Intense Exercise & Potential Heart Damage (aka Athlete's Heart)

如果给心脏供血的血管堵塞或受损，你就可能会发生心肌梗死。

If the vessels that give your heart blood itself become blocked or damaged, you're gonna have or likely to experience what's called a myocardial infarction.

‘心肌’里的‘心’指的是心脏，‘肌’就是肌肉组织。

Again, myo meaning heart, cardio, or being tissue rather.

大家平时说的心脏病发作，指的就是这个。

It's a heart attack is how you've heard this.

这个很好理解。

Very simple to understand.

如果你让任何一块骨骼肌断了氧气和营养供应，它就会停止工作，因为正常的代谢过程没法进行。

If you were to stop providing oxygen and nutrients to any of your skeletal muscle, they would stop working because we can't go through normal metabolic processes.

心脏也是一样的。

The heart is the same.

一旦供氧被阻断，心脏就会缺氧，进而停止收缩。

So if you have an oxygen block, your heart itself becomes hypoxic, the heart will stop contracting.

这会导致组织坏死或损伤，如果情况严重，心脏会停止跳动，人也会死亡，因为心脏一停，全身的血液循环就彻底中断了。

This will cause necrosis or damage, or if severe enough, you will die because the heart will die, and then we don't pump anything throughout the whole world.

所以我们首先关注的，就是冠状动脉本身。

So the first thing we're always paying attention to is the coronary arteries themselves.

它们健康吗？

Are they healthy?

第二类大问题，我称之为电信号异常。

The second broad category here are what I'm gonna call firing issues.

就是引发心脏收缩的电信号。

And this is the electrical signal that causes contraction.

这种情况的表现形式多种多样。

And this can look a lot of different ways.

我给你举两个大致的类型来理解。

I'll give you two rough ways to think about this.

第一种叫心脏骤停。

But the first one is what's called cardiac arrest.

简单说，就是心脏停止了跳动。

This is simply your heart stops charging.

它不再放电了。

It stops firing.

它不再收缩了。

It stops contracting.

问题不一定是缺氧造成的，而是电信号传导出了故障。

It's not the fact that you were necessarily blocked by oxygen delivery, but something got screwed up in the electrical conductivity that caused the problem.

最危险的一种叫室颤，也就是心室颤动。

The most deadly here is called V fib, ventricular fibrillation.

记得心室是在心脏底部的。

So remember the ventricles sit on the bottom.

它们负责收缩，承担最主要的工作，把血液泵到肺部或全身。

They squeeze, do the most work, and they push blood either to the lungs or to the rest of the body.

室颤极其危险。

V fib is incredibly dangerous.

说它是死刑也不为过，差不多就是判了死刑。

In fact, it's I won't go as far as to say it's a death sentence, but it's pretty close.

如果你得了心室颤动，基本上是不可能去运动的。

If you have V fib, you're likely not going to be exercising.

你很可能需要做手术，得采取一些医疗措施。

You're gonna probably have a surgical intervention, something's gonna go on.

这情况真的非常严重。

This is really, really nasty.

虽然这种情况比较少见，但处理起来特别棘手。

It's also very uncommon, but it is particularly difficult to deal with.

左心室不再泵血了，后面会发生什么，你也能猜到了。

The left ventricle does not pump, and well, you can finish the story there.

所谓颤动，其实就是心脏电信号乱了。

The fibrillation part is a way to think about misfiring.

它在不停地抽搐。

It is fluttering.

正常情况下，左心室应该有力地收缩、放松、重新充满血液，再有力地收缩，但现在它却在断断续续地抖动。

So instead of that left ventricle beating strong, relaxing, refilling with blood, beating strong again, it's kind of sputtering.

你可以想象，你的车就像噗、噗、噗地偶尔冒几股黑烟。

You can imagine your car kind of like, pop, pop, pop, pop, shooting some smoke out the back occasionally.

这种情况的问题在于，第一，心脏收缩不够有力。

Well, what happens with that is, number one, you don't get a strong contraction.

所以血液没法被有效泵出去。

And so blood doesn't get out.

这是第一个问题。

That's problem number one.

另一个问题是，心脏的瓣膜系统本来是这样工作的：心房和心室之间的瓣膜打开，让血液流入心室，然后马上关闭。

The other problem is you have things like, because the valve system is working such that we open up a valve from the atria to let blood into the ventricle, then we close that valve.

为什么要关闭呢？

Why?

因为如果它不关，当左心室收缩时，血液就会直接倒流回心房。

Because if it wasn't closed and that left ventricle pumped, you would actually just be shooting blood right back into the atrium.

所以必须有规律地开、关、开、关，才能建立足够的压力，防止血液倒流。

And so you have to have this open, close, open, close, open, close to create pressure in the system and not shoot blood the wrong direction.

现在，心室颤动就破坏了这个机制，因为心脏的电信号在错误的时间放电。

Now, V fib kinda defeats that purpose because things are firing at the wrong time.

结果就是血液被泵进了错误的心腔，这进一步减少了有效血液循环。

And so you're kinda shooting blood into chambers the wrong direction, which again further reduces blood going out and so forth.

所以这确实是个严重的问题。

So it's a real problem.

如果你听说过心脏杂音或者心律不齐，很多时候说的就是这种颤动。

If you've heard of things like a heart murmur or an irregular heartbeat, oftentimes, they're describing this fibrillation.

明白吗？

Okay?

我再强调一遍，如果是心室颤动，这种心律不齐非常危险。

I'll reiterate, if it's a ventricular or V fib, that irregular heartbeat's very dangerous.

如果是房颤，虽然更常见，也依然严重，甚至可能致命，但引发问题的概率低得多。

If it's AFib or atrial fibrillation, it is much more common, still serious, it can absolutely result in death, but it's way less likely to be problematic.

事实上，很多人得了这种病，要么根本没在意，根本不知道，要么检查后，心脏科医生确认没事，还能继续运动。

In fact, many people will have this and either not have any concern, not ever know it, or it will be checked out, be cleared by a cardiologist, and you'll return to sport.

你可能见过运动员的情况，每年一到赛季开始训练营，总有球员突然因心脏问题被 sidelined 几周，之后又重返赛场。

If you've ever seen in athletes where, and this happens every single year, they show up to training camp at the beginning of the season, then all of a sudden they're sidelined for several weeks because something going on with their heart, and then they're back in the game.

很多时候，是因为有人查出了房颤，经过全面检查后医生说：‘没问题，你可以继续。’

A lot of times, it's because someone picked up an AFib, they thoroughly checked it out and they said, okay, you're fine.

然后你就又能上场了。

And now you're back in the game.

所以，我不会说这完全无害，但相比室颤，它的危险性低得多，得了房颤照样能正常参加竞技运动，完全没问题。

And so mostly, I won't say benign is the appropriate term here, but they're not nearly as dangerous, and you can live a full competitive athletic life with AFib and be just fine.

稍后我会具体跟你们讲讲这方面的数据。

Then I'll walk you through the data on that specific point a little bit later.

但房颤真正危险的时候，跟我们刚才说的室颤类似。

But where these do become dangerous is similar to what we've just discussed with V fib.

因为如果心房不能把血液完全排进心室，血液就会淤积。

But in the fact that if your atria is not completely dumping blood into the ventricles, that blood can pool.

血液一淤积，就容易形成血栓。

When you pool blood, it tends to clot.

如果这个血栓被带到心室，就会被泵入全身循环。

If that clot is then moved to the ventricle, it is pushed out into the system.

血栓可能在身体任何地方形成，尤其是如果出现在大脑，就会引发中风，这才是它真正危险的地方。

A clot can develop anywhere, which of course, especially if it happens in your brain will lead to a stroke, and that's why it can become extremely dangerous.

所以我们通常面对的就是这些问题。

So those are the problems we're typically dealing with.

那这些情况为什么会发生呢？

Why do these things happen?

首先得从遗传因素说起。

Well, the first stop is genetics.

我知道，关于运动员突发心脏猝死的讨论，大家常常会说：‘这肯定是遗传问题。’

And so I know that a lot of the discussion around sudden cardiac death or athletes that die tends to be like, well, it was something genetic.

