UPMC Fellow’s Marathon Training Puts Athletes’ Hearts in Focus

On October 25, 2026, the Post-Gazette profiled UPMC cardiology fellow McSurdy, whose marathon training overlaps with her interest in sports and preventive cardiology. She runs five days a week and often trains before hospital rotations that start at 7 a.m. Her professional interests include women’s heart health.

The profile brings an athlete’s perspective to a clinical question: when does an experience belong to normal training, and when does it deserve medical attention? McSurdy described how palpitations, fatigue, and shortness of breath can overlap with the sensations of a difficult training day. That overlap is the useful starting point for endurance athletes over 35.

Adaptation Needs Context

The American College of Cardiology’s October 16, 2026, review provides the clinical background. It defines masters athletes as people aged 35 and older who regularly participate in competitive or high-intensity recreational exercise. Its central message is that exercise-related changes in the heart must be distinguished from cardiovascular disease.

Those changes are often called cardiac remodeling. In this setting, the term refers to changes in heart structure associated with endurance training. The ACC review treats physiological remodeling as something clinicians need to recognize and interpret within the athlete’s overall clinical picture.

That is different from using athletic fitness as an explanation for every symptom. A training history is relevant information, but it is not a diagnosis. The review’s summary of the 2026 ESC/ACC clinical consensus statement addresses assessment and management when masters athletes have abnormal cardiovascular findings.

For a competitive athlete, the distinction matters in both directions. It guards against assuming that every unusual finding requires stopping exercise. It also guards against assuming that a finding must be harmless because the person trains consistently.

Inside The Evidence

One study summarized by the ACC included 151 male endurance athletes in young and middle-aged groups. Researchers used wearable-derived training data and cardiac MRI to examine the relationship between training and cardiac remodeling.

In the ACC’s account, total training duration was the strongest independent predictor of remodeling. It was a stronger predictor than either intensity or session frequency. The finding connects the amount of training with the pattern of cardiac adaptation observed in that study.

The limits belong alongside that result. This was evidence of an association with remodeling, not proof that training volume causes heart disease or establishes that an individual finding is harmless. Because the study included male athletes, its findings should not be presented as directly established for women athletes. The ACC article is a review of studies and consensus guidance rather than a new clinical trial.

The Post-Gazette profile serves a different purpose. It describes one fellow’s training and professional interests rather than testing a medical strategy. It mentions a case report about cardiovascular risk and return to competition after a cardiac event, but it does not provide the clinical details or a return-to-sport protocol.

McSurdy also told the Post-Gazette that questions remain about evaluating and treating heart conditions in athletes. She identified women athletes as a group with unanswered research questions. Her perspective makes the issue tangible without turning her own training routine into medical evidence.

For Masters Athletes

For athletes over 35, the practical translation is not to become less ambitious. It is to keep training decisions and medical interpretation in their proper roles. The consensus summary identifies symptomatic exercise intolerance as a reason for clinical assessment.

Take Changes Seriously

Persistent symptoms or an unusual change in exercise tolerance deserve a medical conversation rather than an automatic explanation based on age or a hard training block. This follows the ACC review’s emphasis on assessing symptomatic athletes. It does not require the athlete to decide which heart condition might be responsible.

A useful role for the athlete is to describe the change clearly to a qualified clinician. What feels different from usual training is relevant to that conversation. Decisions about evaluation belong with the clinician rather than being settled by a workout result or a wearable score.

The same distinction matters when putting a watch’s recovery feedback in context. Training information may help describe the situation. It should not become the final authority on a persistent symptom.

Assessment Has Context

The ACC’s consensus summary identifies transthoracic echocardiography as first-line imaging for symptomatic athletes with exercise intolerance. It also says exercise testing should be sport-specific and aim to reproduce symptoms or reach peak fatigue. These are clinician-led assessment points, not instructions to test symptoms during a training session.

The sport-specific element is worth understanding. The guidance connects the assessment to the athlete’s exercise demands and the symptoms being investigated. For the athlete, the practical task is to explain the problem in the context in which it occurs rather than to select a test independently.

That makes the clinical conversation more specific than simply asking whether endurance training changes the heart. The relevant question is how the athlete’s experience and findings fit together. The review’s emphasis is on interpreting that overall picture.

Interpret Findings Together

The ACC review gives examples of why clinical interpretation matters. Sinus bradycardia and some conduction findings are common in endurance athletes. Symptomatic ventricular arrhythmias or atypical premature ventricular contractions warrant further evaluation.

The review also says that a high coronary calcium score without concerning symptoms does not, by itself, require exercise restrictions. It places that finding within a broader clinical evaluation rather than treating the score as a stand-alone training decision.

The lesson is not to sort unfamiliar medical terms into a reassuring list and a worrying list. It is to have abnormal findings interpreted by a qualified clinician who can consider the overall clinical picture. Neither an isolated result nor athletic identity should carry the entire decision.

Let Life Count

McSurdy’s training offers a separate lesson about scheduling. According to the Post-Gazette, her coach adjusts workouts around hospital rotations and on-call shifts. After an overnight shift, she may do an easier run instead of intervals.

That example shows serious training being adapted to professional demands. The planned session changes while the larger athletic goal remains in place. It is a practical scheduling example alongside the profile’s clinical questions.

For Reendure, the relevant principle is to keep ambitious goals compatible with a training week that fits real life. Work demands belong in the planning conversation alongside the intended workout. Flexibility can be part of an ambitious approach rather than a departure from it.

That fits Reendure’s focus on performance today and continued participation over the long term. The useful distinction is between adjusting a session to fit circumstances and deciding what an unexplained symptom means. Those are different decisions with different sources of guidance.

The Lasting Takeaway

McSurdy’s profile brings the issue into everyday training: a committed athlete can adjust a workout and still recognize that some questions belong in a clinic. The ACC review provides the clinical principle behind that distinction: interpret heart adaptations and symptoms in context.

For masters athletes, the modest takeaway is to stay ambitious while taking persistent symptoms or unusual exercise intolerance seriously. Training history should inform a qualified assessment rather than replace it.

Sources

1. Running target: UPMC cardiology fellow is chasing six marathons while studying the hearts of athletes
2. Sports Cardiology Research and Guideline Highlights: Early ...