In our previous review characteristics of the athlete’s heart were divided into three groups: morphologic (left ventricular (LV) hypertrophy, improved coronary circulation), functional (better diastolic function) and regulatory (lower heart rate (HR)) features. In the present review, the influences of the types of sports and the age on the athlete’s heart are discussed. Studies using echocardiographic, Doppler-echocardiographic, tissue Doppler imaging (TDI) and magnetic resonance imaging (MRI) results are mostly involved. The coronary circulation was investigated overwhelmingly in animal experiments. In the LV hypertrophy a major contributor is the increase of the LV wall thickness (WT) than that of the LV internal diameter (ID). A right ventricular (RV) hypertrophy can also be seen in athletes. Athletic features are induced mostly by endurance training. Approximately two years regular physical training is needed to develop characteristics of the athlete’s heart, hence, in the young children they are less marked. LV hypertrophy and lower HR are characteristic in young and adult athletes, but they are less marked in older ones. A richer coronary capillary network can develop mostly at a young age.
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.
Importance of the athlete’s heart has been arisen in the last decades.
Consequences of the sedentary way of life are the most threatening through the impairments of the cardiovascular system.
Endurance performance is mostly limited by the characteristics of the athlete’s heart.
Sudden death of the athletes is always associated with cardiac disorders.
Main characteristics of the athlete’s heart can be divided into morphologic, functional and regulatory ones.
The main morphologic characteristics are the physiologic left ventricular (LV) hypertrophy and a richer coronary capillary network.
The functional adaptation contains a better systolic and diastolic function, modified metabolism and electric characteristics. The most easily detected modification is the better LV diastolic function.
Adaptation of the cardiac regulation is manifested mostly by a lower heart rate (HR).
Summarizing: the athlete’s heart is an enlarged but otherwise normal heart characterized by a low heart rate, an increased pumping capacity, and a greater ability to deliver oxygen to skeletal muscle.
In the authors’ earlier study the relative aerobic power of Hungarian top-level male water polo players was found to be smaller than that of other top-level athletes, while their echocardiographic parameters proved to be the most characteristic of the athlete’s heart. In the present investigation echocardiographic and spiroergometric data of female top-level water polo players were compared to those of other female elite athletes and of healthy, non-athletic subjects. Relative aerobic power in the water polo players was lower than in endurance athletes. Mean resting heart rates were the slowest in the water polo players and endurance athletes. Morphologic indicators of the heart (body size related left ventricular wall thickness and muscle mass) were the highest in the water polo players, endurance and power athletes. In respect of diastolic functions (diastolic early and late peak transmitral flow velocities) no difference was seen between the respective groups.These results indicate that, similarly to the males, top-level water polo training is associated with the dimensional parameters of the heart rather than with relative aerobic power. For checking the physical condition of female water polo players spiroergometric tests seem to be less appropriate than swim-tests with heart rate recovery studies such as the ones used in the males.
Characteristics of the athlete’s heart have been investigated mostly in the left ventricle (LV); reports referring to the right ventricle (RV) have only appeared recently. The aim of the present study was to compare the training effects on RV and LV in elite male endurance athletes. To this end, echocardiography was conducted in 52 elite endurance athletes (A) and in 25 non-athletes (NA). Differences between A and NA in the morphology was more marked in the RV (body-size-matched (rel.)) long axis diastolic diameter (RVLADd): 63.4 ± 6.3 vs. 56.4 ± 6.3; rel. short axis diastolic diameter (RVSADd): 27.3 ± 3.6 vs. 23.6 ± 2.7 mm/m, RV diastolic area 28 ± 5.0 vs. 21.3 ± 4.3 cm2 in all cases, p < 0.001) than in the LV (rel. LVLADd: 63.8 mm/m ± 5.6 vs. 60.7 mm/m ± 6.6, p < 0.05, rel.LVSADd 37.8 ± 3.1 vs. 35.3 ± 2.4, no difference). In the athletes ratios of peak early to late diastolic filling velocity (2.07 ± 0.51 vs. 1.75 ± 0.36, p < 0.01), the TDI-determined E’/A’ ratio in the septal (1.89 ± 0.55 vs. 1.62 ± 0.55, p < 0.05) and lateral (2.62 ± 0.72, vs. 2.18 ± 0.87, p < 0.001) walls were significantly higher than in NA only in the LV. Results indicate that in male endurance athletes morphologic adaptation is similar or slightly stronger in the RV than in the LV, functional adaptation seems to be stronger in the LV.
