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The North Sea Race Endurance Exercise Study
NEEDED Research Program
Developing new systems to detect heart disease early on and to find optimal levels of physical activity for best health outcome.
Physical activity is important for general health. Exercisers live an average of 7 years longer than those who are physically inactive, and reduced fitness is one of the strongest indicators for development of cardiovascular disease and death. A challenge is that under the physical strain, there is a small increased risk of incidents in some vulnerable people who have heart disease.
The aim of NEEDED's research program is to develop new systems that can detect heart disease earlier and optimize physical strain. This is done using exercise management parameters, which should help increase gains and reduce the risk of heart disease from physical strain.
Investigate the relationship between physical strain and changes in biomarkers (blood tests) and sensor data (heart rate monitors and wattage meters) before and after a physical load in people with and without cardiovascular disease.
Assess the ability of these markers to detect known and unknown disease.
Consider whether these markers can help increase the gain from physical strain in both healthy and sick individuals.
Effect of exercise on cardiovascular disease
Physical inactivity is a growing health problem. The European time use survey (HETUS) shows that Norway is second to last in Europe when it comes to total daily physical activity related to transport, trips, exercise and sports. At the same time, there has been an increase in physical activity during leisure time during the period 1985-2011. Recreational exercise has therefore become increasingly important for public health. For many, exercise competitions such as the North Sea Race are an important motivating factor for training.
The risk of sudden death during competitions are small. One death per million marathon hours has been calculated. In Vasaloppet (90 km cross-country skiing) there were a total of 13 deaths among a total of 698 102 participants in the period 1970-2005. In a large material from France, the risk of sudden cardiac death in elite athletes during training and competition is estimated at 4.6 deaths per million/year. In relation to the health benefits of exercising regularly, the risk of incidents during competition appears to be very small.
Current research is inadequate in several areas of exercise training: There is a lack of data on the benefits and risks of intensive physical activity in likely healthy exercisers and elite athletes.
Systematic collection of information with samples from blood, heart (ECG and ultrasound), heart rate monitors (heart rate and wattage values), information on training status and load intensity can help clarify the boundary between benefits and risks associated with physical activity.
Milestones
NEEDED Pilot Study 2013
The pilot study was related to the North Sea Race of 2013. It was conducted on a scale of 1:10 in relation to the main study and provided valuable information about participants, study design and follow-up. Out of a total of 160 who expressed interest, 97 people who completed the cycling race were included in the study.
NEEDED Main Study 2014
The main study was carried out related to the North Sea Race of 2014. Here, all 1600 registered cyclists were invited to participate in the study. Of these, 1071 participants were included, of which 1013 carried out the project with all necessary measurements. Participants were surveyed 24 hours before the race, as well as 3 and 24 hours after completing the race.
NEEDED Mechanism Study 2018
This study consisted of 59 participants from the North Sea Race of 2018 who had also participated in the North Sea Race affiliated with one of the NEEDED studies from 2013 and 2014, and were found to have normal coronary arteries without narrowing with CT coronary angiography. Extensive measurements were carried out before and after both races, which included blood tests, measurement of lactate, fitness tests (V02-max), ECG, blood pressure, sensor measurements and ultrasound of the heart. The purpose was to investigate the relationship between these measurements and physical strain.
NEEDED Reproducibility
This study consisted of healthy subjects between the ages of 18-35 who performed fitness tests (VO2 max) before and after exercise, performed in the same manner, once a week, three weeks in a row. This was to investigate whether the same load gives the same values of different markers in the blood.
NEEDED Diagnostic
The first part of this study was conducted in 2022, where participants were exercisers with and without established heart disease. The group with established heart disease consisted of people who had undergone coronary angioplasty, but who had resumed prolonged high-intensity exercise. The physical load consisted of a short intensive training session until reaching the maximum performance level (VO2 max) and three longer training sessions, with the same intensity as with the short, but with increasing duration from 20 to 60 minutes. The purpose was to investigate whether there were different reactions to physical strain in the two groups.
NEEDED TopAthletic
This study started in 2024 and will include healthy elite athletes between the ages of 18-35 over a period of two years. The purpose is to determine normal blood troponin levels of athletes. This is an important study to further investigate whether troponins can be used as biomarkers in predicting heart risk and performance in competition.
