Young athlete’s growing heart: sex differences in cardiac adaptation to exercise training during adolescence

Forså, Marianne Inngjerdingen; Bjerring, A W; Haugaa, Kristina H; Smedsrud, Marit Kristine; Sarvari, Sebastian Imre; Landgraff, Hege Wilson; Hallén, Jostein; Edvardsen, Thor

doi:10.1136/openhrt-2022-002155

Cited by 12 publications

(10 citation statements)

References 37 publications

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“…It has been well established that high aerobic exercise capacity is physiologically characterized by higher function of, among others, cardiac contractile parameters both in the cell and the whole organ 30 . − 32 Although debate continues as to how much of this is inherited or acquired (nature versus nurture), human 33,34 and experimental 26,35,36 genetic association studies and the current LCR–HCR model system 7 − 10,26,29 have convincingly shown that a robust inherited component prevails that also at least partly explains the phenotype segregation between those that score for low and those that score for high exercise capacity.…”

Section: Discussionmentioning

confidence: 99%

“…This has also been advocated for by clinical trials evidencing both longterm benefit and safety of introducing added levels of physical activity to children. 30,38 As indicated above, a mechanism that explains the blunted car- widening divergence remains unknown, but it appears to be genetic in origin. [7][8][9]28 Identifying this genetic mechanism would be desirable.…”

Section: Mechanisms and Implications Of Divergencementioning

confidence: 98%

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Inherited physical capacity: Widening divergence from young to adult to old

Kemi,

Hoydal,

Haram

et al. 2024

Annals of the New York Academy of Sciences

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Cardiorespiratory performance segregates into rat strains of inherited low‐ and high‐capacity runners (LCRs and HCRs); during adulthood, this segregation remains stable, but widens in senescence and is followed by segregated function, health, and mortality. However, this segregation has not been investigated prior to adulthood. We, therefore, assessed cardiorespiratory performance and cardiac cell (cardiomyocyte) structure–function in 1‐ and 4‐month‐old LCRs and HCRs. Maximal oxygen uptake was 23% less in LCRs at 1‐month compared to HCRs at 1‐month, and 72% less at 4 months. Cardiomyocyte contractility was 37−56% decreased, and Ca2+ release was 34−62% decreased, in 1‐ and 4‐month LCRs versus HCRs. This occurred because HCRs had improved contractility and Ca2+ release during maturation, whereas LCRs did not. In quiescent cardiomyocytes, LCRs displayed 180% and 297% more Ca2+ sparks and 91% and 38% more Ca2+ waves at 1 and 4 months versus HCRs. Cell sizes were not different between LCRs and HCRs, but LCRs showed reduced transverse‐tubules versus HCRs, though no discrepant transverse‐tubule generation occurred during maturation. In conclusion, LCRs show reduced scores for aerobic capacity and cardiomyocyte structure–function compared to HCRs and there is a widening divergence between LCRs and HCRs during juvenile to near‐adult maturation.

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Section: Discussionmentioning

confidence: 99%

Section: Mechanisms and Implications Of Divergencementioning

confidence: 98%

Inherited physical capacity: Widening divergence from young to adult to old

Kemi,

Hoydal,

Haram

et al. 2024

Annals of the New York Academy of Sciences

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“…This is especially important in patients with previous cardiac surgery as they often have more pulmonary abnormalities on spirometry than those without surgery. Musculoskeletal training has been shown to increase skeletal muscle mass, including cardiac mass which can improve cardiac stroke volume ( 36 ). Other cardiac changes to optimize function can include addressing residual cardiac lesions, medication compliance, and regular surveillance in addition to fitness training.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary responses following cardiac rehabilitation and the relationship with functional outcomes in children and young adults with heart disease

Kershner,

Hardie,

Chin

et al. 2024

Front. Surg.

