads to large increases in arrythmias. This way people know not to pass this threshold, as then that exercise is no longer safe for us to do.

He also wants to find out if the heart irregularities progress further to the point where they become life threatening. Finally, he wants to generalise his findings from cycling to other endurance sports.

As Daniel says,

“I really want to keep exercise safe and healthy for all of us to do. “

This research falls under all three HRI research aims, to optimize function and performance for all individuals, address the global challenge of inactivity, and enable athletes to perform better and compete more successfully.

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Dr Daniel Wundersitz has received funding from the Holsworth Research Initiative in the La Trobe Rural Health School to identify changes in blood clotting before, during and after endurance exercise. The project is part of an international research collaboration with 19 researchers from five different institutions. They seek to understand the impact of endurance exercise on the heart.

Heart health and exercise

Dr Wundersitz is working with Professor Lavie from the John Ochsner Heart and Vascular Institute (Ochsner Clinical School-the University of Queensland) and a team from Bendigo Health. They are looking at how endurance exercise causes alterations in the heart’s electrical activity (known as cardiac arrhythmias). Arrhythmias increase the risk of heart attack (and in a small percentage of cases, sudden death) in healthy and active adults.

Call for study participants

The researchers are looking for study participants. Does this sound like you? You need to be a recreationally active adult living in Bendigo. You will be tested over a three-week period before, during and after endurance cycling on an exercise bicycle at the La Trobe Flora Hill campus physiology clinic.

Safeguarding the health of cyclists 

Increasing numbers of people around the world are performing endurance exercise, so this research has real impact. The goals are to:

• provide evidence for the best time to screen recreational and professional athletes for health issues.
• reduce the financial and health burdens for people with exercise-induced heart complaints, and
• promote physical activity guidelines to enable people to safely perform strenuous endurance exercise.

We look forward to providing more updates on this research in the future.

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