这确实很大程度上是对的，但遗传因素也可能影响心脏的电信号传导。

And that is in large part true, but the genetic side of the equation can cause issues with firing.

就是我之前提到的沃夫-帕金森-怀特综合征。

That's the Wolff Parkinson White thing I talked about earlier.

还记得我跟你说过的怀特教授吗？本质上，沃夫-帕金森-怀特综合征是一种导致心房颤动的遗传病。

Remember professor White I told you, and we've come back to Effectively, what Wolf Parkinson White is is a genetic disease that causes AFib.

明白了。

Okay.

不过情况比这更复杂一些。

Now it's more complicated than that.

我不是想淡化这个问题，但我们现在讨论的正是这个核心。

I don't mean to diminish that topic, but that's really what we're looking at.

我记得在90年代，大家都特别害怕。

And I remember in the 1990s, people were terrified.

正因如此，大家才开始纷纷谈论沃夫-帕金森-怀特综合征。

This is why everyone started talking about Wolf Parkinson's White.

但后来我们逐渐意识到，它确实可能致命，也确实有人因此离世。

But then we actually started to realize, well, again, it can be deadly, and certainly people have died from it.

不过大多数情况下，患者其实都挺正常的。

Most of the time, people are fine.

没关系。

It's okay.

不算好，但还能应付。

It's not great, but it manageable.

这种遗传倾向特别多，尤其是跟心律异常有关的。

There are many, many, many of these genetic dispositions, especially with firing sequences.

我没时间一一讲，但我想提一下叫LDS的这种情况。

I don't have time to cover them all, but one I do wanna point out is called LDS.

这是路易丝·迪茨综合征，不幸的是，我朋友迈克的儿子卢卡斯就遇到了这种情况。

This is Louise Dietz syndrome, and this is exactly what happened, unfortunately, to my friend Mike's son, Lucas.

所以我提一下，因为我知道他们在为这个筹款。

And so I wanted to bring that up because I know they are raising funds for that.

我会在节目笔记里放上他们筹款的链接。

And I'm gonna put a link in the show notes for the fundraiser they're doing for that.

LDS是一种导致结缔组织问题的状况，主要影响心脏、血管以及其他周围组织。

But LDS is a situation that causes connective tissue issues, particularly in the heart, blood vessels, and other surrounding areas.

这会导致所谓的早期心房动脉瘤。

And this leads to what are called premature atrial aneurysms.

因此，周围血管也出现了问题。

And so effectively, we have issues in the vasculature around it.

年轻的、身材瘦削、身体健康的刘易斯本人，就是在游泳时去世的。

Young, lean, healthy, Lewis himself passed away while swimming.

他当时刚练完在做放松，尽管人们立刻尝试抢救、做心肺复苏，但因为动脉瘤的存在，根本无能为力。

He was actually doing a cool down after practice, even though they would try to revive him, perform CPR because there's aneurysm there, there was just nothing they could do about it.

所以我特别想提一下，为了迈克和卢卡斯。

So I wanted to make sure I called that out for Mike and Lucas.

我也再次鼓励大家，可以考虑为这个事业捐款，帮助推动更多研究。

And again, I would encourage you to consider donating to that cause, of course, to provide more research there.

我本人也已经捐了款。

I will personally be making a donation to that as well, have already.

我提这件事，就是为了这些家庭。

But I wanted to call that out for those folks.

除此之外，抛开遗传因素，还有一种情况就是肥厚型心肌病。

On top of that, or going past the genetic side of the equation, another one that happens is that HCM.

你可能会遇到心脏电信号传导方面的问题。

You could have a potential issue with the firing side of the equation.

众所周知，有些人天生就伴有心肌肥厚。

It is also known that some people are simply born with an enlarged heart.

还是说的肥厚型心肌病。

Again, hypertrophic cardiomyopathy.

这很危险，因为它是年轻人突发性心脏猝死最常见的原因。

This is problematic because it is the most common cause of sudden cardiac death in young individuals.

关于具体发病率和数据，我稍后再详细讲。

I'll go over some of the numbers and how frequently it is a little bit later.

但这并不完全是电信号的问题。

But this is not necessarily a firing issue.

根本原因就是心脏本身变大了。

It's simple the fact that you have an enlarged heart.

心脏扩大并不是因为左心室变大了，而是通常——几乎是总是——伴随着心腔容积的缩小。

And enlargement comes not from the left ventricle being bigger, but because it actually often, almost always, or frequently comes with a reduction of chamber size.

想象一下左心室本身。

So imagine the left ventricle itself.

它的壁变得很厚。

You've got a thick wall.

就像你力量训练时，肌肉会增长变强，那就是肌肉肥大。

Well, when you strength train, you gain and you grow muscle, that's muscle hypertrophy.

这里发生的情况是一样的。

Same thing happening here.

但在这个情况下，肥大发生在内部。

But in this particular case, the hypertrophy occurs internally.

所以心腔本身——能容纳血液的空间——就变小了。

So the chamber itself, the area that can hold blood gets smaller.

因此当你剧烈运动时，问题就来了，因为心脏无法满足身体对血量的需求。

And so then when you exert, go through high physical exertion, this becomes a problem because you can't match your output.

心室没有足够的时间重新充满血液，以便再次泵血。

The ventricle doesn't have enough time to refill with blood to pump again.

这就会导致突发性心源性猝死。

And this leads to that again, sudden cardiac death.

虽然目前我们还无法预防这些遗传性异常，但可以通过筛查来采取应对措施。

So while we can't prevent at this point, any of these genetic abnormalities, we can do things about it in terms of screening.

对于肥厚型心肌病，有一些药物是可行的，我们稍后会详细讲。

And in the case of HCM, there are some medications that are possible, which we'll get into a little bit later.

我们需要把这种遗传性问题和慢性心脏病区分开来。

We need to differentiate that genetic based concern from chronic heart disease.

这里说的是由于长期积累造成的适应不良或病理变化，而不是由遗传倾向引起的。

So this is maladaptations or pathology that occurred as a result of a lifetime, not as a result of a genetic predisposition.

我们这里讨论的，就像我之前多次提到的类比一样，比如长期高血压这种情况。

What we're talking about here are in the analogy or the example I've used several times, and we'll continue to use, are things like chronic high blood pressure.

它会模拟运动的效果，但不同的是，你不是每天只运动几分钟或几小时，而是你的主动脉每天每分钟都承受着阻力，持续多年。

What this can do is it mimics exercise, but instead of giving you a little bit of exercise for a few minutes or hours a day, your aorta are under resistance every single minute of every single day for years on end.

如果我告诉你，让你的一块骨骼肌一直这样工作，你肯定会觉得这对组织肯定有害。

If I told you you were gonna do that for one of your skeletal muscles, you would think, well, that's probably gonna be bad for the tissue.

心脏其实也是同样的道理。

Well, the same thing happens with the heart.

对心脏来说，这同样有害。

It's bad for that as well.

这其实就是高血压的本质。

So this is in fact what high blood pressure is.

原因有很多，比如主动脉变硬了，或者弹性下降、变得僵硬，又或者血压太高，心脏很难把血泵出去。

Because we have either a number of different issues, but that cause the aorta to either stiffen or become what we call less compliant, more rigid, or the pressure itself is too difficult to overcome.

左心室每次收缩都得用尽全力把血挤出去，时间一长，血管本身也会受损。

That left ventricle has to squeeze so incredibly hard to get the blood out for every pump, the vascular itself can become damaged.

你可以想象一下，主动脉就像一根能充气的橡胶软管。

So you just imagine the aorta being a fillable hose, a rubbery hose.

正常情况下，当你增加压力时，它会扩张；压力减小后，又会恢复原状。

Well, instead of being a hose where when you put more pressure in it, it expands, and then when you reduce the pressure, it will go back to its normal size.

这就变得像混凝土一样脆了。

Now that turns into a brittle concrete.

所以系统内的压力会更高，因为血管本身失去了弹性，不再能伸缩。

And so the pressure in the system is higher because the vessels themselves, the vasculature does not move.