Results
Kleiven Ø, Bjørkavoll-Bergseth M, Melberg T, Skadberg Ø, Bergseth R, Selvåg J, Auestad B, Aukrust P, Aarsland T, Ørn S. High physical fitness is associated with reduction in basal and exercise induced inflammation. Scand J Med Sci Sports. 2017 Mar 17. doi: 10.1111/sms.12878. [Epub ahead of print] PubMed PMID: 28314078.
Skadberg Ø, Kleiven Ø, Bjørkavoll-Bergseth M, Melberg T, Bergseth R, Selvåg J, Auestad B, Greve OJ, Dickstein K, Aarsland T, Ørn S. Highly increased Troponin I levels following high-intensity endurance cycling may detect subclinical coronary artery disease in presumably healthy leisure sport cyclists: The North Sea Race Endurance Exercise Study (NEEDED) 2013. Eur J Prev Cardiol. 2017 Jan 1:2047487317693130. doi: 10.1177/2047487317693130.
Aakre KM, Kleiven Ø, Skadberg Ø, Bjørkavoll-Bergseth MF, Melberg T, Strand H, Hagve TA, Ørn S. The copeptin response after physical activity is not associated with cardiac biomarkers or asymptomatic coronary artery disease. Clin Biochem.2017 Oct 25. pii: S0009-9120(17)30829-9.
Długosz D, Królak A, Eftestøl TC, Ørn S, Wiktorski T, The North Sea Bicycle Race ECG Project: Time-Domain Analysis. Proceedings of the Federated Conference on Computer Science and Information Systems pp. 1353–1356 DOI: 10.15439/2017F303 ISSN 2300-5963 ACSIS, Vol. 11
Długosz, D., Królak, A., Eftestøl, T., Ørn, S., Wiktorski, T., Jenssen Oskal, K.R., Nygård, M. ECG signal analysis for troponin level assessment and coronary artery disease detection: The NEEDED study 2014 (2018) Proceedings of the 2018 Federated Conference on Computer Science and Information Systems, FedCSIS 2018, art. no. 8511252, pp. 1065-1068. DOI: 10.15439/2018F247
Skadberg Ø, Kleiven Ø, Ørn S, Bjørkavoll-Bergseth MF, Melberg TH, Omland T, Aakre KM. The cardiac troponin response following physical exercise in relation to biomarker criteria for acute myocardial infarction; the North Sea Race Endurance Exercise Study (NEEDED) 2013. Clin Chim Acta. 2018 Jan 20. pii: S0009-8981(18)30041-X. doi: 10.1016/j.cca.2018.01.033.
Le, K., Eftestøl, T., Engan, K., Ørn, S., Kleiven, Ø. High frequency noise detection and handling in ECG signals (2018) European Signal Processing Conference, 2018-September, art. no. 8553046, pp. 46-50. DOI: 10.23919/EUSIPCO.2018.8553046
Le, K., Eftestol, T., Engan, K., Kleiven, O., Orn, S. Invariant Mean Electrical Axis in Electrocardiogram (2018) Computing in Cardiology, 2018-September, art. no. 8744063,. DOI: 10.22489/CinC.2018.151
Kleiven Ø, Omland T, Skadberg Ø, Melberg TH, Bjørkavoll-Bergseth MF, Auestad B, Bergseth R, Greve OJ, Aakre KM, Ørn S. Occult obstructive coronary artery disease is associated with prolonged cardiac troponin elevation following strenuous exercise. Eur J Prev Cardiol. 2019 Jun 1:2047487319852808. doi: 10.1177/2047487319852808. [Epub ahead of print] PubMed PMID: 31154829.
Kleiven Ø, Omland T, Skadberg Ø, Melberg TH, Bjørkavoll-Bergseth MF, Auestad B, Bergseth R, Greve OJ, Aakre KM, Ørn S. Race duration and blood pressure are major predictors of exercise-induced cardiac troponin elevation. Int J Cardiol. 2019 May 15;283:1-8. doi: 10.1016/j.ijcard.2019.02.044. Epub 2019 Feb 23. PubMed PMID: 30842026.
Kleiven Ø, Ørn S. Endurance exercise and myocardial injury. Eur J Prev Cardiol. 2019 Feb;26(3):316-317. doi: 10.1177/2047487318815302. Epub 2018 Nov 30. PubMed PMID: 30744459.
