Echocardiographic changes in the development of the athlete' s heart in 9 to 20-year-old male subjects

The purpose of this cross-sectional investigation was to estimate the age at which specific traits of the "athlete's heart" first appear and how they evolve from the beginning of regular physical training until young adulthood in healthy active males. Male athletes (n=389) and non-athletes (n=55) aged between 9 and 20 years were examined by two-dimensionally guided M-mode and Doppler echocardiography. Intragroup differences were examined by t-tests for independent samples between age groups of two years each. Morphologic variables were related to body size by using ratio indices in which the power terms of numerator and denominator were matched. Relative left ventricular muscle mass (LVMM) was significantly larger in the athletic males at age of 11-12, and this significant difference was maintained with advancing age. Most of this increase of LVMM could be attributed to the increase in wall thickness that became significantly manifest first in the 13- to 14-year-old athletic subjects but was demonstrable in all the other groups. A significantly larger left ventricular internal diameter was only found in the age-group of 15-16. Fractional shortening percentage (FS%) did not show any change, while resting heart rate was decreased in our athletic groups.     

Echocardiographic characteristics in adolescent junior male athletes of different sport events

The purpose of this study was to examine the effects of different sport activities on cardiac adaptation. Echocardiographic data of 137 athletes and 21 non-athletes were measured and compared in two age groups 15-16 and 17-18 years of age. Athletes belonged into three groups according to their sports activity (endurance events, power athletes, ball game players). The observed variables were related to body size by indices in which the exponents of the numerator and the denominator were matched. Left ventricular hypertrophy was manifest in all athletic groups. Power athletes had the largest mean left ventricular wall thickness (LVWTd) in both age groups. In the older age group differences between the athletic groups were smaller, but the endurance and power athletes had significantly higher wall thickness. Left ventricular internal diameter (LVIDd) was the largest in the endurance athletes, while mean relative muscle mass (LVMM) was the largest in the power athletes. LVMM of the older endurance athletes was significantly larger. Muscular quotient (MQ) was the highest in the endurance athletes; in the 17-18-year group there was no inter-event difference. Bradycardia was most manifest in the endurance athletes and ball game players, power athletes had higher resting heart rates than non-athletic subjects. It can be inferred that endurance training induces firstly an enlargement of the left ventricle what is then followed by an increase of muscle mass. In the studied functional and regulatory parameters no difference was found between the athletic and non-athletic groups.     

Cardiac remodelling: concentric versus eccentric hypertrophy in strength and endurance athletes

Cardiac remodelling is commonly defined as a physiological or pathological state that may occur after conditions such as myocardial infarction, pressure overload, idiopathic dilated cardiomyopathy or volume overload. When training excessively, the heart develops several myocardial adaptations causing a physiological state of cardiac remodelling. These morphological changes depend on the kind of training and are clinically characterised by modifications in cardiac size and shape due to increased load. Several studies have investigated morphological differences in the athlete’s heart between athletes performing strength training and athletes performing endurance training. Endurance training is associated with an increased cardiac output and volume load on the left and right ventricles, causing the endurance-trained heart to generate a mild to moderate dilatation of the left ventricle combined with a mild to moderate increase in left ventricular wall thickness. Strength training is characterised by an elevation of both systolic and diastolic blood pressure. This pressure overload causes an increase in left ventricular wall thickness. This may or may not be accompanied by a slight raise in the left ventricular volume. However, the development of an endurancetrained heart and a strength-trained heart should not be considered an absolute concept. Both forms of training cause specific morphological changes in the heart, dependent on the type of sport. (Neth Heart J 2008;16:129-33.)     

Isokinetic knee joint evaluation in track and field events

The purpose of this study was to evaluate maximal torque of the knee flexors and extensors, flexor/extensor ratios, and maximal torque differences between the 2 lower extremities in young track and field athletes. Forty male track and field athletes 13-17 years old and 20 male nonathletes of the same age participated in the study. Athletes were divided into 4 groups according to their age and event (12 runners and 10 jumpers 13-15 years old, 12 runners and 6 jumpers 16-17 years old) and nonathletes into 2 groups of the same age. Maximal torque evaluation of knee flexors and extensors was performed on an isokinetic dynamometer at 60°·s(-1). At the age of 16-17 years, jumpers exhibited higher strength values at extension than did runners and nonathletes, whereas at the age of 13-15 years, no significant differences were found between events. Younger athletes were weaker than older athletes at flexion. Runners and jumpers were stronger than nonathletes in all relative peak torque parameters. Nonathletes exhibited a higher flexor/extensor ratio compared with runners and jumpers. Strength imbalance in athletes was found between the 2 lower extremities in knee flexors and extensors and also at flexor/extensor ratio of the same extremity. Young track and field athletes exhibit strength imbalances that could reduce their athletic performance, and specific strength training for the weak extremity may be needed.     

