Geert Kleinnibbelink

Chapter 10 208 Level of training Ventricular size Untrained individual: First the RV starts to remodel, then the LV will follow Highly trained individual: The RV reaches a plateau, whereas the LV continues to remodel Cardiac structural remodelling pathway hypothesis LV RV Figure 4. Structural cardiac remodelling to exercise hypothesis. When a relatively untrained individual increases their exercise training volume, the RV start to remodel earlier than the LV. When an individual reaches a more trained status the remodelling of the RV will flatten and finally plateauing whereas the LV will continue to remodel. Sex differences in cardiac remodelling to exercise training Although some cross-sectional studies show sex differences between the female and males athlete’s heart, prospective longitudinal studies are lacking. 51, 52 To our knowledge, we explored potential sex differences in cardiac remodelling to the same exercise training for the first time in human individuals ( Chapter 4 ). We demonstrated that an increase in exercise training volume induced significantly larger structural LV remodelling in female elite rowers compared to their male counter peers. Possible explanations for the distinct remodelling may be hormonal, molecular and/or genetic mechanisms. A recent study by Oláh et al . presented similar findings in a rat model of cardiac hypertrophy. 53 These findings should be confirmed in larger prospective cohort studies in human individuals. Female athletes are concerningly underrepresented in current sports and exercise medicine literature. 54 This sex-specific publication bias of the athlete’s heart might impede the external validity of current knowledge onto female elite athletes and thus stresses the importance of highlighting any between-sex differences. Given the importance of