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IntroductionPatients with congenital heart disease (CHD) often have pulmonary abnormalities and exercise intolerance following cardiac surgery. Cardiac rehabilitation (CR) improves exercise capacity in patients with CHD, but minimal study has been performed to see if resting and dynamic pulmonary performance improves following CR in those with prior cardiac surgery.MethodsThis was a retrospective cohort study of all patients who completed ≥12 weeks of CR from 2018 through 2022. Demographic, cardiopulmonary exercise test (CPET), spirometry, 6-minute walk, functional strength measures, and outcomes data were collected. Data are presented as median[IQR]. A Student's t-test was used for comparisons between groups and serial measurements were measured with a paired t-test. A p < 0.05 was considered significant.ResultsThere were a total of 37 patients [age 16.7 (14.2–20.1) years; 46% male] included. Patients with prior surgery (n = 26) were more likely to have abnormal spirometry data than those without heart disease (n = 11) (forced vital capacity [FVC] 76.7 [69.1–84.3]% vs. 96.4 [88.1–104.7]%, p = 0.002), but neither group experienced a significant change in spirometry. On CPET, peak oxygen consumption increased but there was no change in other pulmonary measures during exercise. Percent predicted FVC correlated with hand grip strength (r = 0.57, p = 0.0003) and percent predicted oxygen consumption (r = 0.43, p = 0.009). The number of prior sternotomies showed negative associations with both percent predicted FVC (r = −0.43, p = 0.04) and FEV1 (r = −0.47, p = 0.02).DiscussionYouth and young adults with a prior history of cardiac surgery have resting and dynamic pulmonary abnormalities that do not improve following CR. Multiple sternotomies are associated with worse pulmonary function.

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“…In general, dilation of the chambers accompanied by increased myocardial mass is observed, and low-normal resting functional measures are also frequent findings in adult athletes [1,2]. Pediatric athletes represent a unique population in which the interpretation of Right Ventricular Structure and Function in Adolescent Athletes: A 3D Echocardiographic Study different investigations is a clinical issue; yet there is a lack of data and evidence [3,4].…”

Section: Introductionmentioning

confidence: 99%

Right Ventricular Structure and Function in Adolescent Athletes: A 3D Echocardiographic Study

Ujvári,

Fábián,

Lakatos

et al. 2024

Int J Sports Med

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The aim of this study was to characterize the right ventricular (RV) contraction pattern and its associations with exercise capacity in a large cohort of adolescent athletes using resting three-dimensional echocardiography (3DE). We enrolled 215 adolescent athletes (16±1 years, 169 males, 12±6 hours of training/week) and compared them to 38 age- and sex-matched healthy, sedentary adolescents. We measured the 3DE-derived biventricular ejection fractions (EF). We also determined the relative contributions of longitudinal EF (LEF/RVEF) and radial EF (REF/RVEF) to the RVEF. Same-day cardiopulmonary exercise testing was performed to calculate VO2/kg. Both LV and RVEFs were significantly lower (athletes vs controls; LVEF: 57±4 vs 61±3, RVEF: 55±5 vs 60±5%, p<0.001). Interestingly, while the relative contribution of radial shortening to the global RV EF was also reduced (REF/RVEF: 0.40±0.10 vs 0.49±0.06, p<0.001), the contribution of the longitudinal contraction was significantly higher in athletes (LEF/RVEF: 0.45±0.08 vs 0.40±0.07, p<0.01). The supernormal longitudinal shortening correlated weakly with a higher VO2/kg (r= 0.138, P = 0.044). Similarly to the adult athlete’s heart, the cardiac adaptation of adolescent athletes comprises higher biventricular volumes and lower resting functional measures with supernormal RV longitudinal shortening. Characteristic exercise-induced structural and functional cardiac changes are already present in adolescence.

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Young athlete’s growing heart: sex differences in cardiac adaptation to exercise training during adolescence

Cited by 12 publications

References 37 publications

Inherited physical capacity: Widening divergence from young to adult to old

Inherited physical capacity: Widening divergence from young to adult to old

Pulmonary responses following cardiac rehabilitation and the relationship with functional outcomes in children and young adults with heart disease

Right Ventricular Structure and Function in Adolescent Athletes: A 3D Echocardiographic Study

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