Gokhan Ipekoglu1, Halil Taskın2, Omer Senel3

1Sinop University, Sports Sciences Faculty, Sinop, Turkey
2Selcuk University, Sports Sciences, Faculty, Konya, Turkey
3Gazi University, Sports Sciences Faculty, Ankara, Turkey

Examination of Exercise-Induced Skeletal and Cardiac Muscle Damage in Terms of Smoking

Monten. J. Sports Sci. Med. 2019, 8(2), 5-12 | DOI: 10.26773/mjssm.190901


This study aimed to investigate the effect of acute endurance exercise on cardiac and skeletal muscles in smokers and non-smokers. Eight daily smokers (28.44 ± 3.94 years) and nine non-smokers (29.62 ± 3.46 years) were included. The subjects were not trained and performed continuous endurance exercise on a treadmill for 40 minutes at 70% of maximal heart rate. Venous blood samples were collected at baseline [pre-exercise (PRE)], at immediately after the exercise [post-exercise (POST)], at 2 hours after the exercise (2h), at 24 hours after the exercise (24h) to measure lactate dehydrogenase (LDH), creatine kinase(CK), creatine kinase-myocardial band (CK-MB), cardiac troponin T (TN-T), and myoglobin levels. A progressive increase was observed in all exercise-induced muscle damage parameters of the smoker and non-smoker from PRE to 2h. CK, myoglobin and T-NT levels of smokers were significantly higher than non-smokers at 24h (p=0.039, p=0.018 p=0.008, respectively). No significant difference was found between the smoking and non-smoking groups at all time points regarding CK-MB and LDH levels (p>0.05). Acute endurance exercise leads to more skeletal and myocardial damage in smokers compared to non-smokers. Smoking may increase the risk of cardiovascular events during both exercise and daily physical activity.


smoke, cardiac damage, muscle damage, aerobic exercise

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Anbarasi, K., Vani, G., Balakrishna, K., & Devi, C. S. (2005). Creatine kinase isoenzyme patterns upon chronic exposure to cigarette smoke: protective effect of Bacoside A. Vascular pharmacology, 42(2), 57-61. https://doi.org/10.1016/j.vph.2005.01.003

Borg, G.A. (1982). Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 14, 377-381.

Brancaccio, P., Limongelli, F. M., & Maffulli, N. (2006). Monitoring of serum enzymes in sport. British journal of sports medicine, 40(2), 96-97. https://doi.org/10.1136/bjsm.2005.020719

Brown, L.M., Hill, L. (1991). Some observations on variations in filament overlap in tetanized muscle fibres and fibres stretched during a tetanus, detected in the electron microscope after rapid fixation. J Muscle Res Cell Moti, 12,171-182. https://doi.org/10.1007/BF01774036

Byrne, C, & Eston, R. (2002). The effect of exercise-induced muscle damage on isometric and dynamic knee extensor strength and vertical jump performance. J Sports Sci, 20, 417-425. https://doi.org/10.1080/026404102317366672

Chiu, A., Chan, W. K., Cheng, S. H., Leung, C. K., & Choi, C. H. (1999). Troponin-I, myoglobin, and mass concentration of creatine kinase-MB in acute myocardial infarction. Qjm, 92(12), 711-718. https://doi.org/10.1093/qjmed/92.12.711

Clarkson, P. M., Kearns, A. K., Rouzier, P., Rubin, R., & Thompson, P. D. (2006). Serum creatine kinase levels and renal function measures in exertional muscle damage. Medicine & Science in Sports & Exercise, 38(4), 623-627. https://doi.org/10.1249/01.mss.0000210192.49210.fc

Colakoglu, F. F., Cayci, B., Yaman, M., Karacan, S., Gonulateş, S., Ipekoglu, G., & Er, F. (2016). The effects of the intake of an isotonic sports drink before orienteering competitions on skeletal muscle damage. Journal of physical therapy science, 28(11), 3200-3204. https://doi.org/10.1589/jpts.28.3200

Colakoglu, T., Er, F., Ipekoglu, G., Karacan, S., Colakoglu, F. F., & Zorba, E. (2014). Evaluation of physical, physiological and some performance parameters of the Turkish elite orienteers. Procedia-Social and Behavioral Sciences, 152, 403-408. https://doi.org/10.1016/j.sbspro.2014.09.220

Coombes, J. S., & McNaughton, L. S. (2000). Effects of branched-chain amino acid supplementation on serum creatine kinase and lactate dehydrogenase after prolonged exercise. Journal of sports medicine and physical fitness, 40(3), 240. https://doi.org/10.1016/j.atherosclerosissup.2018.04.417