Kleiven Ø, Bjørkavoll-Bergseth MF, Omland T, Aakre KM, Frøysa V, Erevik CB, Greve OJ, Melberg TH, Auestad B, Skadberg Ø, Edvardsen T, Ørn S. Endurance exercise training volume is not associated with progression of coronary artery calcification. Scand J Med Sci Sports. 2020 Jun;30(6):1024-1032. doi: 10.1111/sms.13643. Epub 2020 Mar 18. PMID: 32100340.
Bjørkavoll-Bergseth M, Kleiven Ø, Auestad B, Eftestøl T, Oskal K, Nygård M, Skadberg Ø, Aakre KM, Melberg T, Gjesdal K, Ørn S. Duration of Elevated Heart Rate Is an Important Predictor of Exercise-Induced Troponin Elevation. J Am Heart Assoc. 2020 Feb 18;9(4):e014408. doi: 10.1161/JAHA.119.014408. Epub 2020 Feb 17. PMID: 32065043; PMCID: PMC7070191.
Wiktorski T, Bjørkavoll-Bergseth M, Ørn S. Methods for preprocessing time and distance series data from personal monitoring devices MethodsX. 2020; 7: 100959. Published online 2020 Jun 12. doi: 10.1016/j.mex.2020.100959 PMCID: PMC7334486
Królak A, Wiktorski T, Bjørkavoll-Bergseth MF, Ørn S. Artifact Correction in Short-Term HRV during Strenuous Physical Exercise. Sensors (Basel). 2020 Nov 8;20(21):6372. doi: 10.3390/s20216372. PMID: 33171676
Skranes JB, Kleiven Ø, Aakre KM, Skadberg Ø, Melberg TH, Omland T, Ørn S. High-Sensitivity Cardiac Troponin I and T Response Following Strenuous Activity is Attenuated by Smokeless Tobacco: NEEDED (North Sea Race Endurance Exercise Study) 2014.J Am Heart Assoc. 2020 Oct 20;9(19):e017363. doi: 10.1161/JAHA.120.017363. PMID: 32930023
Bjørkavoll-Bergseth M, Erevik CB, Kleiven Ø, Eijsvogels TMH, Skadberg Ø, Frøysa V, Wiktorski T, Auestad B, Edvardsen T, Moberg Aakre K, Ørn S. Determinants of Interindividual Variation in Exercise-Induced Cardiac TroponinI Levels. J Am Heart Assoc. 2021 Sep 7;10(17):e021710. doi: 10.1161/JAHA.121.021710. Epub 2021 Aug 28. PMID: 34459237; PMCID: PMC8649268.
Aengevaeren VL, Baggish AL, Chung EH, George K, Kleiven Ø, Mingels AMA, Ørn S, Shave RE, Thompson PD, Eijsvogels TMH. Exercise-Induced Cardiac Troponin Elevations: From Underlying Mechanisms to Clinical Relevance. Circulation. 2021 Dec 14;144(24):1955-1972. doi: 10.1161/CIRCULATIONAHA.121.056208. Epub 2021 Dec 13. PMID: 34898243; PMCID: PMC8663527.
Hansen MW, Ørn S, Erevik CB, Bjørkavoll-Bergseth MF, Skadberg Ø, Melberg TH, Aakre KM, Kleiven Ø. Regular consumption of cod liver oil is associated with reduced basal and exercise-induced C-reactive protein levels; a prospective observational trial : A NEEDED (The North Sea Race Endurance Exercise Study) 2014 sub-study. J Int Soc Sports Nutr. 2021 Jun 28;18(1):51. doi: 10.1186/s12970-021-00437-1. PMID: 34183020; PMCID: PMC8240263.
J Svane, T Wiktorski, S Ørn, TC Eftestøl Recurrent Neural Networks for Artifact Correction in HRV Data During Physical Exercise Nordic Machine Intelligence 3 (1), 11-11 2023
Erevik CB, Kleiven Ø, Frøysa V, Bjørkavoll-Bergseth M, Chivulescu M, Klæboe LG, Dejgaard L, Auestad B, Skadberg Ø, Melberg T, Urheim S, Haugaa K, Edvardsen T, Ørn S. Myocardial inefficiency is an early indicator of exercise-induced myocardial fatigue Frontiers in Cardiovascular Medicine 9, 2023 1081664
Svane J, Wiktorski T, Ørn S, Eftestøl TC. Optimizing support vector machines and autoregressive integrated moving average methods for heart rate variability data correction. MethodsX. 2023 Sep 16;11:102381. doi: 10.1016/j.mex.2023.102381. PMID: 37753351; PMCID: PMC10518477.