如果长期这样，血流产生太多湍流，就像血液不断猛烈撞击血管壁，可能会造成损伤，甚至导致血管破裂。

And in fact, if you do it too much and there's too much turbulence, that's kind of like the blood smashing and slamming up against those walls, you can actually cause issues with that, if not rupture them entirely.

因此，这里的血管弹性就消失了。

And so we lack compliance there.

这还会在左心室形成瘢痕组织。

This also induces scar tissue in the left ventricle.

这在医学上叫纤维化。

This is technically called fibrosis.

严格来说它不完全是瘢痕组织，但今天我们这么理解就可以了。

It's not exactly scar tissue, but this is an equivalent for our conversation today.

就像你过度使用骨骼肌，出现瘢痕组织也一点都不奇怪。

Just like if you overuse skeletal muscle like this, you wouldn't be surprised to develop some scar tissue there.

左心室里也会发生完全相同的情况。

The exact same thing happens in the left ventricle.

所以这里真正的问题依然是血管弹性不足。

And so the true problems here are again, lack of vascular compliance.

同时，你还会看到更多的瘢痕组织和纤维化。

You also now have an increase in scar tissue of fibrosis.

这会导致左心室肥厚，具体表现为心腔变小，是向内增生。

This induces that left ventricular hypertrophy, specifically a reduction in chamber size, it's an inward growth.

由于这些变化累积起来，心肌的收缩力也会下降。

You also then, because of all that, that compiles to reduce contractile strength.

心脏本身变得无力了。

The heart is physically weaker.

心肌细胞收缩时力量不够，没法把足够的血液泵出去，身体越来越弱，这就陷入了一个恶性循环。

The individual muscle fibers themselves do not contract with enough force to push enough blood out, you become weaker, and now you're actually in a cycle of problem.

所有这些因素加在一起，减少了血液供应，让生活变得更加艰难。

All this combines to reduce blood flow and make life more challenging.

所以这个话题之所以这么难，是因为除了慢性高血压之外，那些有我刚才提到这些问题的人，通常根本没什么症状。

So why this entire topic becomes so difficult is because the people that are suffering from these issues I just mentioned outside of the chronic high blood pressure, it's typically asymptomatic.

事实上，运动员心脏或者跑者心脏的患者，往往也没有任何症状，更没有其他合并症。

And in fact, the ones that are dealing with the athlete heart or the runner's heart generally have no symptoms and no other comorbidities.

他们不喝酒。

They don't drink.

他们不抽烟。

They don't smoke.

他们不胖。

They're not overweight.

他们通常很瘦。

They're typically lean.

他们身体很活跃。

They're physically active.

他们懂得管理压力。

They stress manage.

他们把该做的全都做对了。

They do all the things right.

可还是遇到了这个问题。

And they still deal with this issue.

所以这就是为什么我们常把这种情况叫做‘沉默的杀手’。

And so this is why we often call this stuff the silent killer.

如果你有多种合并症，得知自己得了心血管疾病，你并不会感到意外。

Oftentimes, if you have multiple comorbidities, you're not surprised to learn you've got cardiovascular heart disease.

你知道自己超重，知道自己吸烟，诸如此类。

You know you're overweight, you know you smoke, so on and so forth.

但这种情况不同，你根本无从知晓。

But in this case, you don't know that.

因为你很可能已经做到了几乎所有或大部分健康的生活方式，却依然面临这个问题。

Because you're probably doing all, if not most of the right lifestyle things, but you're still dealing with this concern.

因此，我们现在不再用‘运动员心脏’这个科学术语，而是改用‘运动诱导性心血管重塑’，简称EICR。

And so the term we use to describe this now, instead of calling an athlete's heart scientifically, is EICR, exercise induced cardiovascular remodeling.

这是一个重要的术语，因为我们强调这种心脏结构和功能的改变是由运动引起的。

And this is an important term because we're saying the remodeling or the change in size and function is exercise induced.

前面的‘运动诱导’这个标签，就是为了说明：虽然最终表现相似，但因为是运动导致的，所以不是病理性的，反而可能有益。

That front flag there of exercise induced, is our way to distinguish the same end result because it came from exercise is now not pathological, but potentially even advantageous.

所以要识别出来真的很难。

And so it's really difficult to identify.

就像我之前说的，如果你只是做个常规筛查，比如拍个心脏影像，很可能根本看不出这里的问题。

Looking at this stuff, as I mentioned, just as a screen, you were to run-in and get, say, some imaging of your heart, you may not necessarily see what's going on here.

事实上，我见过一些数据，显示就算做心电图，也可能漏掉一半以上的病例，因为没有一个单一的检测方法能搞定。

In fact, there was some data that I came across showing that even if you were to run like an ECG, you probably would miss fifty percent of these issues because there's not one single place to go.

而且你根本没法确定这到底是适应不良，还是正常反应。

And because you don't necessarily know if this is maladaptive or not.

说到肥厚型心肌病，萨姆，我之前跟你说过一些数据，现在告诉你具体数字。

And then when it comes to HCM, Sam, I told you I shared to you some numbers earlier, and here you go.

大约每五百个人里，就有一个患有肥厚型心肌病。

About one in five hundred people have HCM.

但真正因此丧命的人极少，大多数人根本不知道自己有这病。

But very few will be dead from it, and the vast majority will never even know that they have it.

所以在这档节目里，我通常用三个‘I’来讲解。

And so typically in this show, I like to cover it in the format of the three I's.

第一个‘I’是‘排查’，也就是怎么去检测它？

The first I being investigate, which is how do I measure it?

第二个‘I’是，怎么解读这些结果？

Second being, how do I interpret those results?

第三个‘I’是，怎么干预？

And the third I being, how do I intervene?

那具体该怎么做？

What do I do about it?

我会稍微调整一下顺序，先讲第二个‘I’——解读，之后再回头谈排查，比如该做哪些检查。

I'm gonna switch that order a little bit, and I'm gonna cover the second I, interpretation first, and then I'll get into investigation or what do I measure, what tests do I run a little bit later.

因为说实话，我们前面大部分对话其实已经在讲‘解读’了。

And that's because you really Honestly, we've been covering interpret for the vast majority of our conversation already.

所以我先把这个部分收个尾，之后再跟你们说具体该做哪些检查，以及该怎么应对。

And so I just wanna finish polishing that part off, and then I'll share with you what tests you can run and what you can do about it a little bit after that.

那我们现在就来聊聊第二个‘I’——解读。

So let's start that second eye right now.

为了准备今天的内容，我读了很多论文，找到了大量优质的资料。

In the preparation for today, I read a lot of papers and found a ton of excellent resources.

这些资料我大部分都会放在节目笔记里。

And I'm gonna put the vast majority in the show notes.

因为内容确实太专业了。

And that's because it's really very technical.

我不想花时间细讲左心室壁厚度多少毫米这类细节，毕竟这些数字普通人根本搞不懂。

I just didn't wanna spend the time covering the millimeters of thickness of the left ventricle and things like that, where you just don't really know what that means.

但我还是会把所有这些内容都放进节目笔记里。

But I do wanna include all those in the show notes.

不过，运动引起的心脏结构改变，也就是EICR，主要包含三个部分。

But the exercise induced cardiac remodeling, EICR, has three main components.

首先是结构性的，我们之前已经讲过不少相关内容了。

The first being structural, we've described a number of these things already.

其次是功能性的，也就是心脏是怎么工作的。

The second being functional, how does the heart work?

第三是电生理方面的。

And the third being electrical.

这部分我们可以快速过一遍，因为前面已经打好了基础。

And we can go through this pretty quickly because we've laid the foundation already.

总的来说，这里做个总结。

Overall summary here.

从结构上看，我们主要关注左心室，特别是它的整体大小或质量。

From a structural side, we're gonna hone in mostly on that left ventricle, and we're looking at the overall size or mass.

我们也在观察心腔是否扩张。

We're looking at the dilation or the chamber size.

虽然描述方式有很多种，但指的都是这些内容。

This is described a bunch of different ways, but that's what we're referring to.

所以心室本身的大小，决定了它能容纳多少血液。

So how big the ventricle is itself, how much space it has to fill up with blood.

第三个叫超常舒张期。

And the third one is called supernormal diastole.