Aerobic power as a factor in women's response to work in hot environments.

Twelve young women, athletes (n = 6) and nonathletes (n = 6), walked on a treadmill at loads equivalent to approximately 30% Vo2 max for two 50-min periods in three environments: 1) 28 degrees C, 45% rh, 2) 35 degrees C, 65% rh, and 3) 48 degrees C, 10% rh. There were no differences between groups in rectal temperature, heart rate, evaporative heat loss, or mean skin temperature at 28 or 35 degrees C or during the first work period in the 48 degrees C environment. However, a significantly lower cardiac output (Q) and stroke volume (SV) observed for nonathletes by the 46th min of work at 48 degrees C may explain why no nonathletes were able to complete a 2nd h of work while four of six athletes successfully finished the period. It appears that in conditions of severe heat stress (48 degrees C) athletes were able to maintain a cardiac output sufficient to meet the metabolic requirements and the large increase in peripheral blood flow for a longer period of time than nonathletes.     

Doppler echocardiographic examinations in the assessment of the athletic heart

Doppler echocardiography is a method with the help of which flow velocity and the duration of different intervals can be estimated. The ratio between early and late peak velocities (E/A) is linearly proportional to diastolic function, i.e. to ventricular compliance. Data of 179 athletes and of 42 nontrained young healthy men indicated that the E/A quotient was higher in athletes than in the sedentary controls (2.086 +/- 0.505 vs. 1.905 +/- 0.384) in young adult age, but of the different athletes it was the only group of endurance athletes that showed a significant increase. Regular physical training seems to protect against an age-dependent impairment of left ventricular compliance, as an increased E/A ratio can be observed at the age of 31-45 years (1.77 +/- 0.46 vs. 1.43 +/- 0.276) as well as in men above 45 years of age (1.61 +/- 0.36 vs. 1.24 +/- 0.36). Bradycardia of the athletic heart resulted in a significantly longer duration of the cardiac cycle in athletes than in non-athletes. Different phases of the cardiac cycle, however, were not equally modified. There were periods the absolute duration of which were slightly decreased, unchanged or slightly increased, but the relative ones are strongly decreased: such as isovolumetric contraction time (ICT), acceleration of the transaortic flow (AOAT), deceleration of the transaortic flow (AODT), acceleration period of the early diastolic filling (EACC), and deceleration period of the early diastolic filling (EDT). There were periods the absolute duration of which increased proportionally to the increase of the whole cardiac cycle, while relative duration was not changed: isovolumetric contraction time (IVRT) and the atrial systole (A). There was one period that showed the greatest variability in the different subjects and both its absolute and relative duration was definitely increased in the athletes: this was the EA period, i.e. the period from the end of early filling to the beginning of the atrial systole.     

Optimum onset period for training based on maximum peak velocity of height by wavelet interpolation method in Japanese high school athletes

The Wavelet Interpolation Method (WIM) was applied to the longitudinal records of individuals' heights and weights from 6 to 17 years of age (1983 to 1994) in an athlete group (male: 45, female: 50) and a control group (male: 85, female: 85). The criterion of maturity was derived from age at Maximum Peak Velocity (MPV) of height in the control group. Ages at MPV of height and weight were compared between the athletes and control subjects. The WIM was also applied to mean heights from 6.5 to 17.5 years of all the subjects classified by maturation rate in order to derive a model of growth velocity types.Among the athletes, the males were early-maturing and the females tended to be late-maturing. The difference between the ages at MPV of height and weight in males and females was less in the athletes group than in the control group. For the growth velocity model, in the athlete group, three types could be confirmed among the males, and five among the females. By making use of the type models, it was possible to clarify the spans of adolescence as classified by maturation rates, and it was concluded that the period following the age at MPV seems appropriate for the introduction of regular athletic training for each level of maturity.     

