Terry Kavanagh Heart Health Lab

The focus of our laboratory is heart function and exercise. Key questions we are trying to answer include:

• what are the cardiac consequences of 'excessive' exercise performed over a lifetime
• what are the mechanisms of exercise-induced cardiac fatigue
• how does the heart adapt to acute and chronic exercise in health and disease

We have an interest in the spectrum of health, from long-standing athletes to clinical populations including heart failure, hypertension and atrial fibrillation.
Related studies examining peripheral vascular function and the effects of exercise are also part of our investigations.

Our research is conducted in an exercise physiology laboratory (U of T) and in the Division of Cardiology at Mt. Sinai Hospital, where a full stress echocardiography and cardiac catheterization laboratory is used for both non-invasive and invasive exercise studies.
We are currently recruiting motivated graduate students (preferably PhD) to contribute to our ongoing and planned studies (see Current Research Projects).

Research Environment

Two laboratory environments enable our research efforts. Numerous studies are conducted within the faculty. Both laboratory and field studies also utilize various monitoring techniques, from beat-to-beat and ambulatory blood pressure, Holter ECG, and assessment of maximal oxygen intake, vascular stiffness, blood flow and vascular conductance and heart rate variability.

At Mt. Sinai Hospital, the Clinical Cardiovascular Research Laboratory allows for both invasive and non-invasive assessments of cardiac function during exercise, using a dedicated research cardiac catheterization suite and a separate physiology research laboratory. We utilize cardiac catheterization techniques to assess myocardial mechanics, cardiac and pulmonary hemodynamics, in addition to stress echocardiography to image the heart for various types of measurements during acute and chronic exercise interventions.

Current Projects

Cardiac Consequences of Excessive Endurance Exercise. Using both animals (mice) and humans, the effects of long-term endurance exercise and competition on cardiac size and function will be assessed. A series of studies will examine the intra-cardiac and pulmonary vascular response to training and acute exercise stress. We are interested in determining why some endurance athletes may be at greater risk of arrhythmias in middle age.

Cardiac Costs of Pick-up Hockey in Middle-Aged Men. This study will examine the cardiovascular responses to the unique exercise conditions of hockey on-ice and during time on the bench. Ambulatory ECG and blood pressure monitoring will be used to evaluate the ‘cardiac cost’ of this exercise compared to graded exercise testing.

Cardiac Consequences of Excessive Endurance Exercise. Using both animals (mice) and humans, the effects of long-term endurance exercise and competition on cardiac size and function will be assessed. A series of studies will examine the intra-cardiac and pulmonary vascular response to training and acute exercise stress. We are interested in determining why some endurance athletes may be at greater risk of arrhythmias in middle age.

Mechanisms of Cardiac Fatigue During Prolonged Exercise. The causes of the transient decline in cardiac performance after long periods of exercise are unclear. We are now pursuing an animal model to extend the work where our human studies have left off.

Financial Incentives in Optimizing Cardiac Rehabilitation Compliance. The use of financial incentives to encourage post-program cardiac patients to maintain exercise habits is a very novel field of study within the cardiac rehabilitation field.


Research collaborations from various institutions across Toronto strengthens our research expertise in basic science and physiology (Faculty of Medicine), cardiology (UHN/Mt. Sinai, St. Michaels’ Hospital), cardiac rehabilitation (Toronto Rehab, Cardiac Programme), environmental physiology (Defence Research and Development, Canada).

Dr. Paul Dorian, MD (Division of Cardiology, St. Michael's Hospital): Exercise and electrophysiology, atrial fibrillation

Dr. Kim Connelly, MD (Division of Cardiology, St. Michael's Hospital): Exercise and cardiac Imaging, atrial fibrillation

Dr. Andrew Yan, MD (Division of Cardiology, St. Michael's Hospital): Exercise and cardiac Imaging, atrial fibrillation Dr. Peter Backx, DVM, PhD (Dept. Physiology, Fac. Medicine, U of T): Animal studies of exercise and atrial fibrillation, cardiac fatigue and prolonged exercise

Dr. Scott Thomas, PhD (Fac. Kinesiology & Physical Education):Exercise and blood pressure, post-exertional hypotension, exercise training and ageing

Dr. Zion Sasson, MD (Dept. Medicine, Division of Cardiology, UHN/Mt. Sinai Hospital): Stress echocardiography, exercise and cardiac mechanics