这指的是在运动引起强烈心血管变化时，心室会获得异常强的舒张能力。

This is basically saying when we have exercise induced hard cardiovascular changes, the ventricles themselves get an excessive ability to relax.

其实我们在骨骼肌里也能看到同样的现象。

Now we actually see a same thing happening in the skeletal muscle.

提升力量最快的方法之一，就是学会在肌肉收缩之间更快地放松。

One of the fastest ways that you can increase your strength is when you start to actually learn how to relax your muscles faster in between contractions.

我知道这听起来有点反直觉，可以去看看我们关于肌肉的那几期内容。

I know this sounds counterintuitive, go check out our muscle episodes there.

但心脏里也是一样的道理。

But the same thing happens here in the heart.

动脉和心室在两次跳动之间放松得越快、扩张得越充分，就能吸入越多血液，从而泵出更多血。

The faster your arteries and ventricles can relax in between beats, and the more they can distend, the more blood you can fill them back up with, which means more blood can come out of them.

所以我们真的要注意这一点，也就是左心室的容积感和舒张速度，如果你这么理解的话。

And so that's something we really wanna pay attention to, that left ventricular both feeling space as well as relaxation speed, if you wanna think about that way.

这些都是主要的结构性因素。

So those are the big structural ones.

从功能角度来看，其实就这么简单。

From a functional perspective, it really is honestly kind of this simple.

如果这种适应提升了每搏输出量，那几乎总是正面的。

If the adaptation induces greater stroke volume, it's almost always positive.

如果导致每搏输出量下降，那几乎总是负面的，这一点基本上就足够了。

If it induces reduced or less stroke volume, it's almost always negative, and you could basically full stop there.

每当我们的心脏收缩一次，就会泵出一定量的血液。

Now, with stroke volume, every time your heart pumps, it kicks out a certain amount of blood.

从心脏泵出的血量，就是每搏输出量，或者叫每次心跳的输出量。

The amount of blood that comes out of that is the volume of the stroke or the heartbeat.

我们说的就是这个。

That is what we're talking about.

所以，不管怎么做到的，只要每次心跳泵出的血量更多，通常都是好事。

So the more blood that comes out, your stroke volume, however it got there, it's almost always assured to be a good thing.

如果反过来，血量减少了，那一般就不太妙。

Or if it reduces it, it's generally bad.

一旦我们理解左心室的工作原理，这一点就非常清楚了。

And this makes so much sense once we think about how the left ventricle works.

如果最终结果是每次心跳泵出更多血液，那大概率是好事。

If the net result is you pumping more blood out per pump, it's probably good.

如果是相反的情况，那显然就是不好的信号。

If it's the opposite, it makes sense that that's a bad thing.

从最大摄氧量的角度来想一想。

Think about this from the perspective of v o two max.

大家都很关注如何提升最大摄氧量，觉得这样能活得更久。

Everyone is excited and talking about how you need to maximize this to live as long as you can.

但我们得明白，最大摄氧量的一个关键决定因素，其实就是每搏输出量。

Well, we need to realize and understand the fact that one of the major determinants of your v o two max is your stroke volume.

你可以去查完整的公式，我之前 elsewhere 提到过。

You can go look up the full equation, and I've described it elsewhere.

但眼下来说，只要你提升或增大每搏输出量，你的最大摄氧量就会跟着提高。

But for right now, if you maximize or increase your stroke volume, you're gonna increase your VO two max.

事实上，很多人认为，提升每搏输出量是改善最大摄氧量最有效的方法。

And in fact, one would argue pretty well that that is the single biggest way to improve your VO two max is to increase that stroke volume.

这是因为像心率这样的其他因素——也是最大摄氧量公式的一部分——基本是固定的。

And that's because things like your heart rate, which is another part of our VO2 max equation, is fairly fixed.

你很难提高自己的最大心率。

You really can't increase your maximal heart rate.

你的年龄、性别、基因这些因素，早就决定了你的心率上限。

Your age, your sex, and genetics, and things like that are gonna tell you where you're at there.

事实上，随着年龄增长，你的心率上限只会越来越低。

In fact, your max heart rate's only going to go down as you age.

但每搏输出量却非常有可塑性。

But your stroke volume is extremely plastic.

而且，关于运动如何提升每搏输出量，我们已经有六十多年的研究了。

And we have, gosh, sixty plus years of research on stroke volume increasing with exercise.

这方面的证据非常扎实。

It's incredibly robust.

不一定要跑步。

It does not take running.

也不一定非得是有氧运动，高强度、低强度，什么形式都行。

It does not take aerobic exercise, high intensity, low intensity, blah, blah, blah.

它对运动的反应很广泛，而且对锻炼的响应特别快、特别明显。

It's nonspecific responder, but a very, very fast and eloquent responder to exercise.

所以，这就是我们提升的空间。

So that's our place of improvement.

在这个过程中，你会获得两个方面的改善。

What ends up happening there is you get two things.

一个是心室充盈量的增加。

You get an increase in ventricular filling.

心室能容纳更多的血液。

So the ventricles fill up with more blood.

血液多了，泵出去的量自然也就多了。

More blood in there means there's more blood to pump.

同时，舒张末期容积会降低，也就是说，每次心跳结束后，心室里残留的血液总量变少了。

You also have what's called lower end diastolic volume, which just simply means after the end of the pump, you have less total volume.

这其实就是一种更专业的说法，用来描述一种叫射血分数的现象。

Fancy way of saying, or similar, I guess, of describing a phenomenon called ejection fraction.

这里我不细说了，你只要理解这个概念就行。

I don't need to go into the details here, but just think about it.

假设你心室里有10个单位的血液，泵出去5个，那射血分数就是50。

If you had, I'll just say 10 units of blood in your ventricle, and you pumped out five, your ejection fraction would be 50.

换句话说，理论上能泵出多少，实际完成了多少？

In other words, of all that was possible there, how much was left after the beat?

如果你能提升这个数值，现在只剩两三个单位残留，泵出了七八个，你算一算，这个逻辑就清楚了。

If you can improve that, and so now your ejection fraction, you only have two or three units left, you've pumped out seven or eight, then again, you can do the math there, that makes general sense.

这些内容我们以后的节目里还会再聊，但刚才说的基本上就是核心了。

So more on all those potentially in future episode, but that's basically what we're talking about.

我们刚才讲了不同结构上的变化。

So we described the different structural changes.

功能上或者结果上的变化，就是我刚刚提到的那些。

The functional or the outcome changes are the ones I just highlighted.

第三类是电生理方面的变化，比如迷走神经张力增强。

And the third electrical are things like an increase in vagal tone.

记住，迷走神经是直接连接到心脏的。

So remember the vagus nerve goes directly to your heart.

当你激活它的时候，心率就会下降。

When you ramp this thing up, you lower your heart rate.

慢性耐力运动会让心率降低，其中一个原因就是，每次心跳泵出的血量变多了，所以不需要跳那么频繁。

And this is one of the things that happens with chronic endurance exercise that allows your heart rate to lower is because the fact you don't have to pump as often because you're getting out more blood per pump.

这里的机制，同样是迷走神经张力的提升。

The mechanism here is again, an increase in vagal tone.

迷走神经负责调节交感神经和副交感神经之间的平衡。

Now the vagus nerve is what regulates this drive between your sympathetic and parasympathetic system.

由于迷走神经张力增强，心脏变得更放松，从而能更好地充盈血液。

And so what also happens here, because you have a lower or increased vagal tone, you have a more relaxed heart, which allows it to fill more.

也正是这种状态，容易引发像房颤这样的问题。

It's also then what causes the problems with things like AFib.

我这儿提前说一点，但既然说到这儿了，你可以想象心脏变得特别放松、平静。

So I'm jumping ahead a little bit, but since we're right here, you have a Just think of it as like a more relaxed and zen heart.

记得那些瓣膜在心脏收缩后必须严密闭合。

And so remember those valves are supposed to be shutting tightly after the pump.

当你特别放松、状态轻松时，瓣膜闭合的紧迫感就降低了。

Well, when you're more relaxed and you're chilling, they don't have as much urgency to shut.

于是它们没法完全关严。

And they don't slam all the way.

