Exercise at the Extremes: Toward an Understanding of Increased Cardiovascular Risk in the Tactical Athlete

Abstract Purpose of Review Tactical athletes (TAs) comprise the military, fire, law enforcement, and related occupations for whom the performance of intense exertion in life-threatening conditions, and with minimal warning, is a sworn duty. Given the extreme environmental and exercise exposures intrinsic to their occupation, it is not surprising that TAs may be at an increased risk of near- and long-term cardiovascular events. Because society depends on TAs, understanding the impact of these extraordinary occupational exposures on cardiac health is paramount. In this review, we (1) characterize the tactical athlete, (2) define extreme environments and extreme exercise, and (3) discuss the impact of these extraordinary exposures on the health of tactical athletes. In doing so, we discuss mechanisms by which higher levels of cardiovascular disease may be observed in this population and highlight areas in need of further study. Recent Findings Compared to competitive athletes, there has been limited research on the TA community. Recently, Petek et al. identified significant knowledge gaps that merit urgent attention. Importantly, the need to investigate possible cardiotoxic risks of nontraditional risk factors (i.e., unique environmental exposures) is emphasized. Summary While highly variable both across and within disciplines, TAs are often subject to increased environmental exposures to meet the demands of their occupation. Additional research is needed to understand the cardiovascular impact of hazardous environmental exposures, exercise dose, and attendant psychological and physical stressors; ultimately these efforts will provide a benefit not only to TAs, but also to the society they serve.