Erevik CB, Kleiven Ø, Frøysa V, Bjørkavoll-Bergseth M, Chivulescu M, Klæboe LG, Dejgaard L, Auestad B, Skadberg Ø, Melberg T, Urheim S, Haugaa K, Edvardsen T, Ørn S. Echocardiographic assessment of myocardial efficiency predicts exercise performance. Eur J Sport Sci. 2024;24:319–329. DOI: 10.1002/ejsc.12082
Bjorkavoll-Bergseth M, Erevik C, Kleiven Ø, Wiktorski T, Auestad B, Skadberg Ø, Aakre KM, Eijsvogels TMH, Ørn S. The relationship between workload and exercise-induced cardiac troponin elevations is influenced by non-obstructive coronary atherosclerosis. Scand J Med Sci Sports. 2024;34:e14667. DOI: 10.1111/sms.14667
Erevik CB, Kleiven Ø, Frøysa Ø, Bjørkavoll‐Bergseth M, Chivulescu M, Klæboe LG, Dejgaard L, Auestad B, Skadberg Ø, Melberg T, Urheim S, Haugaa K, Edvardsen T, Ørn S. Exercise‐Induced Cardiac Troponin I Elevation Is Associated With Regional Alterations in Left Ventricular Strain in High‐Troponin Responders. J Am Heart Assoc. 2024 July 2; e034382; https://www.ahajournals.org/doi/epub/10.1161/JAHA.124.034382
Svane J, Wiktorski T, Eftestøl T, Ørn S Machine Learning Methods For Classification of Individuals With Coronary Artery Calcification. 2024 IEEE 37th International Symposium on Computer-Based Medical Systems (CBMS) doi: 10.1109/CBMS61543.2024.00013
Svane J, Wiktorski T, Eftestøl T, Ørn S Alterations in the Autonomic and Hemodynamic Response to Prolonged High-intensity Endurance Exercise in Individuals with Coronary Artery Calcification. Experimental Physiology 2024 https://doi.org/10.21203/rs.3.rs-4102585/v1
Organisation and responsibilities
The project group is responsible for the medical-professional development of the project, obtaining statutory and internal approvals, organisation and progress within established budgets, and all publication. The rights to the study and publication of the results are owned by the project group.
The steering group is responsible for contracts, media plan and media strategy, and supervise that projects are carried out within the formal approvals and agreements that is in place, at any given time.
Helse Stavanger HF, represented by the Research Director, is responsible for project compliance to the Health Research Act. The NEEDED projects follows Helse Stavanger's internal research routines, are registered in Helse Stavanger's internal project registry and stores sensitive data on the Western Norway Regional Health Authority secure research server.
The business aspects and agreements involved in NEEDED projects are handled according to internal routines in Helse Stavanger HF and Stavanger Helseforskning AS, on behalf of the project organization.
Project group
Aina Andreassen, general manager of the North Sea Race
Anders Galaasen Bakken MChiro, PhD
Magnus Bjørkavoll-Bergseth MD
Rolf Bergseth MD
Stein Ørn (project leader) MD, PhD, Professor II
Tor Harald Melberg MD, PhD, associate professor
Øyunn Kleiven MD, PhD
Øyvind Skadberg MD
Steering group
Aina Andreassen, general manager of the North Sea Race
Anders Galaasen Bakken MChiro, PhD
Magnus Bjørkavoll-Bergseth MD
Rolf Bergseth MD
Stein Ørn (project leader) MD, PhD, Professor II
Tor Harald Melberg MD, PhD, associate professor
Øyunn Kleiven MD, PhD
Øyvind Skadberg MD
Other members and student contributions
Post doc
Anders Galaasen Bakken (SUH)
PhD students
Øyunn Kleiven (UiB), completed PhD
Magnus Bjørkavoll-Bergseth MD (UiB), completed PhD
Focus on research in acute myocardial infarction and cardiac arrest – including invasive diagnostics and treatment, as well as heart failure, rhythm disturbances, exercise and sports cardiology.