Dr. Susanna Mak, MD, PhD (Dept. Medicine, Division of Cardiology, UHN/Mt. Sinai Hospital): Cardiac mechanics and hemodynamics during exercise; Age, gender and cardiac responses to exercise

Dr. Marius Locke, PhD (Fac. Kinesiology & Physical Education): Exercise and cardio-protection, exercise and inflammation

Dr. Paul Oh, MD (Toronto Rehab, Cardiac Programme): Cardiac rehabilitation, Exercise Compliance

Dr. David Alter, MD, PhD (Toronto Rehab, Cardiac Program), Cardiac rehabilitation

Dr. Robert Nolan, PhD (UHN/Toronto General Hospital), Behavioural Psychology, Exercise and Heart Failure

Dr. Paula Harvey, MD, PhD (UHN/Women’s College Hospital), Vascular physiology, estrogen deficiency and vascular dysfunction

Recent Funding

Canadian Institutes of Health Research

Cardiac Consequences of Excessive Exercise


Canadian Institutes of Health Research

Canadian e-Platform to Promote Community-Based Support

For Chronic Heart Failure: CHF-CePPORT (Group Grant, R Nolan, PI)


Canadian Institutes of Health Research

Mechanisms of Exercise Induced Atrial Fibrillation
(Co-Investigator with P Backx, Principal Investigator)


Ontario Centre of Excellence, Technical Problem Solving
(TPS) Grant.

The Development and Validation of a Health Incentive Program Questionnaire (HIP-Q).



Leanna Lee (MSc)
Exercise with a Twist: left ventricular torsion and recoil in young, middle-aged and endurance-trained men
2012 Robert Lakin (MSc) Autonomic and vascular effects of interval training
Sam Esfaniari (MSc)
Left ventricular adaptations after high-intensity vs. continuous aerobic training
Emma O'Donnell (PhD)
Women and cardiovascular function: role of estrogen in vascular health in menopausal women
2013 Talylor Gray (MSc) Pulmonary vascular mechanics in long-standing male endurance athletes at rest and during exercise
2010 Marc Mitchell (PhD) Financial incentives in cardiac rehabilitation Co-supervising: G. Faulkner, Faculty of Kinesiology & Physical Education
Robert Lakin (PhD)
Mechanisms of cardiac fatigue  
Sam Esfandiari (PhD)
Pulmonary and heart interactions during exercise Co-supervising: S. Mak, Institute of Medical Sciences
2014 Steve Wright (PhD) Cardiac and pulmonary function during exercise with left ventricular assist device Co-Supervising: S. Mak, Institute of Medical Sciences
2013 Laura Banks, PhD Proarrhythmic substrates of exercise and cardiac remodeling  
2010-2011 Nadir Elmayan, MD, Cardiology Fellow (Zion Sasson, MD, Clinical Supervisor) Reliability of dobutamine stress echocardiography


