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Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, Siekierzycka A, Kalinowski L, Lewicka E, Dąbrowska-Kugacka A. Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. Am J Physiol Heart Circ Physiol 2024; 326:H1065-H1079. [PMID: 38391314 DOI: 10.1152/ajpheart.00756.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.
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Affiliation(s)
- Zofia Lasocka-Koriat
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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Yang WH, Park JH, Park SY, Park Y. Energetic Contributions Including Gender Differences and Metabolic Flexibility in the General Population and Athletes. Metabolites 2022; 12:metabo12100965. [PMID: 36295868 PMCID: PMC9612238 DOI: 10.3390/metabo12100965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/29/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022] Open
Abstract
Metabolic flexibility includes the ability to perform fat and carbohydrate oxidation, as well as oxidative capacity, which is associated with mitochondrial function, energetic contributions, and physical health and performance. During a session of graded incremental exercise testing (GIET), we investigated metabolic flexibility, the contributions of three energy systems, and performances of individuals with different metabolic characteristics. Fifteen general population (GP; n = 15, male n = 7, female n = 8) and 15 national-level half-marathon and triathlon athletes (A; n = 15, male n = 7, female n = 8) participated in this study. During GIET, heart rate (HR), oxygen uptake (V˙O2mean and V˙CO2mean), metabolic equivalents (METs) in V˙O2mean, and blood glucose and lactate concentrations (La−) were measured. Furthermore, jogging/running speeds (S) at specific La−, fat and carbohydrate oxidations (FATox and CHOox), and energetic contributions (oxidative; WOxi, glycolytic; WGly, and phosphagen; WPCr) were calculated. The percentages of HRmax, relative V˙O2mean, V˙CO2mean, and METs in V˙O2mean were all lower in A than they were in GP. FATox values were lower in GP than in A, while CHOox and La− were higher in GP than in A. Negative correlations between La− and FATox were also observed in both groups. Contributions of WOxi, WGly, and WPCr were higher in GP than in A during GIET. Moreover, values of WGly, and WPCr were significantly lower and higher, respectively, in male GP than in female GP. Furthermore, S at specific La− were higher in A than in GP. It is suggested that an individualized low-intensity recovery exercise program be established, to achieve increased metabolic flexibility and oxidative capacity (aerobic base), such as public health improvements and a greater volume of higher exercise intensities; this is the type of exercise that elite athletes worldwide mostly perform during their training period and progression. This may prevent cardiac/metabolic diseases in GP.
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Affiliation(s)
- Woo-Hwi Yang
- Graduate School of Sports Medicine, CHA University, Seongnam-si 13503, Korea
- Department of Medicine, General Graduate School, CHA University, Seongnam-si 13503, Korea
- Correspondence: ; Tel.: +82-31-728-7917
| | - Jeong-Hyun Park
- Graduate School of Sports Medicine, CHA University, Seongnam-si 13503, Korea
| | - So-Young Park
- Graduate School of Sports Medicine, CHA University, Seongnam-si 13503, Korea
| | - Yongdoo Park
- Department of Biomedical Engineering, College of Medicine, Korea University, Seoul 02841, Korea
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Hwang J, Moon NR, Heine O, Yang WH. The ability of energy recovery in professional soccer players is increased by individualized low-intensity exercise. PLoS One 2022; 17:e0270484. [PMID: 35771850 PMCID: PMC9246211 DOI: 10.1371/journal.pone.0270484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/12/2022] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to investigate whether individualized low-intensity exercise (ILIE) within the recovery domain before lactate threshold 1 (LT 1) improves energetic recovery and general endurance capacity in professional soccer players. Twenty-four professional soccer players (age: 24.53 ± 4.85 years, height: 180 ± 6.30 cm, body mass: 75.86 ± 8.01 kg, body fat: 12.19 ± 2.69%) participated in the study (n = 24). The 1-h ILIE intervention involved 27 jogging sessions spanning nine weeks and jogging speed corresponding to 72% of LT 1 (7.15 ± 0.95 km∙h−1). Pre-ILIE and post-ILIE LT testing variables measured within 9 weeks included blood lactate concentrations (La−) and heart rate (HR) at specific exercise intensities during ILIE LT test. The jogging/running speeds (S), delta (Δ) S, HR, and ΔHR were measured at 1.5, 2.0, 3.0, and 4.0 mmol∙L−1 La−, respectively. Values of La− and HR at the same exercise intensities (5.4–16.2 km∙h−1) in the post-ILIE LT test compared with pre-ILIE LT test were significantly decreased (P < 0.05 and P < 0.01, respectively). Furthermore, S at all specific La− levels (1.5, 2.0, 3.0, and 4.0) were significantly increased, while HR at 2.0, 3.0, and 4.0 La− decreased significantly (P < 0.05 and P < 0.01, respectively). Low to moderate positive correlations were observed between ΔS and ΔHR at 1.5 and 2.0 La− (r = 0.52 and r = 0.40, respectively). The nine-week ILIE improved energy recovery and general endurance of professional soccer players. This relates to repeated high-intensity intermittent sprints during the 90-min soccer game.