De Winter, R. J., Koster, R. W., Sturk, A., & Sanders, G. T. (1995). Value of myoglobin, troponin T, and CK-MBmass in ruling out an acute myocardial infarction in the emergency room. Circulation, 92(12), 3401-3407. https://doi.org/10.1161/circ.92.12.3401

Ernst, A., & Zibrak, J. D. (1998). Carbon monoxide poisoning. New England journal of medicine, 339(22), 1603-1608. https://doi.org/10.1056/NEJM199811263392206

Ezzati, M., Henley, S. J., Thun, M. J., & Lopez, A. D. (2005). Role of smoking in global and regional cardiovascular mortality. Circulation, 112(4),489-497. https://doi.org/10.1161/CIRCULATIONAHA.104.521708

Fox, E. L., Bowers, R. W., & Foss, M. L. (1993). The physiological basis for exercise and sport (No. Ed. 5). Brown & Benchmark.

Fu, F., Nie, J., & Tong, T. K. (2009). Serum cardiac troponin T in adolescent runners: effects of exercise intensity and duration. International journal of sports medicine, 30(03), 168-172. https://doi.org/10.1055/s-0028-1104586

Green, M. S., Jucha, E., & Luz, Y. (1986). Blood pressure in smokers and nonsmokers: epidemiologic findings. American heart journal, 111(5), 932-940. https://doi.org/10.1016/0002-8703(86)90645-9

Greer, B. K., Woodard, J. L., White, J. P., Arguello, E. M., & Haymes, E. M. (2007). Branched-chain amino acid supplementation and indicators of muscle damage after endurance exercise. International journal of sport nutrition and exercise metabolism, 17(6), 595-607. https://doi.org/10.1123/ijsnem.17.6.595

Güzel, N. A., Hazar, S., & Erbas, D. (2007). Effects of different resistance exercise protocols on nitric oxide, lipid peroxidation and creatine kinase activity in sedentary males. Journal of sports science & medicine, 6(4), 417.

Hachey, B. J., Kontos, M. C., Newby, L. K., Christenson, R. H., Peacock, W. F., Brewer, K. C., & McCord, J. (2017). Trends in use of biomarker protocols for the evaluation of possible myocardial infarction. Journal of the American Heart Association, 6(9), e005852. https://doi.org/10.1161/JAHA.117.005852

King, C. E., Dodd, S. L., & Cain, S. M. (1987). O2 delivery to contracting muscle during hypoxic or CO hypoxia. Journal of Applied Physiology, 63(2), 726-732. https://doi.org/10.1152/jappl.1987.63.2.726

Laustiola, K. E., Lassila, R., Kaprio, J., & Koskenvuo, M. (1988). Decreased beta-adrenergic receptor density and catecholamine response in male cigarette smokers. A study of monozygotic twin pairs discordant for smoking. Circulation, 78(5), 1234-1240. https://doi.org/10.1161/01.CIR.78.5.1234

Lewicki, R., Tchorzewski, H., Denys, A., Kowalska, M., & Golińska, A. (1987). Effect of physical exercise on some parameters of immunity in conditioned sportsmen. International journal of sports medicine, 8(05), 309-314. https://doi.org/10.1055/s-2008-1025675

Lippi, G., Schena, F., Salvagno, G. L., Montagnana, M., Gelati, M., Tarperi, C., ... & Guidi, G. C. (2008). Influence of a half-marathon run on NT-proBNP and troponin T. Clinical Laboratory Journal For Clinical Laboratories And Laboratories Related, 54(7), 251.

Martinsen, E. W., & Stephens, T. (1994). Exercise and mental health in clinical and free-living populations. Illinois: Human Kinetics Publishers.

Maughan, R. J., Donnelly, A. E., Gleeson, M., Whiting, P. H., Walker, K. A., & Clough, P. J. (1989). Delayed-onset muscle damage and lipid peroxidation in man after a downhill run. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 12(4), 332-336. https://doi.org/10.1002/mus.880120412

Middleton, N., George, K., Whyte, G., Gaze, D., Collinson, P., & Shave, R. (2008). Cardiac troponin T release is stimulated by endurance exercise in healthy humans. Journal of the American College of Cardiology, 52(22), 1813-1814. https://doi.org/10.1016/j.jacc.2008.03.069

Morton, A. R., & Holmik, E. V. (1985). The effects of cigarette smoking on maximal oxygen consumption and selected physiological responses of elite team sportsmen. European journal of applied physiology and occupational physiology, 53(4), 348-352. https://doi.org/10.1007/BF00422852

Newby, L. K., & Ohman, E. M. (2000). The Role of the Troponins and Other Markers of Myocardial. Acute Coronary Syndromes. New York: Marcel Dekker Inc.