O’Donnell E, Goodman J, Mak S, Harvey P. Impaired Vascular Function in Physically Active Premenopausal Women with Functional Hypothalamic Amenorrhea is Associated with Low Shear Stress and Increased Vascular Tone. J Clinical Endocrinology and Metabolism. In Press, 2014
Marzolini S, Goodman J, Oh P. Quality of Life and Psychosocial Measures Influenced by Exercise Modality in Patients with Coronary Artery Disease. European Journal of Physical and Rehabilitation Medicine. In Press, 2014.
Esfandiari S*, Sasson Z, Goodman J. Short-term high-intensity interval and continuous moderate-intensity training improve maximal aerobic power and diastolic filling during exercise. European Journal of Applied Physiology. 114(2):331-43. 2014.1
Nolan RP, Payne AYM, Ross H, White M, D'Antono B, Chan S, Barr SI, Gwadry-Sridhar F, Nigam A, Perreault S, Farkouh M, McDonald M, Goodman J, Thomas S, Zieroth S, Issac D, Oh P, Rajad M, Chen M, Liu S, Zbib A. An Internet-Based Counseling Intervention with Email Reminders that Promotes Self-Care in Adults with Chronic Heart Failure: CHF-CePPORT Randomized Controlled Trial Protocol. In Press: JMIR Res Protoc 0000;##(##):e##URL:http://www.researchprotocols.org/0000/0/e0/doi:10.2196/resprot.2957PMID:
Mitchell MS*1, Goodman, JM, Alter, DA, Oh, PI, John, LK, Pakosh, MT & GEJ Faulkner. Financial incentives for exercise adherence in adults: Systematic review and meta-analysis. American Journal of Preventive Medicine. Nov;45(5):658-67, 2013.
Nolan R, Liu S, Feldman R, Dawes M, Barr S, Lynn H, Gwardy-Sridhar F, Thomas SG, Goodman JM, Oh P, Kaczorowski J, Chessex C, Hachinski V, Shoemaker K. Reducing risk with e-based support for adherence to lifestyle change in hypertension (REACH): Protocol for a multi-centered randomized controlled trial. BMJ Open. Aug 21;3(8):e003547. 2013.
Lakin R*, Notarius C, Thomas S, Goodman J. Effects of moderate-intensity aerobic cycling and swim exercise on post-exertional blood pressure in healthy, young untrained and triathlon-trained men and women. Clin Sci (Lond). Dec;125(12):543-53. 2013
Elmayergi N, Goodman JM, Lee LS*, Sasson Z. Reliability and Repeatability of Left Ventricular Systolic Performance Measures During Dobutamine Stress Echocardiograms. Eur J Preventative Cardiology Int J Cardiovasc Imaging. Aug;29(6):1281-6. 2013
Goodman J, Thomas S, Burr J. Cardiovascular Risks of Physical Activity in Apparently Healthy Individuals: Risk Evaluation for Exercise Clearance and Prescription. Can Fam Phys. Jan;59(1):46-9. 2013.
Caileigh M. Pilmer B.Sc., Bonita Porter MD, Joel A. Kirsh MD, Audrey L. Hicks Ph.D., Norman Gledhill Ph.D., Veronica Jamnik Ph.D., Brent E. Faught Ph.D., Doris Hildebrandt B.A., Neil McCartney Ph.D., Robert M Gow MBBS,Goodman JM., Andrew D. Krahn MD. Scope and Nature of Sudden Cardiac Death before age 40 in Ontario: A Report from the Cardiac Death Advisory Committee of the Office of the Chief Coroner. Heart Rhythm. Apr;10(4):517-23. 2013
Mitchell M*, Manson M, Allison K, Robertson J, Donnelly P, Goodman J. Leveraging Legacies: Will the Toronto 2015 Pan Am Games Really Benefit Public Health? University of Toronto Medical Journal, 90:2; December 2012.
Lee LS*, Mariani JA, Sasson Z, Goodman JM. Exercise with a twist: Left ventricular twist and recoil in healthy young and middle-aged men, and middle-aged endurance-trained men. J Am Soc Echocardiogr. Sep;25(9):986-93. doi: 10.1016/j.echo.2012.05.018, 2012.
Liu S*, Thomas SG, Sasson Z, Banks L, Busato M, Goodman JM. Blood pressure reduction following prolonged exercise in young and middle-aged endurance athletes. Eur J Prev Cardiol. Dec;20(6):956-62. 2013.