Creatine kinase (CK) is widely used as a monitoring tool to make inferences on fatigue and readiness in elite soccer. Previous studies have examined the relationship between CK and GPS parameters, however these metrics may not accurately describe the players' load during soccer-specific movements. Football Movement Profile (FMP) monitoring is a viable option for such purposes, providing solely inertial sensor-based data and categorizing movements according to intensity (very low, low, medium, high) and movement type (running-linear locomotive, dynamic – change of direction or speed).
We investigated the relationship between the FMP distribution of youth (U16–U21) national team soccer players and the absolute day-to-day change in CK. We applied Spearman's correlations, principal component analysis and K-means clustering to classify players' CK responses according to their specific FMP.
Moderate to large negative associations were found between very low intensity FMP parameters and CK change (r = −0.43 ± 0.12) while large positive associations were identified between CK change and other FMP metrics (r = 0.62 ± 0.12). Best fitting clustering methods were used to group players depending on their CK sensitivity to FMP values. Principal component analysis explained 83.0% of the variation with a Silhouette score of 0.61 for the 4 clusters.
Our results suggest that soccer players can be clustered based on the relationship between FMP measures and the CK change. These findings can help to plan soccer training or recovery sessions according to the desired load on skeletal muscle, as FMP monitoring might bridge the limitations of GPS telemetry.
Összefoglaló. Az elhízás és következményes megbetegedései fontos
népegészségügyi problémát jelentenek hazánkban is. Kezelése komoly szakmai
kihívás, ugyanakkor prevenciója eredményesebb lehet. Az elhízott betegekkel
leggyakrabban találkozó háziorvosok, más szakorvosok és egészségügyi szakemberek
részéről nagy igény van egy viszonylag rövid, áttekinthető, naprakész
gyakorlatias útmutatóra. A különböző orvosszakmai társaságokban tevékenykedő,
évtizedes szakmai tapasztalatokkal rendelkező szerzők összefoglalják
tudományosan megalapozott, bizonyítékokon alapuló ismereteiket. Az elhízás
kezelését lépcsőzetesen célszerű megkezdeni, előtte felmérve a beteg
motivációját, általános állapotát, lehetőségeit. A szerzők leírják az
energiaszükséglet meghatározásával, az étrenddel és a fizikai aktivitás
megtervezésével kapcsolatos alapvető szempontokat. Felsorolják a hazánkban
elérhető gyógyszereket és metabolikus sebészeti beavatkozásokat, az életmódi
támogatás igényét. Az elhízás megelőzésében az élet első 1000 napjának
táplálkozása, a későbbiekben a szülői minta a meghatározó. Sok kihasználatlan
lehetősége van a háziorvosok, a lakóközösségek, az állami szervek koordinált
együttműködésének, helyi kezdeményezéseknek. Az elhízás betegségként való
meghatározása egyaránt igényel egészségpolitikai és kormányzati támogatást, az
elhízottak ellátására szakosodott multidiszciplináris centrumok számának és
kompetenciájának növelését. Orv Hetil. 2021; 162(9): 323–335.
Summary. Obesity and related morbidities have a high public health
impact in Hungary. The treatment is a challenge, but prevention seems more
effective. General practitioners, other specialists and health care
professionals who are treating obese persons require short, summarized, updated
and practical guideline. Hungarian medical professionals of different scientific
societies, having decennial practices, are summarizing their evidence-based
knowledge. Obesity management requires step by step approach, evaluating
previously the general health condition, motivation and options of the patients.
The measurement of energy requirement, planning of diet and physical activities,
available surgical methods and medications are described in detail with life
style and mental support needed. The most important period in the prevention of
obesity is the first 1000 days from conception. Other significant factors are
the life style habits of the parents. Proper obesity prevention requires better
coordination of primary health care, community and governmental activities.
Obesity should be defined as morbidity, therefore stronger governmental support
and more health-policy initiatives are needed, beside increasing number and
developing of multidisciplinary centres. Orv Hetil. 2021; 162(9): 323–335.