Nie, J., Tong, T. K., George, K., Fu, F. H., Lin, H., & Shi, Q. (2011). Resting and post-exercise serum biomarkers of cardiac and skeletal muscle damage in adolescent runners. Scandinavian journal of medicine & science in sports, 21(5), 625-629. https://doi.org/10.1111/j.1600-0838.2010.01096.x

Park, W., Miyachi, M., & Tanaka, H. (2014). Does aerobic exercise mitigate the effects of cigarette smoking on arterial stiffness?. The Journal of Clinical Hypertension, 16(9), 640-644. https://doi.org/10.1111/jch.12385

Powers, S. K., Lawler, J. O. H. N., Dempsey, J. A., Dodd, S. T. E. P. H. E. N., & Landry, G. R. E. G. (1989). Effects of incomplete pulmonary gas exchange on VO2 max. Journal of applied physiology, 66(6), 2491-2495. https://doi.org/10.1152/jappl.1989.66.6.2491

Prapavessis, H., Cameron, L., Baldi, J. C., Robinson, S., Borrie, K., Harper, T., & Grove, J. R. (2007). The effects of exercise and nicotine replacement therapy on smoking rates in women. Addictive behaviors, 32(7), 1416-1432. https://doi.org/10.1016/j.addbeh.2006.10.005

Ross, J. H., Attwood, E. C., Atkin, G. E., & Villar, R. N. (1983). A study on the effects of severe repetitive exercise on serum myoglobin, creatine kinase, transaminases and lactate dehydrogenase. QJM: An International Journal of Medicine, 52(2), 268-279. https://doi.org/10.1093/oxfordjournals.qjmed.a067760

Sanchis-Gomar, F., Pareja-Galeano, H., Gomez-Cabrera, M. C., Candel, J., Lippi, G., Salvagno, G. L., ... & Viña, J. (2015). Allopurinol prevents cardiac and skeletal muscle damage in professional soccer players. Scandinavian journal of medicine & science in sports, 25(1), 110-115. https://doi.org/10.1111/sms.12213

Schumann, G., & Klauke, R. (2003). New IFCC reference procedures for the determination of catalytic activity concentrations of five enzymes in serum: preliminary upper reference limits obtained in hospitalized subjects. Clinica chimica acta, 327(1-2), 69-79. https://doi.org/10.1016/S0009-8981(02)00341-8

Sewright, K. A., Hubal, M. J., Kearns, A., Holbrook, M. T., & Clarkson, P. M. (2008). Sex differences in response to maximal eccentric exercise. Medicine and science in sports and exercise, 40(2), 242-251. https://doi.org/10.1249/mss.0b013e31815aedda

Siegel, A.J., Silverman, L.M., Evans, W.J. (1983). Elevated skeletal muscle creatine kinase MB isoenzyme levels in marathon runners. JAMA, 250, 2835-2837. https://doi.org/10.1001/jama.1983.03340200069032

Smith, J. E., Garbutt, G., Lopes, P., & Pedoe, D. T. (2004). Effects of prolonged strenuous exercise (marathon running) on biochemical and haematological markers used in the investigation of patients in the emergency department. British journal of sports medicine, 38(3), 292-294. https://doi.org/10.1136/bjsm.2002.002873

Srivastava, R., Blackstone, E. H., & Lauer, M. S. (2000). Association of smoking with abnormal exercise heart rate responses and long-term prognosis in a healthy, population-based cohort. The American journal of medicine, 109(1), 20-26. https://doi.org/10.1016/S0002-9343(00)00441-1

Suzuki, K., Totsuka, M., Nakaji, S., Yamada, M., Kudoh, S., Liu, Q., ... & Sato, K. (1999). Endurance exercise causes interaction among stress hormones, cytokines, neutrophil dynamics, and muscle damage. Journal of applied physiology, 87(4), 1360-1367. https://doi.org/10.1152/jappl.1999.87.4.1360

Suzuki, K., Yamada, M., Kurakake, S., Okamura, N., Yamaya, K., Liu, Q., ... & Sugawara, K. (2000). Circulating cytokines and hormones with immunosuppressive but neutrophil-priming potentials rise after endurance exercise in humans. European journal of applied physiology, 81(4), 281-287. https://doi.org/10.1007/s004210050044

Tanaka, H., & Safar, M. E. (2005). Influence of lifestyle modification on arterial stiffness and wave reflections. AJH, 18, 137-144. https://doi.org/10.1016/j.amjhyper.2004.07.008

Volek, J. S., Kraemer, W. J., Rubin, M. R., Gómez, A. L., Ratamess, N. A., & Gaynor, P. (2002). L-Carnitine L-tartrate supplementation favorably affects markers of recovery from exercise stress. American Journal of Physiology-Endocrinology and Metabolism, 282(2), 474-482. https://doi.org/10.1152/ajpendo.00277.2001