Liu S*, Goodman J, Nolan R, Lacombe S, Thomas S. Blood pressure responses to acute and chronic exercise are related in prehypertensives. Med Sci Sports Exerc. 2012, 1644-52. Mar 26. 2012.
Burr J, Goodman J, Thomas S, Jamnik R, Gledhill N. Addressing the Cardiometabolic Risk of Working in Physically Demanding Occupations . Current Cardiovascular Risk Reports, 4: 347-354, 2012.
O’Donnell E*, Goodman J Harvey P. Cardiovascular Consequences of Ovarian Disruption: A Focus on Functional Hypothalamic Amenorrhea in Exercising Women, J Clin Endo Metab. 6(12):3638-48, 2011.
Lacombe SP*, Goodman, JM, Spragg ,CM,, Liu, S, Thomas SG. Interval and Continuous Exercise Elicit Equivalent Post-Exercise Hypotension Despite Differences in Baroreflex Sensitivity and Heart Rate Variability. Appl Physiol Nut and Met. 36(6):881-91, 2011.
Banks L*, Sasson Z, Esfandiari S*, Busato M*, Goodman JM. Cardiac function following prolonged exercise: influence of age. J Appl Physiol. J Appl Physiol, 110:1541-8, 2011.
Goodman JM, Burr J, Thomas S. Evidence-based risk assessment and recommendations for exercise testing and physical activity clearance: Apparently Healthy Individuals. Applied Physiology, Nutrition, and Metabolism, 36:(S1): S14-S32, 2011.
Thomas S, Goodman JM, Burr J. Evidence-based risk assessment and recommendations for exercise testing and physical activity clearance: Individuals with cardiovascular disease. Applied Physiology, Nutrition, and Metabolism, 36:(S1) S190-S213, 2011.
Warburton DER, Jamnik VK, Bredin, SDB, Burr J, Charlesworth S, Chilibeck P, Eves N, Heather F, Goodman JM, Jones L, McKenzie DC, Rhodes R, Riddell M, Shephard RJ, Stone J, Thomas S, Zehr PE, Gledhill N. Executive Summary: The 2011 Physical Activity Readiness Questionnaire (PAR-Q+) and the Electronic Physical Activity Readiness Medical Examination (ePARmed-X+). The Health & Fitness Journal of Canada, Vol 4, No 2. 2011.
Banks, L*, Sasson Z, Busato M*, Goodman, JM. Impaired left and right-ventricular function following prolonged exercise in young athletes: Influence of exercise intensity and responses to dobutamine stress. J Appl Physiol.108(1):112-9, 2010.
Goodman JM, Marzolini S*. Are multiple sets and usual aerobic training recommended for treatment of CHD, Letter, Med Sci Sports Exerc. 41:733, 2010.
Goodman JM, Busato GM*, Frey E*, and Sasson Z. Left ventricular contractile function is preserved during prolonged exercise in middle-aged men. J Appl Physiol 106: 494-499, 2009.
O'Donnell E*, Kirwan LD*, and Goodman JM. Aerobic exercise training in healthy postmenopausal women: effects of hormone therapy. Menopause 16:430-439: 2009.
Goodman JM, Marzolini S*. Are multiple sets and usual aerobic training recommended for treatment of CHD, Response, Med Sci Sports Exerc. 41:733, 2009.

Athletic Heart and Exercise Study

Our laboratory’s research examines how exercise affects heart function. This includes the heart’s adaptive responses to various types of exercise and how it’s affected after long-term training. We know that moderate exercise can improve heart function, reduce cardiovascular risk, and extend lifespan. Long-term intensive and prolonged exercise training leads to heart ‘remodeling’, called the Athletic Heart Syndrome. This generally produces a stronger, larger and efficient pump and is considered beneficial. However, a growing body of evidence suggests that some individuals who have been engaged in intensive endurance exercise for many years may be prone to heart rhythm problems, some of which may appear in young athletes, but more commonly arise in middle age. This particular study aims to find how high levels of exercise training over many years relate to changes in heart structure, function, and rhythm. It will also help us develop much more understanding about potential risk factors for the development of arrhythmias. Adults with a history of high-volume training (what some describe as ‘excessive’ exercise) over a long time period, will be compared to adults who have maintained light-to-moderate exercise history over a similar time-frame.

Study featured on CBC

- 45-65 years old (males and females included)
- Physically active for at least the past 10-20 years, falling into one of the following groups :

  • Endurace-trained (distance cyclists, runners, triathletes) OR
  • Recreationally-active (not more than 2.5 hours of activity per week)
  • Either group, no history of cardiovascular disease

(those with a diagnosis of atrial fibrillation or atrial flutter should call us (416-978-0762) as you may qualify to enter a different, but similar study).

University of Toronto and affiliated hospitals (St. Mikes and Mt. Sinai)

  • Advanced resting and exercise heart rhythm assessments
  • Lifestyle and medical history questionnaires and standard blood draw
  • Heart imaging via Echocardiography and Magnetic Resonance Imaging (for some)
  • Able to attend up to 4 week-day visits (lasting up to 90 minutes each)
  • VO2max test

If you are interested, please review our study consent form.

If you think you may be eligible, please complete the Pre-Screening Form online. This will help our study team to determine if you are eligible to participate in our study.

Thank you for reviewing our consent form and completing the pre-screening form. Our study team will be in contact with you shortly to confirm your eligibility.

Please complete the following questionnaires once your eligibility has been confirmed and you have completed Study Visit #1 at St. Michael’s Hospital:

STEP 1: Please complete the forms in the order as listed below.

Physical Activity Readiness Questionnaire (PAR-Q)

STEP 2: Please complete the following questionnaire.

Lifetime Total Physical Activity Questionnaire (LTPAQ)


KPE Faculty

  • Professor Emeritus, Cardiac Health & Exercise