当心脏有力收缩时，就会有一小部分血液回流到心房，这就产生了杂音。

So then when you have these nice big heart contractions, a little bit of blood kinda shoots back onto the atria that causes this heart murmur.

我们通常认为，运动诱发的房颤就是这样发生的：迷走神经张力大幅升高，心脏的整体可塑性也增强，导致心脏扩张得更明显，从而出现轻微的 flutter 和 flickering 现象。

That's effectively what we think is happening with exercise induced AFib is you actually get such an increase in vagal tone and such an increase in overall plasticity of the heart, in this case, it dilates more, that we just get this little bit of extra kind of fluttering and flickering there.

目前还不清楚，如果是运动引起的，这种情况到底有多危险。

And so it's at this point not necessarily known how dangerous that is if it is exercise induced.

也不确定，是不是因为经常锻炼的人更关注身体变化，才更容易注意到这种现象——他们不一定总是这样，但确实常常更敏感。

It's also not known if this just happens to be noticed more in people who exercise because they are not always, but oftentimes a little bit more in tune with what's happening in their body.

所以他们可能更容易察觉到这种异常。

So they might feel this a little bit more.

这么说来，你的心脏太放松了，多少也算个原因。

So you can kind of blame this a little bit on your heart being a little bit too relaxed.

也许我们该稍微降低一下迷走神经的张力，多留意一点，但这也未必是病理性的。

Maybe we should like ease up a little bit on the vagal tone there, pay a little bit more attention, but it also may not be pathological.

这里提到的这三点，每一点都值得单独深入聊聊。

Highlighting everything right there, worthy of a little bit more discussion of each one of those three areas in detail right here.

那我们先从左心室开始。

So let's start with the left ventricle.

这些东西我之前提过，咱们简单回顾一下。

I've mentioned this stuff already, so we can recap this.

但记住，如果它提升了每搏输出量和运动表现，那大概率是好事。

But remember, if it enhances stroke volume and it enhances exercise performance, it's probably good.

我们之前聊过心腔扩大这个问题。

We talked about that chamber dilation.

注意，这里说的是内部空间变大了。

Remember, this is the inside getting larger.

很多关于运动员的大规模研究，其中常被引用的是意大利运动员的一组数据。

A lot of research from large cohorts of athletes, one in particular that's used quite often here is a group of Italian athletes.

美国这边的研究者也做过类似的工作。

They've done similar things with athletes here in The US.

总的来说，这些论文里提到的现象都差不多。

And in general, we're hearing about the same things in all these papers.

但比例相当高。

But a large percentage.

事实上，我见过一些研究显示，高达百分之八十到九十的耐力型运动员心脏腔室都会增大。

In fact, I've seen some studies that have even indicated up to eighty to ninety percent of a Neurons athletes are gonna have an increase in chamber size.

所以可以说，这种变化非常普遍，你经常能见到。

So I think it's fair to say this is a very common adaptation that you'll see routinely.

如果想看具体数据，不同论文说法不一，大约有50%的人左心室直径会超过55毫米。

If you want exact numbers there, you're gonna depending on the paper, something about 50% will have an increase in left ventricle diameter of more than 55 millimeters.

如果你是心脏科医生，这个数字对你来说是有意义的。

If you're a cardiologist, that will make sense to you.

如果你不是，也没关系。

If you're not, fine.

而有10%到20%的人甚至会超过60毫米。

And then somewhere between 1020% will be even greater than 60 millimeters.

如果你觉得这些数字不重要，那就跳过，你已经明白重点了。

So those numbers don't matter to you, fine, move on, you get the point.

如果你感兴趣，这里有个小细节。

If they do, interesting tidbit.

至于左心室大小或者心室壁增厚，力量型运动员通常不会出现这种情况。

In terms of the left ventricular size or the mid wall thickening, if you will, it doesn't necessarily happen that often in strength training athletes.

接下来我马上告诉你为什么会这样。

And in fact, I'll share with you why exactly this happens in a second.

我们主要讨论的是耐力型、有氧或心肺训练。

So we're mostly talking about kind of endurance aerobic or cardiovascular training.

所以才叫心肺训练嘛。

That's why we call it cardiovascular training.

通常我们看到这种情况时，心室壁厚度确实会增加，大概在12到13、14毫米之间。

And most of the time when we see this, we do see an increase in that wall thickness, 12 to kinda thirteen, fourteen millimeters is the range there.

如果超过15毫米，可能就需要进一步检查了。

You start getting past 15, you might wanna do some additional testing.

不过一般来说，数值都落在这个范围内。

But those are kinda where the numbers generally lie there.

这里还有一些其他值得关注的情况。

A number of other things may pop up that are worthy of note here.

不对称性肥厚是个特别值得关注的问题。

Things like asymmetrical hypertrophy is a particular problem.

比如左心室比右心室明显过大、纤维化，就像我之前提到的，还有收缩储备不足或射血分数偏低等情况。

So whether this is excessively larger left ventricular size relative to right size, fibrosis, as I've mentioned, contractile reserve, or ejection fraction being poor.

如果你是从心脏病学角度出发，还有很多其他指标值得留意。

And there's a whole host of things you can look at, again, if you're in the cardiology side that you'd wanna pay attention to.

但我在这里想强调的是，我们已经多次提到过：单靠左心室大小，是无法区分运动性心脏重塑和心肌病的，很遗憾。

But the point that I'm making here is something we've said several times now, and that's the fact that that left ventricular size alone can't differentiate the EICR from cardiomyopathy, unfortunately.

但它能给我们一些线索，指引我们下一步该往哪里查。

But it can leave us clues and it can tell us where we want to go from there.

接下来你会经常听到一些术语，我知道这里会稍微专业一点，但请继续听下去。

Some terms you're gonna hear here routinely, and I know again, we're gonna get a little bit technical here, so stay with me.

我提这些，是因为这些词在运动科学里很常见，但在心脏病学里含义完全不同。

And I'm bringing this up though, because these are common in exercise science, but they have a different meaning in cardiology.

离心性肥厚和向心性肥厚。

Eccentric versus concentric.

在运动领域，这些词的意思是不一样的。

When you say those in exercise, they mean something different.

说到心脏问题时，向心性重塑通常不是好现象。

When you say them with a heart, concentric remodeling is generally the bad thing.

我来解释一下具体指什么。

Here's what they're referring to.

还记得我之前举过的高血压例子吗？

Remember the high blood pressure example I've given earlier.

如果你长期高血压，左心室就得一直用力向内收缩。

If you have chronic high blood pressure, your left ventricle has to squeeze concentric.

就像一直在做紧缩的动作。

Like it's a squeeze contraction all the time.

这常常会导致心腔变小。

This often results in that reduced chamber size.

但如果你长期锻炼，因为运动时大部分动脉和静脉都会扩张，以增加血流。

However, when you're chronically exercising, because when you exercise, most of your arteries and veins dilate to increase blood flow.

这实际上并不会让左心室突然承受更高的血压。

That actually doesn't cause the left ventricle to overcome higher blood pressure acutely.

但真正发生的是，你泵出了更多的血液。

What does happen though is you're pushing way more blood out.

所以回流到心脏的血量也大大增加了。

And so you have a lot more blood coming back in.

这叫前负荷，对吧？也就是静脉回流。

This is called preload, right, or venous returns.

静脉里回流的血液大量涌向右心房。

The amount of blood returning from the veins going back and slamming into that right atria.

所有这些血液都猛地冲进那里。

That all slams into there.

所以你实际看到的是，血液从内部压迫心室壁的压力。

So what you're actually seeing is pressure coming from blood pushing outward on the chamber.

因此，心室不是被迫收缩把血泵出去，而是被血液填满。

So instead of the chamber having to contract to push the blood out to the body, it's filling up.

你想象一下，我把大量水倒进一个气球里，气球因为内部水压向外膨胀。

And just imagine me dumping a bunch of water into a balloon and the balloon expands inside because of pressure from the water pushing inside, pushing outwards.

所以这才叫‘偏心性’。

That's why they call it eccentric.

它是在拉长。

It's extending.

并不是让那里的肌纤维收缩变短。

It's not causing the fibers there to contract and shorten.

