22 August 2018

The hearts of athletes who have participated in the Olympic Games three times in a row become larger. In particular, the right side of the heart, which pumps oxygen-depleted blood to the lungs, increases in size during the first four years. Thereafter the size of the heart stabilizes.

This was shown in a study conducted by Vincent Aengevaeren and Thijs Eijsvogels, members of the theme Vascular damage, which was published this month in the Journal of the American College of Cardiology (JACC).
Athletes who engage in long-term intensive exercise training place high demands on their hearts, which have to pump hard to provide the body with sufficient blood. It has long been known that the left side of the heart, which pumps oxygen-rich blood into the body, increases in strength and size as a result of the training. Aengevaeren and Eijsvogels have now shown that the right side, which pumps the oxygen-poor blood to the lungs, also becomes larger. Previous research had suggested that the right side of the hearts of athletes who exercise frequently and intensively would possibly start to contract less strongly. This was based on the hypothesis that the right side is less able to withstand the increased stress during exercise than the left.
Italian athletes
Eijsvogels and Aengevaeren wanted to know more about the possible negative effects of extreme exercise on the right side of the heart. Together with the Institute of Sports Medicine and Science in Rome, they studied ultrasound scans of the hearts of 50 Italian athletes. About half of them participated in sports that require great endurance, such as rowing, cycling, running and swimming. The other half consisted of athletes participating in sports that do not require as much endurance, such as tennis, fencing or synchronized swimming.
Crème de la crème
The athletes participating in the study were required by law to undergo a number of physical examinations, also involving heart ultrasound scans, every year. This gave the researchers the opportunity to study many heart scans over a longer period of time. Eijsvogels: “The unique feature of this study is that it concerns top athletes who qualified for three consecutive Olympic games: Beijing 2008, London 2012 and Rio 2016. So these athletes were absolutely the ‘crème de la crème’.”
Additional adaptations of the heart
On the ultrasound scans the researchers observed that specifically the right side of the heart of the top athletes continued to develop during the research period. This development had no negative effects on the function of the heart. After the first measurement, when the athletes were qualifying for the Beijing Olympics, the heart adapted to the long-term intensive training. Aengevaeren: “These athletes had already been training for at least ten years. You can consider participation in the Olympic Games as the pinnacle of their career. Our study shows that training at the highest level apparently results in additional adaptations of the heart, which were greater on the right side. However, it is possible that adaptations on the left side had already taken place, because these were highly trained athletes.”
There appeared to be differences in the adaptation of the heart between athletes in endurance and non-endurance sports, although the researchers indicated that there is a lot of variation in how the athletes have to perform, especially in non-endurance sports. For example, sports such as water polo and tennis place a much greater load on the heart than horseback riding or sailing. Interestingly, the researchers found no difference between the heart measurements at four and eight years into the study. The degree of adaptation of athletes’ hearts during intensive training is apparently limited.


Right Heart Remodeling in Olympic Athletes During 8 Years of Intensive Exercise Training
Vincent L.Aengevaeren MD, StefanoCaselli MD, PhD, CataldoPisicchio MD, Fernando M.Di Paolo MD, Maria T.E.Hopman MD, PhD, AntonioSpataro MD, Thijs M.H.Eijsvogels, PhD, AntonioPelliccia MD

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