Effect of training on left ventricular structure and functioning of the normotensive and the hypertensive subject

OBJECTIVE: To review the literature on the effects of training on left ventricular structure and functioning of the normotensive and the hypertensive subject. METHOD AND RESULTS: Meta-analytical techniques were applied to selected echocardiographic reports on the effects of exercise training on the heart of normotensive subjects. The combined analysis of studies revealed that the hearts of competitive athletes may differ from those of nonathletes. Long-distance runners develop predominantly eccentric left ventricular hypertrophy, strength athletes predominantly concentric hypertrophy and cyclists a mixed type of hypertrophy. Relative to their respective controls, left ventricular mass was larger by 64% (P < 0.01) in cyclists, 48% (P < 0.001) in runners and 25% (P < 0.05) in strength athletes. There were no differences in left ventricular systolic and diastolic function at rest. The meta-analyses of longitudinal studies in which athletes or nonathletes were assessed in active and inactive periods showed that physical training per se can affect cardiac structure. The few reports concerning hypertensive patients suggest that dynamic physical training seems to reduce rather than increase left ventricular mass, in which effect the reduction in blood pressure might play a part. CONCLUSION: Cross-sectional and longitudinal studies indicate that physical training may increase heart size in the normotensive subject. In contrast, heart size in the hypertensive patient may decrease in response to dynamic training.