Higher ghrelin and lower leptin secretion are associated with lower LH secretion in young amenorrheic athletes compared with eumenorrheic athletes and controls

Amenorrhea is common in young athletes and is associated with low fat mass. However, hormonal factors that link decreased fat mass with altered gonadotropin pulsatility and amenorrhea are unclear. Low levels of leptin (an adipokine) and increased ghrelin (an orexigenic hormone that increases as fat mass decreases) impact gonadotropin pulsatility. Studies have not examined luteinizing hormone (LH) secretory dynamics in relation to leptin or ghrelin secretory dynamics in adolescent and young adult athletes. We hypothesized that 1) young amenorrheic athletes (AA) would have lower LH and leptin and higher ghrelin secretion than eumenorrheic athletes (EA) and nonathletes and 2) higher ghrelin and lower leptin would be associated with lower LH secretion. This was a cross-sectional study. We examined ghrelin and leptin secretory patterns (over 8 h, from 11 PM to 7 AM) in relation to LH secretory patterns in AA, EA, and nonathletes aged 14-21 yr. Ghrelin and leptin were assessed every 20 min and LH every 10 min. Groups did not differ for age, bone age, or BMI. However, fat mass was lower in AA than in EA and nonathletes. AA had lower LH and higher ghrelin pulsatile secretion and AUC than nonathletes and lower leptin pulsatile secretion and AUC than EA and nonathletes. Percent body fat was associated positively with LH and leptin secretion and inversely with ghrelin. In a regression model, ghrelin and leptin secretory parameters were associated independently with LH secretory parameters. We conclude that higher ghrelin and lower leptin secretion in AA related to lower fat mass may contribute to altered LH pulsatility and amenorrhea.     

Athletic Heart Remodeling in Athletes with Arterial Hypertension

Although the prevalence of arterial hypertension (AH) in athletes is significantly lower than that in the general population, the prevalence of high blood pressure (BP) and increased left ventricular mass in a number of sports with high isometric loads (speed and strength sports) is higher than that in cyclic sports with high aerobic load. Specific risk factors of hypertension in athletes include high intake of sodium, alcohol, caffeine, and a number of illicit drugs, such as erythropoietin, growth hormone, and oral contraceptives in women. The development of athletic heart is determined by training and competitive activity and generally does not lead to the disorders of systolic and diastolic function. However, elevated BP in athletes increases the risk of myocardial hypertrophy and remodeling, which is one of the possible contraindications for sports with high static loads.     

Effect of Specialization in Sports on the Structural and Functional States of the Left Ventricle of the Heart in Schoolchildren of Different Biological Age

The structural and functional states of the left ventricle of the heart were studied by echocardiography in schoolchildren of three age groups. The first group included 10- to 13-year-old boys without features of sexual maturation. The second group included 13- to 15-year-old adolescents during puberty. The third group included 16- to 18-year-old adolescents with developed secondary sexual characteristics. The children were trained in sports: middle-distance running, swimming, and wrestling. It was found that the posterior wall of the ventricular myocardium in young athletes of all age groups and any specialization in sports was thicker than in untrained children of the same age. Similarly, the trained children were characterized by larger anteroposterior size of the ventricular cavity, larger cavity volume and total volume, greater myocardium mass (both absolute and calculated per kg body weight), more substantial ventricular stroke volume, lower heart rate, lesser ejection fraction, and smaller degree of shortening of the anteroposterior size of the ventricular cavity during systole as compared to untrained children of the same age. The difference between trained and untrained schoolchildren increased with increasing age, duration of the period of training in sports, and level of training in sports (athletic qualification). The training-induced changes in the structural and functional parameters of the left ventricle of the heart in middle-distance runners were larger than in schoolchildren trained in swimming and, particularly, in wrestling.     

