Sports Medicine

, Volume 4, Issue 4, pp 245–267 | Cite as

Effect of Exercise on Serum Enzyme Activities in Humans

  • Timothy D. Noakes
Review Article


Increased serum enzyme activity after exercise was first reported in 1958; subsequent studies have established that many factors determine the degree to which the serum activities of a variety of enzymes increase during and after exercise.

The serum activities of those enzymes found especially in muscle, particularly creatine kinase, increase in proportion to the intensity and duration of the preceding exercise, peaking 24 hours after exercise; the effect of duration is dominant, so that the highest postexercise serum enzyme activities are found after very prolonged competitive exercise such as ultradistance marathon running or triathlon events. Weight-bearing exercises which include eccentric muscular contractions such as bench stepping and downhill running induce the greatest increases in serum enzyme activities; serum enzyme activities increase very little even after prolonged participation in those non-weight-bearing activities such as swimming and cycling which do not include eccentric muscular contractions. Prolonged (>2 hours) daily training or competition in weight-bearing activities produces chronically elevated serum enzyme activities. Serum enzyme activities increase more with exercise in males, Blacks and the untrained than th ey do in females, Whites and the trained, respectively; age does not appear to influence the degree to which serum enzyme activities increase with exercise. There is a remarkable individual variability in the degree to which serum enzyme activities increase with exercise; a 50-fold difference in post-race serum creatine kinase activities has been found in healthy and equally trained athletes completing the same 90km ultra-marathon footrace. The biochemical explanation for this degree of individual variability is not currently understood; possibly persons who show abnormally large increases in serum enzyme activities with exercise may have as yet unrecognised subclinical myopathies. No circadian rhythms have been identified for serum enzyme activities; activities rise during the day because of increased physical activity. The rise in serum enzyme activities is greater after exercise at altitude or in the heat than after equivalent exercise at sea level or in the cold.

The most likely explanation for the increased serum enzyme activities that follow prolonged weight-bearing activities that also cause marked muscle soreness, is myofibrillar damage in particular sarcomeric Z-disk disruption. Alternate postulates such as sarcolemmal damage due to muscle glycogen depletion or lipid peroxidation seem less likely as they fail to explain the very different responses of serum enzyme activities to equivalent running or cycling exercise, both of which induce the same degree of muscle glycogen depletion and free radical production. The rise in serum enzyme activities that occurs, particularly after prolonged exercise such as marathon running, mimics exactly the changes that occur with acute myocardial infarction; thus the clinical interpretation of increased serum enzyme activities in persons who are physically active must be approached with extreme caution. The value of alternate diagnostic tests including the measurement of the serum content of the acute phase response protein s to distinguish the normal exercise response from that occurring during acute myocardial infarction, has yet to be determined. Serum creatine kinase activity measured both at rest and after exercise is useful in the diagnosis of Duchenne muscular dystrophy and, in particular, in the detection of the female carriers of this condition. There is, as yet, no proven value in the routine measurement of serum enzyme activities in athletes in training. In particular, serum enzyme activities cannot distinguish between appropriate training and overtraining. In addition, especially after very prolonged exercise such as ultra-marathon running, serum enzyme activities return to normal weeks or even months before normal running performance returns. Thus, complete recovery from prolonged exercise cannot be predicted on the basis of serum enzyme activities.

At present, the most interesting clinical application for the measurement of serum enzyme activities in the active and apparently healthy population might be the identification of subclinical myopathies, some of which may predispose to the development of acute renal failure or heatstroke during very prolonged exercise.


Creatine Kinase Apply Physiology Duchenne Muscular Dystrophy Serum Activity Serum Creatine Kinase 
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Copyright information

© ADIS Press Limited 1987

Authors and Affiliations

  • Timothy D. Noakes
    • 1
  1. 1.Sports Science Centre, Department of PhysiologyUniversity of Cape Town Medical SchoolCape TownSouth Africa

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