- Academic Editor
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Chronic and intense exercise programs lead to cardiac adaptations, followed by
increased left ventricular wall thickness and cavity diameter, at times meeting
the criteria for left ventricular hypertrophy (LVH), commonly referred to as
“athlete’s heart”. Recent studies have also reported that extremely
vigorous exercise practices have been associated with heightened left ventricular
trabeculation extent, fulfilling noncompaction cardiomyopathy criteria, as part
of exercise-induced structural adaptation. These changes are specific to the
exercise type, intensity, duration, and volume and workload demands imposed on
the myocardium. They are considered physiologic adaptations not associated with a
negative prognosis. Conversely, hypertrophic cardiac adaptations resulting from
chronic elevations in blood pressure (BP) or chronic volume overload due to
valvular regurgitation, lead to compromised cardiac function, increased
cardiovascular events, and even death. In younger athletes, hypertrophic
cardiomyopathy (HCM) is the usual cause of non-traumatic, exercise-triggered
sudden cardiac death. Thus, an extended cardiac examination should be performed,
to differentiate between HCM and non-pathological exercise-related LVH or
athlete’s heart. The exercise-related cardiac structural and functional
adaptations are normal physiologic responses designed to accommodate the
increased workload imposed by exercise. Thus, we propose that such adaptations
are defined as “eutrophic” hypertrophy and that LVH is reserved for pathologic
cardiac adaptations. Systolic BP during daily activities may be the strongest
predictor of cardiac adaptations. The metabolic demand of most daily activities
is approximately 3–5 metabolic equivalents (METs) (1 MET = 3.5 mL of O