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Affiliation(s)
- Jihwan Hwang
- Graduate School of Sports Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Na-Ram Moon
- Graduate School of Sports Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Oliver Heine
- Olympic Training Centre Rhineland, Cologne, North Rhine-Westphalia, Germany
| | - Woo-Hwi Yang
- Graduate School of Sports Medicine, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Medicine, General Graduate School, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea
- * E-mail:
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Rajan D, Garcia R, Svane J, Tfelt-Hansen J. Risk of sports-related sudden cardiac death in women. Eur Heart J 2021; 43:1198-1206. [PMID: 34894223 DOI: 10.1093/eurheartj/ehab833] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/21/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022] Open
Abstract
Sudden cardiac death (SCD) is a tragic incident accountable for up to 50% of deaths from cardiovascular disease. Sports-related SCD (SrSCD) is a phenomenon which has previously been associated with both competitive and recreational sport activities. SrSCD has been found to occur 5-33-fold less frequently in women than in men, and the sex difference persists despite a rapid increase in female participation in sports. Establishing the reasons behind this difference could pinpoint targets for improved prevention of SrSCD. Therefore, this review summarizes existing knowledge on epidemiology, characteristics, and causes of SrSCD in females, and elaborates on proposed mechanisms behind the sex differences. Although literature concerning the aetiology of SrSCD in females is limited, proposed mechanisms include sex-specific variations in hormones, blood pressure, autonomic tone, and the presentation of acute coronary syndromes. Consequently, these biological differences impact the degree of cardiac hypertrophy, dilation, right ventricular remodelling, myocardial fibrosis, and coronary atherosclerosis, and thereby the occurrence of ventricular arrhythmias in male and female athletes associated with short- and long-term exercise. Finally, cardiac examinations such as electrocardiograms and echocardiography are useful tools allowing easy differentiation between physiological and pathological cardiac adaptations following exercise in women. However, as a significant proportion of SrSCD causes in women are non-structural or unexplained after autopsy, channelopathies may play an important role, encouraging attention to prodromal symptoms and family history. These findings will aid in the identification of females at high risk of SrSCD and development of targeted prevention for female sport participants.
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Affiliation(s)
- Deepthi Rajan
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Rodrigue Garcia
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,The Department of Cardiology, University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France
| | - Jesper Svane
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.,Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
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Abstract
Purpose of the review For many years, competitive sport has been dominated by men. Recent times have witnessed a significant increase in women participating in elite sports. As most studies investigated male athletes, with few reports on female counterparts, it is crucial to have a better understanding on physiological cardiac adaptation to exercise in female athletes, to distinguish normal phenotypes from potentially fatal cardiac diseases. This review reports on cardiac adaptation to exercise in females. Recent findings Recent studies show that electrical, structural, and functional cardiac changes due to physiological adaptation to exercise differ in male and female athletes. Women tend to exhibit eccentric hypertrophy, and while concentric hypertrophy or concentric remodeling may be a normal finding in male athletes, it should be evaluated carefully in female athletes as it may be a sign of pathology. Although few studies on veteran female athletes are available, women seem to be affected by atrial fibrillation, coronary atherosclerosis, and myocardial fibrosis less than male counterparts. Summary Males and females exhibit many biological, anatomical, and hormonal differences, and cardiac adaptation to exercise is no exception. The increasing participation of women in sports should stimulate the scientific community to develop large, longitudinal studies aimed at a better understanding of cardiac adaptation to exercise in female athletes.
