Volume 29, Issue 162, August 2025

The Cardiovascular Paradox of Marathon Running: Acute Stress, Chronic Adaptations, and Longterm Health Implications

Lidia Żyła^1♦, Tomasz Czapiewski¹, Maksymilian Szymczak¹, Wiktor Szymajda¹, Aleksandra Trojańska²

¹University Clinical Hospital in Poznań, Przybyszewskiego 49, 60-355 Poznań, Poland
²Medical University of Gdańsk, Marii Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland

^♦Corresponding author
Lidia Żyła, University Clinical Hospital in Poznań, Przybyszewskiego 49, 60-355 Poznań, Poland

ABSTRACT

This article explores the intricate relationship between marathon running and cardiovascular health. As participation in marathons increases year by year, scientific research into the acute responses and chronic adaptations of the cardiovascular system is becoming more common. Acute cardiac responses contain temporary elevations in cardiac biomarkers and changes in cardiac function, which especially affect the right ventricle. However, chronic adaptations include beneficial cardiac remodeling. The review analyzes evidence from numerous studies documenting these cardiovascular changes, exploring both potential concerns and substantial benefits. Although numerous scientific articles suggest possible risks associated with extreme endurance training, epidemiological data shows that marathon runners have a significantly lower risk of cardiovascular disease. This study investigates impact on the left and right ventricular chambers, vascular function, autonomic regulation and correlation between exercise intensity and cardiovascular health. The study also discusses the clinical implications of screening, monitoring, and recovery protocols, providing a balanced perspective on the cardiovascular impact of marathon participation. Furthermore, the study combines the current evidence to inform clinical practice, that with proper preparation and medical screening, marathon running can be advantageous for cardiovascular health.

Keywords: marathon running, cardiac biomarkers, ventricular function, arterial compliance, arrhythmias, cardiovascular adaptation

Medical Science, 2025, 29, e133ms3614

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DOI: https://doi.org/10.54905/disssi.v29i162.e133ms3614

Published: 18 August 2025