而是因为大量血液猛烈回流到动脉和心室，导致心腔因为内部压力而被拉长或扩张。

It's actually causing the chambers to lengthen or widen because of internal pressure because so much blood flow is smashing back into the arteries and ventricles.

这就是为什么这种所谓的‘偏心性刺激’往往会导致心腔体积增大。

This is why that quote unquote eccentric stimuli tends to result in a greater chamber size.

各位，这可是最根本的原理了。

Folks, this is as said principle as it gets.

特定适应于所施加的需求。

Specific adaptation to imposed demand.

这两者所施加的负荷是不同的。

The demand is different between these two things.

所以虽然它们都会让心脏变大，但背后的机制完全不同，完全取决于心脏受到的应力方式。

So while they both result in your quote unquote heart getting bigger, they're getting buried differently based specifically on the way that they are being stressed.

所以我才觉得有必要花时间带你们仔细梳理一下这些解剖结构和专业术语，这样反而能帮你们更清楚地理解。

And this is why I felt appropriate to take the time to walk you through both this anatomy and a little bit of this technical jargon, because it actually hopefully makes this less confusing.

现在你们应该明白了吧，为什么会有这样的说法——原因就在这儿。

And it's now like, why is this saying Well, this is why.

它们其实并不完全一样。

It's not actually identical.

虽然感觉上差不多，但本质上差别很大。

Even though it feels identical, it is quite different.

因此，身体的生理反应也就不一样了。

And so we have a different physiological response.

现在，我们也可以用实际的运动来重现同样的情况。

Now we can do the exact same thing here with actual exercise.

所以，在心脏方面，这种运动被称为等张运动。

So again, in the heart, they call it isotonic exercise.

这就是你常说的耐力训练。

This is your endurance stuff.

比如跑步、骑车、游泳这些。

This is your running, cycling, swimming.

当你做这些运动的时候，想想身体得发生什么变化。

When you do that stuff, I mean, think about what has to happen.

你需要让大量血液持续不断地流动，时间还很长。

You have to have a lot of volume of blood sustained for a long period of time.

而且你身体的外周阻力并不高。

And you don't have a lot of what's called peripheral resistance.

实际上，它常常还会更低。

In fact, oftentimes it's less.

你的血管都扩张开了。

You've dilated vessels.

你并不是在大量收缩肌肉，对吧？

You're not squeezing a ton of muscle, right?

当你收缩肌肉时，会挤压血管，让血液更难泵出。

When you squeeze muscle that squeezes the blood vessels, that makes it harder to pump blood.

在这种典型的耐力运动中，你并不会频繁地这么做。

You're not doing that a ton with this classic endurance style of exercise.

因此，面对这种等张性有氧运动，通常会看到四个心腔的扩张程度比较均衡。

And so what you generally or commonly see in response to this isotonic cardiovascular exercise is a fairly even distribution of dilation between all four cardiac chambers.

心房会变大，心室也会变大。

So the atria get bigger and ventricles get bigger.

这可以说是一种均衡型的心肌肥厚。

This is a balanced hypertrophy, if you will.

不过在运动的细分类型中，还是存在一些差异的。

Now there are some differentiators there within subgroups of exercise.

比如，有研究显示，赛艇运动员更容易出现轻度的左心室离心性肥厚，因为承受的压力更大；而长跑运动员则更多表现为左心室离心性肥厚，但左心室质量保持正常。

Like For example, there's some literature on rowers who tend to develop a little more eccentric left ventricular hypertrophy just due to more pressure, where distance runners are gonna be looking more like eccentric left ventricular hypertrophy with normal left ventricular mass.

所以心脏会变大，但如果你刚才没听懂，也不用担心。

So it gets larger, but it's not if that blew past you, don't worry about it.

不过如果你是这类运动员，可能会觉得这点挺有意思。

But if you're in those groups of athletes, you might have found that interesting.

这跟力量训练或者抗阻运动不一样，那种情况我们通常称之为等长收缩。

This differs from strength training or resistance exercise, where we would generally call this, again, isometric.

当然，这里说的等长收缩不是指骨骼肌，而是针对心脏而言。

Again, not at the level of the skeletal muscle, it's isometric for the heart.

比如举重就是这种情况。

This is lifting.

还有摔跤，类似这样的运动也一样。

This is wrestling, things like that.

而这正好跟我刚才说的完全相反。

Well, now it's exact opposite what I just described.

由于外周阻力急剧上升，就像我之前提到的，查一下相关研究你会发现，最大强度的硬拉过程中，血压可能高达450/300，甚至更高，这意味着血管几乎完全被堵住了。

You have a huge increase in peripheral resistance because, as I just mentioned, in fact, if you look at some of the literature, you'll see blood pressure during a maximal effort deadlift be as high as four fifty over 300, or even higher potentially, which basically means you're full blood occlusion.

因为全身大部分肌肉都紧绷到极致，血液根本流不动。

No blood is pumping anywhere because all of the muscles or most of them on your body are squeezing so hard, blood can't move.

这对心脏来说是另一种压力，但仍然是有益的压力。

So it's a different stressor to your heart, but it's still a positive stressor.

再加上这种压力负荷，情况就更明显了。

And so you combine this with a little bit of a pressure overload.

这时候你会看到左心室中部的壁增厚，但心腔不会扩大。

This is when you tend to see that mid left ventricular wall thickening, but you don't see chamber dilation.

回流到心脏的血量并没有增加。

We're not getting a ton of preload back.

力量训练时，一般来说，血液并不会大量流动。

We're not causing a lot of blood to be moving a ton when we're strength training, again, in general.

所以回流的血量也不会增多。

So we're not seeing a ton of blood returning.

心腔的直径也不会因此变大。

We're not seeing that increasing diameter size.

所以，如果一个人想最大程度地提升心血管健康，这就是为什么力量训练、速度训练和爆发力训练通常并不是最佳选择。

And so if one were to want to maximize their cardiovascular health, this is why in general, strength training, speed training, power training are probably not our best bet to maximize cardiovascular health.

它们确实有一些好处，但要想真正看到心腔扩大这样的改善——就像我们之前说的，这可是非常有益的——我们很可能得在某个时候进行一些持续性的有氧运动。

They have some benefits, But to really see those increases, improvements in chamber size, which is, again, as we described, a really positive thing, we're probably gonna have to do some sustained effort at some point.

现在我们明白了这一点，接下来可以聊聊哪些因素会影响这种适应性变化的发生程度，以及哪些不会发生。

So now that we've got that understood, we can kind of move on and talk about some of the things that will determine how much of that adaptation occurs and how much does not.

我之前简单提过，但说实话，目前的数据还不够充分，不过看起来性别确实会影响运动引起的心脏结构变化。

I've mentioned really quickly earlier, and I just honestly don't have enough data to go off of here, But there does seem to be sex specific differences in the amount of exercise induced cardiac remodeling that occurs.

已经有几项针对数百名顶尖运动员的高质量研究显示，女性的心脏变化幅度确实不如男性明显，但也不是完全没有变化。

There are some excellent studies done with several 100 elite athletes, and it just doesn't seem to be moving as much in females as it does in men, though it does move.

如果感兴趣的话，你可以在节目笔记里找到我提到的那些论文，里面都有详细数据。

And in the show notes, you can look at the papers I'm talking about and look at the specifics there if that's of interest.

此外，还有祖先背景和遗传因素这些方面也值得考虑。

But there's also things considered like ancestry and genetics.

实际上，这个领域现在正朝着这些方向发展。

And this is actually where the field is moving.

但现在还为时过早。

But it's really early.

我看到不少人过早得出了不太公正的结论。

I've seen a number of people jump, I think, to what are unfair conclusions at this point.

我可以明确告诉你，我们现在几乎还处在蒙昧阶段。

But I can tell you right now, we are really almost in the dark ages here.

我要说的重点是这个。

Here's what I'm getting at.

我稍后会再分享一些其他的差异。

I'll share some more differences towards the end of today.

到目前为止，大多数涉及遗传学的研究都在寻找单个基因突变。

But what we have seen now is most of the research that has even looked into genetics are trying to identify single point mutations.

虽然这些心肌病似乎常由某个特定位点的异常引起，但情况并不一致。

And while it does seem that much of these cardiomyopathies maybe have a single place of error, it's not consistent.