Cardiovascular adaptations to exercise training in the elderly

Maximal O2 uptake (VO2max) and left ventricular function decrease with age. Endurance exercise training of sufficient intensity, frequency, and duration increases VO2max in the elderly. The mechanisms underlying the increased VO2max in the elderly are enhanced O2 extraction of trained muscle during maximal exercise leading to a wider arteriovenous O2 difference, and higher cardiac output in the trained state. However, increased cardiac output during true maximal exercise has not been documented in elderly subjects. Endurance exercise training results in a lower heart rate and rate pressure product during submaximal exercise at a given intensity. However, no improvement in left ventricular function has been reported in the elderly after exercise training. Highly trained master athletes exhibit proportional increases in the left ventricular end-diastolic dimension and wall thickness suggestive of volume-overload hypertrophy compared with age-matched sedentary controls. The magnitude of left ventricular enlargement is similar to that in young athletes. The failure of exercise training to alter the age-related deterioration of left ventricular function in the elderly may reflect an insufficient training stimulus rather than the inability of the heart to adapt to training in elderly subjects.     

The third heart sound after exercise in athletes: an exploratory study

The purpose of our study was to investigate the frequency of the third heart sound (S3) of athletes after exercise, and to determine whether the frequency and amplitude of S3 were related to cardiac function. The phonocardiogram exercise test (PCGET) was used in this study, and healthy volunteers consisting of 84 athletes (age 21.0±1.7 years; 62 males and 22 females) and 45 non-athletes (age 24.1±2.0 years; 33 males and 12 females) were enrolled. All subjects were healthy except one with a cardiac murmur without known cause. Immediately after exercise, S3 occurred in 21 athletes (25.0%) and 10 non-athletes (22.2%) during PCGET. There were very significant differences between pre-exercise and post-exercise in the frequency of S3 (P<0.01), and no significant difference between athletes and nonathletes (P>0.05). The prevalence of S3/S2≥1 was significantly (P<0.05) higher for the athlete group (47.1%) as compared to the non-athlete group (10%). Those results indicated that the emergence of S3 was an indicator of heart burden, and S3 after exercise in the athlete group was physiological. Our study showed that the amplitude of S3 had a very sensitive response to cardiac function reduction and S3/S2≥1 could eventually be used to assess cardiac fatigue states.     

Left ventricular size and systolic function in Thoroughbred racehorses and their relationships to race performance.

Cardiac morphology in human athletes is known to differ, depending on the sports-specific endurance component of their events, whereas anecdotes abound about superlative athletes with large hearts. As the heart determines stroke volume and maximum O(2) uptake in mammals, we undertook a study to test the hypothesis that the morphology of the equine heart would differ between trained horses, depending on race type, and that left ventricular size would be greatest in elite performers. Echocardiography was performed in 482 race-fit Thoroughbreds engaged in either flat (1,000-2,500 m) or jump racing (3,200-6,400 m). Body weight and sex-adjusted measures of left ventricular size were largest in horses engaged in jump racing over fixed fences, compared with horses running shorter distances on the flat (range 8-16%). The observed differences in cardiac morphologies suggest that subtle differences in training and competition result in cardiac adaptations that are appropriate to the endurance component of the horses' event. Derived left ventricular mass was strongly associated with published rating (quality) in horses racing over longer distances in jump races (P < or = 0.001), but less so for horses in flat races. Rather, left ventricular ejection fraction and left ventricular mass combined were positively associated with race rating in older flat racehorses running over sprint (<1,408 m) and longer distances (>1,408 m), explaining 25-35% of overall variation in performance, as well as being closely associated with performance in longer races over jumps (23%). These data provide the first direct evidence that cardiac size influences athletic performance in a group of mammalian running athletes.     

Relationships between physical activity and musculoskeletal disorders in former athletes

The purpose of the study was to determine the prevalence and risks for musculoskeletal disorders (MSD) in relation to previous athletic status and current physical activity level in former athletes. Main anthropometric data, sports history, current physical activity and MSD were estimated using a questionnaire in 219 (148 males, 71 females) former athletes (35-75 years old) and 79 controls (33 males, 46 females). According to the previous participation in top-level sports, former athletes were divided into three groups: (a) endurance, n=120 (76 males, 44 females); (b) speed-power, n=57 (43 males, 14 females); (c) team sports, n=42 (29 males, 13 females). The most prevalent MSD among the male and female ex-athletes were back and knee pain. The endurance ex-athletes group (both males and females) had significantly higher risk for the knee problems than the control group (Odds ratio--OR 5.9, 95% CI 1.7-20.00, p < 0.05). Team sports athletes (males and females) showed significantly higher risk for Achilles' tendon injuries (OR 3.19 95% CI 1.19-8.5, p < 0.05) as compared to controls. Back pain did not show any significant associations with previous physical activity and current physical activity level. Current physical activity was significantly associated with a lower risk for the knee and hip pain. Body mass index was positively associated with knee problems. In conclusion, our study results revealed that previous participation in enduranve sports events is associated with a significantly higher risk for knee problems. At the same time current regular physical exercise 6-11 times per month is associated with a lower prevalence of knee and hip problems as compared to those who exercised less than 6 times per month.     

