Sport Sciences for Health

, Volume 15, Issue 3, pp 585–593 | Cite as

Neutrophil-to-lymphocyte ratio and exercise intensity are associated with cardiac-troponin levels after prolonged cycling: the Indonesian North Coast and Tour de Borobudur 2017 Troponin Study

  • Mahalul AzamEmail author
  • Eka Setyaningsih
  • Sri Ratna Rahayu
  • Arulita Ika Fibriana
  • Budhi Setianto
  • Nyoman Suci Widyastiti
  • Suhartono Suhartono
  • Hardhono Susanto
  • Martha Irene Kartasurya
  • Udin Bahrudin
  • Thijs M. H. Eijsvogels
Original Article



The mechanism of cardiac-troponin elevation after exercise remains unclear. Studies have reported that leucocyte ratios are related to coronary artery disease. The present study explored the relationship between leucocyte ratios, exercise intensity, and post-exercise cardiac-troponin I (cTnI) levels.


Ninety-two participants in a long-distance cycling tour were included in this study. Baseline and post-exercise blood samples were collected to determine cTnI concentrations. Biochemical parameters and leucocyte ratios were measured at baseline. Exercise intensity was examined by recording the heart rate (HR). Exercise intensity was determined as the percentage of peak HR to maximal predicted HR. Based on clinical cutoff points of the cTnI assay, cTnI levels were defined as < 10 ng/mL and ≥ 10 ng/mL.


Eighty-eight participants completed the cycling tour after a median time of 7.3 h, at a median intensity of 81.8% of maximal HR. cTnI concentrations increased from 5.2 ± 9.83 ng/mL at baseline to 13.6 ± 36.12 ng/mL post-exercise, with 31.8% of the study population having cTnI ≥ 10 ng/mL. Neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio, recovery HR, mean and peak HR, and exercise intensity were associated with post-exercise cTnI levels in bivariate analysis. After adjustment for potential confounders, only NLR and exercise intensity were significantly related to post-exercise cTnI levels in the multivariable model.


NLR and exercise intensity are significantly associated with post-exercise cTnI levels, suggesting that inflammatory factors may play a role in the magnitude of exercise-induced cTnI release beyond exercise intensity.


Cardiac stress Lymphocyte Neutrophil Physical-exertion Troponin 



Coronary artery disease


Confidence interval


Cardiac-troponin I


Heart rate


Monocyte-to-lymphocyte ratio


North coast


North Sea Race Endurance Exercise study


Neutrophil-to-lymphocyte ratio


Odds ratio


Sudden cardiac death


Tour de Borobudur



The study was funded by the Directorate of Research and Public Service, Ministry of Research, Technology and Higher Education of the Republic of Indonesia (Grant number DIPA

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Ethical Committee of the Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital, Semarang, Indonesia; approval number 607/EC/FK-RSDK/X/2017) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Public Health, Sport Sciences FacultyUniversitas Negeri SemarangSemarangIndonesia
  2. 2.Department of Cardiology and Vascular Medicine, Faculty of MedicineUniversity of IndonesiaJakartaIndonesia
  3. 3.Department of Clinical Pathology, Faculty of MedicineDiponegoro UniversitySemarangIndonesia
  4. 4.Department of Environmental Health, Faculty of Public HealthDiponegoro UniversitySemarangIndonesia
  5. 5.Department of Anatomy, Faculty of MedicineDiponegoro UniversitySemarangIndonesia
  6. 6.Department of Public Health Nutrition, Faculty of Public HealthDiponegoro UniversitySemarangIndonesia
  7. 7.Department of Cardiology and Vascular Medicine, Faculty of MedicineDiponegoro UniversitySemarangIndonesia
  8. 8.Department of PhysiologyRadboud University Medical CenterNijmegenThe Netherlands

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