所以很遗憾，我们没法靠一次基因检测就下定论。

And so unfortunately, we can't run a single genetic test.

我们不能只看一个单核苷酸多态性，就断定你有这类问题。

We can't look at a single nucleotide polymorphism and tell you have one of these issues.

我这么说是因为现在到处都有人吹嘘这些，还在卖相关产品，但跟研究文献完全对不上。

I'm saying that because I've seen this now purported several places, and people are selling these things, and it doesn't match with the literature.

这根本就不太稳定。

It's just not consistent.

我们还看到一些说法，把所谓的‘白人’和‘黑人’之间的差异简单归类。

We've also seen a little sprinkling of this being different between folks that are quote, white versus folks that are quote, black.

我这么讲是因为文献里本来就是这样做的。

And I'm saying it that way because that's really all the literature does.

你去做这类研究，通常用问卷问：你是白人吗？

You'll run studies like this, they'll often use questionnaires, and they'll say, are you white?

你是黑人吗？

Are you black?

但我们都清楚，所有白人之间、所有黑人之间的差异多得惊人。

But as we all know at this point, there are a a enormous number of differences between all white people and all black people.

所以我们需要把这些再细分成更小的群体，因为这样笼统地看几乎没什么意义。

So we need to break these into subgroups because that that almost tells us nothing.

所以，我希望这个领域未来能转向更合理、更具体的分类方式，来弄清楚是否存在某些亚群，更容易受到遗传倾向、运动影响或其他因素的影响。

And so this is actually where I hope the field will move to is saying, let's move to more appropriate and more specific ways to categorize folks, to see, are there subpopulations that are at a higher risk of either the genetic predispositions or the exercise induced or otherwise.

我们确实掌握一些信息，但依然不清楚这些意味着什么，原因在于，就连我们如何界定不同族裔和遗传群体，目前都还不够精准。

So we have some information there, but again, don't have a crystal clear understanding of what that means because of, I'll just say suboptimal or lack of precision with even how we categorize different ancestries and genetic groups for this particular topic.

第三点值得考虑，也是我们接下来要重点讨论的，那就是训练暴露程度。

Third thing to consider here, and this is the big one that we can get into, and this is what we call training exposure.

这一点其实很好理解，取决于你训练了多久、多拼命、频率多高，这些都会直接影响身体适应的程度。

And this should be fairly intuitive depending on how long you train, how hard you train, how often you train, this will determine how much adaptation actually occurs.

我没法给出确切的数据，但我会尽量说清楚。

I don't have exact numbers to give you, but I'll do my best here.

目前看来，心脏的初期重塑主要发生在向心性阶段。

What it looks like is happening is that initial cardiac remodeling is happening in that concentric phase.

之后，离心性重塑才会逐渐出现。

After that, the eccentric starts to occur.

而这正是我们持续锻炼时所关注的重点。

And this is again what we're looking for with sustained exposure.

最低门槛方面，似乎每周运动五小时左右是个关键节点。

The minimal thresholds, there seems to be a breaking point at about five hours of exercise per week.

明白吗？

Okay?

具体数值会因研究论文而略有不同，但总体来看，四到八小时之间似乎是个临界点。

So depending on what paper you're gonna look at, again, little bit different, but somewhere in the neighborhood of four to eight hours seems to be the breaking point.

如果你每周锻炼时间少于这个量，可能会出现心血管适应，比如心率变慢、最大摄氧量提升。

So if you're doing less than that, you might experience cardiovascular adaptations, bradycardia, lower heart rate, VO two max go up.

但要说心脏结构上的改变，比如心室大小这些，你得持续每周练上四到五小时，坚持好几个月甚至几年，心脏本身的大小和结构才会真正开始变化。

But in terms of the structural remodeling, you know, ventricular size, so on and so forth, you probably need to be accruing again in that four to five hours per week range consistently for many months, if not years, before the heart itself will start to change its actual size and structure.

超过每周四到八小时，我们才会看到之前提到的那些其他适应性变化。

Past four to eight hours is when we start to see some of these other adaptations that we've described.

所以再次强调，这里我们讨论的不是功能性的变化，比如最大摄氧量或每搏输出量。

So again, remember here, we're not talking about functional changes, VO two max, or stroke volume.

这些变化发生得很快。

Those happen really quickly.

每天哪怕只运动几分钟，也可能产生这些效果。

Those can actually happen with even minutes of exercise per day.

事实上，我最近在社交媒体上分享了一些新数据，不仅关于有氧或耐力运动的‘碎片化锻炼’，现在还出现了关于力量训练碎片化锻炼的研究。

In fact, I recently posted on social media, some new data actually on not only aerobic or endurance exercise snacks, but there's some research now on strength training snacks.

就是说，你抽空做几组俯卧撑和仰卧起坐，用自身体重，然后继续做别的事。

So these are things where you basically break out and do as many pushups and sit ups as you can, body weight, and then go back to exercise.

这些方法已经被证明能提升最大摄氧量。

These things have been shown to improve VO two max.

对没怎么锻炼过的人来说，效果可能有限，但这个观点很有启发性。

Now a small amount in untrained people, But it highlights the point.

要提升身体功能，根本不需要每天练好几个小时。

You don't need hours and hours and hours of exercise to see improvement in function.

但要想让心脏本身的结构和形态发生改变，可能需要每周坚持练好几个小时，持续数月甚至数年。

But you probably need several hours per week for a long time to see changes in anatomical or morphological positions of the actual heart itself.

这个数字在老年人身上可能会更高一些，这也符合我们在运动科学中看到的其他现象。

That number probably is leaving a little bit higher in older individuals, and that would be consistent with everything else we see in exercise science.

这些适应性变化可能需要更长的时间才能出现，但确实会发生。

Probably just takes a little bit longer for those adaptations to occur, but it does seem to occur.

所以，即使你年纪大了，多年甚至更久没有进行有氧训练，也一点都不晚。

So even if you are an older individual and you haven't been doing your cardiovascular training for some years or maybe longer, it's not too late.

你依然可以开始，身体依然会呈现出积极的结构变化。

You can still do it, and we still would expect to see positive morphological changes in the body.

我认为这大致概括了左心室发生的变化。

So I think that is a fair summary of what's happening in the left ventricle.

我花最多时间讲这部分，是因为前面提到过的一些原因。

I spent the most time there for the reasons I've described a little bit earlier.

在结束之前，我还会简单提一下其他几点，但会快一点带过，因为相关数据较少，重要性也没那么高。

I will hit a couple of other things before we leave this position, but I'll go much quicker through them because there's less data for us to cover, and it's a little bit less relevance.

本期节目由TrueMed赞助播出。

Today's episode is brought to you by TrueMed.

最近我在想，到底是什么真正决定了运动表现。

Lately, I've been thinking about what actually drives performance.

归根结底就两点：训练的质量，以及你恢复得怎么样。

It really comes down to two things, the quality of your training and how well you recover from it.

这两方面都特别重要。

And both sides of that equation matter.

你用来训练和恢复的工具——高品质的健身器材、助眠产品、恢复设备，价格都不便宜。

And the tools you use to train and the tools you use to recover, high quality fitness equipment, sleep support, recovery tools can get expensive.

所以我特别欣赏TrueMed在做的事。

And that's why I love what TrueMed is doing.

他们的宗旨就是让健康更易获得，帮你用税前的HSA或FSA账户资金支付符合条件的健康产品。与其把这些看成额外开销，不如说是动用你本来就已经为健康预留的钱。

Their whole mission is to make health more accessible by helping you use pre tax HSA or FSA dollars on eligible health FSA So instead of thinking about this as extra spending, you're using money that's already set aside for your health.

对很多人来说，这意味着能省下大约三成的花费，具体要看你的财务状况和资格。

For a lot of people, that means saving an average of 30% on those purchases, depending on your finances and eligibility.

我以前一直以为HSA和FSA的钱只能用来付诊疗费或者某些医疗用品。

I always thought HSA and FSA funds were only for doctor's appointments and certain medical products.