Effect of ectopic excitation on the ventricular pump function in chicken

The pump function of the heart ventricles was studied in chest-open anaesthetized adult female chickens under sinus rhythm and ectopic excitation of different localization. The intraventricular pressure in the right and left heart ventricles was measured by insertion of catheters through the ventricular free walls. Maximum systolic pressure, end-diastolic pressure, contractility (dP/dtmax) and relaxation (dP/dtmin) of both heart ventricles, and duration of the asynchronous contraction time of the left ventricle were analyzed. It was revealed that reduction of the pump function of the left ventricle tends to be greater under right ventricular ectopic excitation compared with left ventricular one. In comparison with the sinus rhythm, the pump function of the right ventricle was preserved to a greater extent under stimulation of the left ventricular apex and was significantly impaired under right ventricular ectopic excitation. Relaxation of both heart ventricles was more susceptible to ventricular ectopic excitation than contractility, and was more vulnerable in the right ventricle than in the left one. The direction of changes of the pump function of the heart ventricles in chickens under ventricular ectopic excitation was similar to changes of the pump function of mammalian hearts.     

A hemodynamic comparison of young and older endurance athletes during exercise

This study assessed the hemodynamic responses to exercise of master athletes (56 +/- 5 yr of age) who placed in the top 10% of their age groups in local 10-km competitive events, competitive young runners (26 +/- 3 yr), young runners matched in training and performance to the master athletes (25 +/- 3 yr), and healthy older sedentary subjects (58 +/- 5 yr). The maximal O2 consumption (VO2max) of the master athletes was 9 and 19% lower than that of the matched young and competitive young runners, respectively. When compared at the same relative submaximal work rates, these three groups had similar stroke volumes and arteriovenous O2 (aVO2) differences, though the master athletes had lower VO2, cardiac output, and heart rate, and higher vascular resistance. The older sedentary group had a lower stroke volume, aVO2 difference, and higher vascular resistance than the master athletes. Maximal stroke volume and estimated aVO2 difference were the same in the three groups of athletes; the lower maximal heart rate of the master athletes appears to account for their lower VO2max. The older sedentary subjects' VO2max was 47% lower than that of the master athletes; this difference was almost equally the result of a lower stroke volume and a lower a-VO2 difference. Thus these older athletes did not exhibit the decline in maximum stroke volume and aVO2 difference that occurs with aging in sedentary individuals; they also appear to have retained a greater peripheral vasodilatory response than their sedentary peers.     

Morphological and functional differences in cardiac parameters between power and endurance athletes: a magnetic resonance imaging study

The present study compared morphological and functional parameters of the left ventricle by magnetic resonance imaging (MRI) in competitive athletes engaged in endurance and power activities and sedentary control subjects. Twenty male subjects, 7 endurance-trained athletes (ETA) (age 23.8+/-3.5 yr), 7 strength-trained athletes (STA) (age 22.8+/-4.0 yr), and 6 sedentary controls (age 24.1+/-2.2 yr) were studied by MRI. In the ETA group body size related left ventricular mass (rel.LVM) was significantly higher than that in the STA group (71.0+/-9.2 vs 57.4+/-15.7 g/m3). The difference between their size related left ventricular wall thickness (rel.LVWT) values (9.37+/-1.0 vs 8.37+/-1.8 mm/m) was near to the level of significance (p=0.057). Relative left ventricular internal diameter (rel.LVID) was significantly higher in the ETA group compared to the STA group (42.3+/-1.0 vs 40.1+/-2.5 mm/m, p<0.05). The muscular quotient (MQ=LVWT/LVID) of the ETA group was not significantly higher compared to the strength athletes. Relative left ventricular end-diastolic volume (LVEDV) was also higher in the ETA group than in the STA group (69.5+/-6.7 vs 59.9+/-8.2 ml/m3, p<0.05) and the controls (53.6+/-3.7, p<0.001). Significantly higher relative stroke volume (SV) was measured in the ETA group compared to the STA group and the controls (41.0+/-5.7; 32.6+/-6.9; 32.0+/-3.2 ml/m3). According to the present data, the strongest impact on LV cavity size and wall thickness is caused by long-term high intensity endurance training. Intense strength training does not necessarily induce wall thickening.     