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Affiliation(s)
- Clea Simone S S Colombo
- MSc Sports Cardiology, Cardiology Clinical Academic Group, St George's University of London, Cranmer Terrace, SW 17 0RE, London, UK. .,Cuore Dello Sport, Valinhos, R. Luiz Spiandorelli Neto, 60, s307. Valinhos, São Paulo, Brazil.
| | - Gherardo Finocchiaro
- Cardiology Clinical Academic Group, St George's University of London, Cranmer Terrace, SW 17 0RE, London, UK
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Lu L, Wu D, Li L, Chen L. Apelin/APJ system: A bifunctional target for cardiac hypertrophy. Int J Cardiol 2017; 230:164-170. [DOI: 10.1016/j.ijcard.2016.11.215] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/06/2016] [Indexed: 12/26/2022]
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Hotouras A, Ribas Y, Zakeri SA, Nunes QM, Murphy J, Bhan C, Wexner SD. The influence of obesity and body mass index on the outcome of laparoscopic colorectal surgery: a systematic literature review. Colorectal Dis 2016; 18:O337-O366. [PMID: 27254110 DOI: 10.1111/codi.13406] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/28/2016] [Indexed: 02/08/2023]
Abstract
AIM The relationship between obesity, body mass index (BMI) and laparoscopic colorectal resection is unclear. Our object was to assess systematically the available evidence to establish the influence of obesity and BMI on the outcome of laparoscopic colorectal resection. METHOD A search of PubMed/Medline databases was performed in May 2015 to identify all studies investigating the impact of BMI and obesity on elective laparoscopic colorectal resection performed for benign or malignant bowel disease. Clinical end-points examined included operation time, conversion rate to open surgery, postoperative complications including anastomotic leakage, length of hospital stay, readmission rate, reoperation rate and mortality. For patients who underwent an operation for cancer, the harvested number of lymph nodes and long-term oncological data were also examined. RESULTS Forty-five studies were analysed, the majority of which were level IV with only four level III (Oxford Centre for Evidence-based Medicine 2011) case-controlled studies. Thirty comparative studies containing 23 649 patients including 17 895 non-obese and 5754 obese showed no significant differences between the two groups with respect to intra-operative blood loss, overall postoperative morbidity, anastomotic leakage, reoperation rate, mortality and the number of retrieved lymph nodes in patients operated on for malignancy. Most studies, including 15 non-comparative studies, reported a longer operation time in patients who underwent a laparoscopic procedure with the BMI being an independent predictor in multivariate analyses for the operation time. CONCLUSION Laparoscopic colorectal resection is safe and technically and oncologically feasible in obese patients. These results, however, may vary outside of high volume centres of expertise.
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Affiliation(s)
- A Hotouras
- National Centre for Bowel Research and Surgical Innovation, London, UK. .,Department of Surgery, Whittington Hospital NHS Trust, London, UK.
| | - Y Ribas
- Department of Surgery, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain
| | - S A Zakeri
- Department of Surgery, Whittington Hospital NHS Trust, London, UK
| | - Q M Nunes
- NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - J Murphy
- Academic Surgical Unit, Imperial College London, London, UK
| | - C Bhan
- Department of Surgery, Whittington Hospital NHS Trust, London, UK
| | - S D Wexner
- Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
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Posselt BN, Cox AT, D'Arcy J, Rooms M, Saba M. Atrial and ventricular tachyarrhythmias in military personnel. J ROY ARMY MED CORPS 2015; 161:244-52. [PMID: 26246345 DOI: 10.1136/jramc-2015-000494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 01/08/2023]
Abstract
Although rare, sudden cardiac death does occur in British military personnel. In the majority of cases, the cause is considered to be a malignant ventricular tachyarrhythmia, which can be precipitated by a number of underlying pathologies. Conversely, a tachyarrhythmia may have a more benign and treatable cause, yet the initial clinical symptoms may be similar, making differentiation difficult. This is an overview of the mechanisms underlying the initiation and propagation of arrhythmias and the various pathological conditions that predispose to arrhythmia genesis, classified according to which parts of the heart are involved: atrial tachyarrhythmias, atrial and ventricular, as well as those affecting the ventricles alone. It encompasses atrial tachycardia, atrial flutter, supraventricular tachycardias and ventricular tachycardias, including the more commonly encountered inherited primary electrical diseases, also known as the channelopathies. The clinical features, investigation and management strategies are outlined. The occupational impact-in serving military personnel and potential recruits-is described, with explanations relating to the different conditions and their specific implication on continued military service.
