From the paper's discussion section
However, we cannot exclude
the possibility of a chance finding given the
low prevalence of metabolic risk factors in
the highest-activity trajectory group. Nonetheless,
further evidence examining the cardiac
benefits vs risk of prodigious amounts of exercise
to the level of excessive is warranted.
However, it may also be possible that higher
PA engagement confers atherosclerotic benefit
by promoting plaque stabilization and preventing
its rupture, leading to thrombosis.
Along these lines, recent studies in healthy,
middle-aged, highly active adults have reported
that higher doses of exercise were associated
with higher levels of CAC and that the
atherosclerotic plaques were, in fact, likely to
be more calcified plaques, suggesting that the
stable nature of coronary plaques in highly
active individuals may mitigate plaque
rupture.4