Modeling human performance in running

This paper focuses on the characteristics of a model interpreting the effect of training on athletic performance. The model theory is presented both mathematically and graphically. In the model, a systematically quantified impulse of training produces dual responses: fitness and fatigue. In the absence of training, both decay exponentially with time. With repetitive training, these responses satisfy individual recurrence equations. Fitness and fatigue are combined in a simple linear difference equation to predict performance levels appropriate to the intensity of training being undertaken. Significant observed correlation of model-predicted performance with a measure of actual performance during both training and tapering provides validation of the model for athletes and nonathletes alike. This enables specific model parameters to be estimated and can be used to optimize future training regimens for any individual.     

Myopericarditis and sudden cardiac death due to physical exercise in male athletes

In the period 1998-, we registered four sudden and unexpected cardiac deaths in male athletes due to myopericarditis during or after physical exercise. Three of them were professional soccer players and the fourth was engaged in swimming. One aged 29, had symptoms of tiredness, heart enlargement and left ventricular premature beats during training. Three of them, aged 17-18-18, were without symptoms. Three died during training and the fourth died in the hospital after head trauma at training. In the first one, aged 29, forensic autopsy showed chronic myopericarditis, thickening of the left ventricular wall of 15 mm and enlargement of the whole heart. The second one, aged 17, had subacute diffuse myopericarditis, suppurative tonsillitis and narrowed ascending aorta. The third, aged 18, had chronic myopericarditis and cardiac aneurysm of the left ventricle. The fourth, aged 18, had fibrinous pericarditis, thickening of the left ventricle 20 mm, hypoplastic ascending aorta, bilateral bronchopneumonia and cerebral contusion with edema. In Croatia, death rate among athletes, including all its causes, reached 0.15/100,000, in athletes suffering from myopericarditis it was 0.34/100,000, in others who practice exercise recreatively it amounted to 0.57/100,000 (p=0.0068), and in all males who practice exercise it measured 0.75/100,000 (p=0.0014). Physical exercise has to be contraindicated in cases of myopericarditis for at least six months from the onset of the illness.     

Sex differences in the cross-sectional areas of psoas major and thigh muscles in high school track and field athletes and nonathletes

The present study aimed to examine the sex differences in the cross-sectional areas of the psoas major, quadriceps femoris, hamstrings, and adductors in high school track and field athletes and nonathletes. The cross-sectional areas of the psoas major at L4-L5 and three thigh muscles at the mid-thigh were determined in the right side of the body using magnetic resonance imaging in 61 sprinters (29 boys and 32 girls), 50 jumpers (28 boys and 22 girls), 33 throwers (18 boys and 15 girls), and 40 nonathletes (20 boys and 20 girls), aged from 16 to 18 yrs. On the whole, the cross-sectional area for every muscle group was greater in the athletes than in the nonathletes and in the boys than in the girls. The average value of the cross-sectional area for the girls as a percentage of that for the boys in every subject group was lower in the psoas major (57.6-64.7%) than in the thigh muscles (67.8-82.9%). Among the thigh muscles, the muscle group which showed significant sex differences in the ratio of cross-sectional area to the two-third power of lean body mass was limited to the quadriceps femoris in the sprinters and nonathletes and hamstrings in the throwers. However, the ratio for the psoas major was significantly higher in the boys than in the girls in all subject groups. The current results indicate that, although regular participation in sports training during adolescence promotes hypertrophy in the psoas major and thigh muscles in not only boys but also girls, a greater sex difference exists in the muscularity of the psoas major than of the thigh muscles, in athletes and nonathletes.