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Affiliation(s)
- Bonnie N Posselt
- Defence Medical Services, Royal Centre for Defence Medicine, Birmingham, UK
| | - A T Cox
- Defence Medical Services, Royal Centre for Defence Medicine, Birmingham, UK Department of Cardiology, St George's, University of London, London, UK
| | - J D'Arcy
- Defence Medical Services, Royal Centre for Defence Medicine, Birmingham, UK Department of Cardiology, RCDM (Oxford), John Radcliffe Hospital, Oxford, UK
| | - M Rooms
- Regional Occupational Health Team (North), Catterick Garrison, North Yorkshire, UK
| | - M Saba
- Regional Occupational Health Team (North), Catterick Garrison, North Yorkshire, UK
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Abstract
Physical activity is a potent therapy for both the prevention and treatment of cardiovascular disease. Exercise appears to most benefit people who are the least active. There is some evidence to suggest that a curvilinear relationship exists between exercise and survival, whereby beyond an optimal level of fitness, the principle of diminishing returns applies. Indeed, some go further in suggesting that there is evidence that extreme athletic training may be harmful in some individuals. The incidence of sudden cardiac death in athletes is greater than in matched, nonathletic counterparts, and this finding is driven by the provocation of an underlying cardiac abnormality by strenuous exertion. The task of detecting pathological myocardial substrate in athletes is made difficult by physiological adaptations to exercise that can mimic the appearance of cardiomyopathies and ion channelopathies in some individuals. This article details the clinical evaluation of the athlete with reference limits for cardiac physiological remodeling and discusses the diagnostic dilemmas that arise.
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Affiliation(s)
- Andrew D'Silva
- Department of Cardiovascular Sciences, St. George's University of London, London, UK
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Luijkx T, Cramer MJ, Buckens CF, Zaidi A, Rienks R, Mosterd A, Prakken NHJ, Dijkman B, Mali WPT, Velthuis BK. Unravelling the grey zone: cardiac MRI volume to wall mass ratio to differentiate hypertrophic cardiomyopathy and the athlete's heart. Br J Sports Med 2013; 49:1404-9. [DOI: 10.1136/bjsports-2013-092360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2013] [Indexed: 11/03/2022]
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Luijkx T, Cramer MJ, Zaidi A, Rienks R, Senden PJ, Sharma S, van Hellemondt FJ, Buckens CF, Mali WP, Velthuis BK. Ethnic differences in ventricular hypertrabeculation on cardiac MRI in elite football players. Neth Heart J 2013; 20:389-95. [PMID: 22777563 DOI: 10.1007/s12471-012-0305-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Left ventricular (LV) trabeculation may be more pronounced in ethnic African than in Caucasian (European) athletes, leading to possible incorrect diagnosis of left ventricular non-compaction cardiomyopathy (LVNC). This study investigates ethnic differences in LV hypertrabeculation amongst elite athletes with cardiac magnetic resonance (CMR) and electrocardiography (ECG). METHODS 38 elite male football (soccer) players (mean age 23.0, range 19-34 years, 28/38 European, 10/38 African) underwent CMR and ECG. Hypertrabeculation was assessed using the ratio of non-compacted to compacted myocardium (NC/C ratio) on long-axis and short-axis segments. ECGs were systematically rated. RESULTS No significant differences were seen in ventricular volumes, wall mass or E/A ratio, whereas biventricular ejection fraction (EF) was significantly lower in African athletes (European/African athletes LVEF 55/50 %, p = 0.02; RVEF 51/48 %, p = 0.05). Average NC/C ratio was greater in African athletes but only significantly at mid-ventricular level (European/African athletes: apical 0.91/1.00, p = 0.65; mid-ventricular 0.89/1.45, p < 0.05; basal 0.40/0.46, p = 0.67). ECG readings demonstrated no significant group differences, and no correlation between ECG anomalies and hypertrabeculation. CONCLUSIONS A greater degree of LV hypertrabeculation is seen in healthy African athletes, combined with biventricular EF reduction at rest. Recognition of this phenomenon is necessary to avoid misdiagnosis of LVNC.
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Affiliation(s)
- T Luijkx
- Department of Radiology, University Medical Center Utrecht, room E 01.132, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands,
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