Current evidence cannot affirm that high levels of exercise are dangerous, although there is an indication of diminishing mortality benefit and increased AF risk. There is still much to learn about the athlete`s heart, and clinicians should remain open to potential harms in order to fairly advise athletes aiming for sporting excellence. For the rest of us, as with nearly everything in medicine, exercise in moderation may be the wise approach. Key messages Exercise has significant health benefits, reduces cardiac events and improves survival. There may be diminishing mortality benefit at higher levels of exercise but an upper limit has yet to be defined High levels of exercise are associated with increased atrial fibrillation (AF) risk, although its clinical implications are not well understood. Risk stratification for anticoagulation is extrapolated from data from non-athletes, and nuances in the management of this specific group should be explored Intensive exercise may be associated with adverse structural and functional changes in the heart. However, their significance is unclear and further study is needed to explore their impact on cardiovascular morbidity and mortality
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