厉害的是，你可以用 TrueMed 支付符合 IRS 规定的健康产品，比如健身器材、助眠设备、恢复工具等等，当作医疗开支来处理。

What's amazing is that you can use TrueMed to pay for eligible products that can improve your health as medical expenses under IRS guidelines, fitness equipment, sleep support, recovery tools, and more.

去 truemed.com/perform 看看哪些东西符合条件。

Go to truemed.com/perform and check what qualifies.

花几分钟就能搞定。

It takes just a couple of minutes.

这绝对是充分利用你健康预算的最好方式。

This is hands down the best way to make the most out of your health dollars.

TrueMed 适用于符合条件的用户。

TrueMed is for qualified customers.

HSA 和 FSA 的税务优惠因人而异。

HSA, FSA tax savings vary.

从右心室开始讲，其实原理和左心室差不多，但难点在于我们缺乏正常值参考数据。

So starting with the right ventricle, it's honestly pretty similar, but really it's more difficult than the left ventricle because we don't have normative data.

关于左心室的大小，我还能给你比较准确的数据，但右心室到底是什么样，我们目前还不清楚。

So while I was able to give you pretty good information about the left ventricle in terms of actual size, we don't know what that looks like from the right ventricle.

所以目前我们主要依赖对左心室的了解，接着直接进入心房部分。

And so we're gonna lean heavily on what we understand from the left side at this point, and then actually just go ahead and move on to the atria.

这里的研究结论非常明确。

There are really well established adaptations here.

耐力型有氧运动，主要影响的是心脏的耐力部分。

Aerobic exercise is endurance side of the equation.

这类人群几乎都有更大的左心房。

These folks almost always have a larger left atria.

如果我们还记得刚才提到的心脏解剖结构，这一点就很好理解了。

And if we remember the anatomy from several moments ago, this should make plenty of sense.

这方面已经有不少扎实的研究了。

Some good studies have been done here.

研究对象通常是几百名运动员，有时甚至多达五六百人。

You're talking about research on several 100, sometimes up to five or 600 athletes.

我们 consistently 观察到，运动员的左心房容积明显大于同年龄、同体重的普通人。

And we really consistently see this finding, this left atrial volume just being much bigger than age and body weight matched controls.

所以右心房和左心房的结论非常相似。

So it's very, very similar conclusions between the right atria and the left atria.

我想我们已经清楚了来龙去脉，那就继续往下讲。

And I think we know our story, and so we'll go ahead and move on.

还有之前提到过的其他要点，我会快速带过，比如射血分数的问题。

Other stuff to pay attention to that I will also go quickly over are the things that I've mentioned before with the ejection fraction.

一些研究显示，高达百分之九十的耐力运动员，其射血分数要么正常，要么偏高。

So some papers have shown, you know, up to ninety percent of endurance athletes will have either the same or an elevated or increased ejection fraction.

简单提醒一下，这意味着每次心跳，左心室泵出的血液更多。

So a reminder, this means you're getting more blood out of the left ventricle per pump.

这当然是好事。

That's a good thing.

没必要浪费力气，让一半血液还留在心室里。

We don't need to waste our time pumping it, leaving half the blood still in the ventricle.

所以射血分数偏高通常是正面的。

And so an elevated ejection fraction is generally good.

但与此同时，你确实会发现大约有百分之十的运动员，他们的射血分数低于预期，也就是低于百分之五十。

But at the same time, you actually then see about ten percent of athletes that have lower than expected ejection fraction, you know, lower than fifty percent, if you will.

这一点需要引起注意。

So something to pay attention to.

你本来预期会看到正面的结果。

You're gonna expect positive results there.

但如果你没看到，或者发现数值反而低于正常水平，那就值得进一步排查了。

But if you don't see or you see actually lower than standard, this may be something you wanna look into for further investigation there.

这种情况可能根本无关紧要。

It could be completely irrelevant.

也可能是早期心肌病的征兆，或者是一些我们目前完全不了解的其他问题。

It could be a sign of early cardiomyopathy, or it could be actually some other thing that we just don't have any idea about.

尤其是当我们知道，整体运动能力和心血管健康其实是提升的。

Especially if we know that the net result is increase in exercise function, overall cardiovascular fitness.

所以在做临床判断之前，必须把这些因素都放在整体背景下综合考虑。

We need to take all these things into context before making a clinical evaluation.

好的。

Alright.

这里还有一些需要注意的地方。

Some other stuff to pay attention to here.

一些数据显示，这种射血分数可能主要受遗传因素影响。

Some data suggest that this ejection fraction is actually particularly genetically driven.

目前这些研究的质量到底怎么样，我也说不准，但我确实看到过一些相关资料。

I don't know how good that stuff is at this point in terms of quality of evaluation, but I did see some stuff there.

所以我只是想提一下，值得留意一下这个点。

And so I wanted to flag it as something to potentially pay attention to.

更具体地说，我们这里讨论的是在大规模基因检测样本中发现的几种多态性位点。

Probably more specifically here, we're looking at a different number of polymorphisms that have been identified in these kind of large genetic testing pools.

我读那些论文的时候，心里其实有点怀疑。

To me, when I read those papers, I kinda walked away going, maybe?

我不太确定。

I don't know.

好的。

Okay.

我这里看到一些东西，但对我个人来说，这还太早了。

I see something here, but this was a too early signal for me personally.

如果你看了，也许会有不同看法，但我就不替你做判断了。

If you read it, maybe you feel differently, but I'll leave that up to you.

在有更多证据之前，我不会轻易下结论，不过这事值得留意。

So I'm waiting for more evidence on that particular point before I try any further conclusions, but something to pay attention to.

我想提一下这个领域里几项具有里程碑意义的研究。

Wanna highlight a couple of really landmark studies in this area.

有一系列研究叫作ProHeart研究。

There's a series of them called the ProHeart studies.

我简单总结一下，其中有一项研究大约有八十名参与者。

And just to summarize them really, really quickly here, one of them in particular had two eighty or so participants.

这些都还是年轻人，十八九岁左右。

These are early, you know, 18, 19 year olds.

但有趣的是，这些人都是顶尖运动员。

But what's interesting is they're elite athletes.

主要是男性，但都是国家级和国际级的耐力型运动员。

So you're talking about mostly males, but these are national and international level endurance athletes.

我觉得他们平均的VO2 max大概在63到64之间。

I think the average VO2 max here was 63 or 64.

这些人每周锻炼十五到十六个小时。

And these folks were exercising fifteen to sixteen hours per week.

当你仔细看数据时，会发现相当一部分人，有的甚至达到百分之十五到十六，出现了左心室或右心室射血分数降低的情况。

And when you looked at that, you started seeing things like a large percentage of them, some were sometimes to fifteen to sixteen percent, had that reduced ejection fraction or either the left ventricle or the right ventricle.

还有一些比例较小的人，只在右心室或左心室出现射血分数下降，也有人两个心室都受影响。

And then some other smaller percentages had maybe reduced ejection fraction in the right side only, or the left side only, or some of them had both.

所以整体结果，就像我前面说的那样。

And so the overall findings were again, like I described earlier.

虽然大多数耐力运动员的射血分数会提升，但仍有不小的比例——有时高达百分之十——反而变得更差。

The fact that while the majority of endurance athletes have an improvement in ejection fraction, a non small amount, sometimes up to 10%, actually see worse.

但之前我已经提过好几次了，我们其实还不清楚这种情况到底是好是坏。

But now several times have said this, we actually just don't know if that's bad or not.

不过为了继续推进，我们就先假设这是可以接受的，接下来我要谈的是另一个问题：当情况真的变糟时，到底发生了什么？

But we're gonna call that good for our understanding of this part and move on toward the next thing I wanna discuss, which is kind of a way of saying, when it actually goes bad, what is really happening here?

提醒一下，运动几乎总是有益的。

As a reminder, exercise is almost always a good thing.

但这个话题的核心问题是，如果我们把运动推到极致，可能会发生什么？

But the real question on this particular topic is if we take exercise to an extreme, what could plausibly happen?

会出现哪些不良适应？

What are the maladaptations?

归根结底，主要就这三类问题。

You can really boil them down into three particular things.

第一是心律失常的风险。

The first is arrhythmia risk.

我说的就是房颤。

That's that AFib I'm talking about.