The effects of running, cycling, and duathlon exercise performance on cardiac function, haemodynamics and regulation

This thesis examined the effects of prolonged exercise, specifically Olympic Distance (OD)duathlon upon ultrasound derived indices of cardiac function, cardiac autonomic regulation measured via heart rate variability (HRV), and high-sensitivity cardiac troponin T (hs-cTnT)release.

The primary aims were to (1) ascertain the influence of Olympic distance (OD) duathlon performance on cardiac function; (2) to investigate potential relationships between autonomic regulation, hs-cTnT release, and cardiac function, and (3) to investigate the effect of the individual legs of an OD duathlon on post-exercise cardiac function and to quantify the potential performance reserve of highly-trained endurance athletes when completing standalone legs of the duathlon. Findings from a systematic review and meta-analysis(Chapter 1) on research that performed serial echocardiographic and troponin measurements before and after exercise, intensity predicted changes in post-exercise cardiac troponin release and diastolic function. The findings agreed with previous meta-analyses using a more recent sample of studies; however, the recommendation for future studies to implement advanced cardiac imaging techniques, such as myocardial speckle tracking into their data collection would provide a more sensitive measure of post-exercise cardiac function. Whilst a large degree of heterogeneity in the results exists, this was in part explained by study exercise heart rate, participant age, and the prevalence of cardiac troponin release above the clinical detection threshold.

The study performed in Chapter 3 was the first to investigate the effects of OD duathlon exercise on immediate and 24 hours post-exercise cardiac function. Additionally, a second OD duathlon was performed by participants with intra-leg measurements of cardiac function. In a highly trained cohort, there was evidence of transient post-exercise reductions in cardiac function and elevated serum high-sensitivity cardiac troponin T (hs-cTnT) above the clinical reference value, which was largely resolved within 24h of recovery. This study also demonstrated the reliability of lab-based duathlon exercise in a highly trained cohort and identified the pacing features of experienced multi-sport athletes that partially explained the different findings between the running and cycling legs of the duathlon.

By investigating each leg of the duathlon individually (10k run, 5k run, 40k cycle), both at duathlon race-pace (DM) and maximal (Max) intensity on separate occasions, the performance reserve of the highly-trained cohort was quantified and further explored. The studies presented in Chapters 4 and 5 revealed that experienced duathletes were able to improve their speed across each leg by between 5-15% in a laboratory setting, compared to the duathlon effort. Additionally, the maximal effort 10k run leg provoked the most persistent changes to cardiac function that were present at 6h of recovery. Changes in cardiac function post DM 10k confirmed the findings of Chapter 3 that the greatest magnitude of cardiac perturbations occur following the initial 10k run leg. Aside from the Max 10k run and 40k cycle trials, all perturbations had resolved within 6h of recovery after each bout of exercise, highlighting the importance of recovery following maximal intensity efforts.

The lack of 6h and 24h recovery data in Chapter 4, and Chapters 5 and 6, respectively is a shortcoming of these findings and therefore limits interpretation in the context of providing athletic guidance. Future research in this area should endeavour to include 6h and 24h recovery measures as standard, as multi-sport athletes typically perform multiple daily training sessions. The implications of substantial cardiac fatigue accumulation over many years of endurance training history are still unclear, and athletes may benefit from preventingits occurrence.