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Cardiac adaptation in elite female athletes

Embargoed for release: Sunday 29 August at 1120hrs

Stockholm, Sweden, 29 August: A study conducted in the UK has established the extent of cardiac adaptation amongst female athletes competing in a number of sports.  Previous studies of cardiac adaptation have been conducted only on male athletes, yet a growing number of females participate at elite level in many sports, nowadays including some such as rugby and boxing that were traditionally undertaken only by males. The results show evidence of changes to the heart, particularly to ventricle wall thickness and cavity size. In addition, the study considered whether ethnicity was a factor in the degree of measured cardiac adaptation.

The study was led by Professor Sanjay Sharma, of St. Georges University, London where he is Professor of Cardiology. He is also a member of the ESC’s European Association for Cardiovascular Prevention and Rehabilitation (EACPR), and Medical Director of the London Marathon. “Female athletes do not exhibit the same extent of cardiac adaptation as males. This is because they tend to be smaller and leaner with a lower body mass, and do not reach the same levels of exercise intensity,” he says. “Also, due to the physical differences in chest wall morphology, the typical QRS complexes of females measured on a 12-lead ECG are much less pronounced. The purpose of this study was to determine what changes do occur in elite female athletes that undertake an intensive training regime.”

The study has resulted in four findings:

  • Females that engage in regular sport show modest increases in left ventricular wall thickness and cavity size when compared to sedentary females
  • The magnitude of left ventricular wall thickness and cavity size is a function of many demographic factors including age and size, as well as the sport undertaken
  • In absolute terms, the realistic limits tend to be <11mm wall thickness and <60mm cavity size in Caucasian females
  • When these limits are exceeded, the cause is more likely to be a pathological condition such as hypertrophic cardiomyopathy or dilated cardiomyopathy

In order to extend the relevance of the findings to other ethnic groups, the study examined and investigated existing research but discovered that there is limited published data available. One report that compared Caucasian male athletes with African and Afro-Caribbean male athletes suggests that Caucasians have lower left ventricular hypertrophy (LVH) and a lesser prevalence of re-polarisation for very similar group demographics and sporting disciplines.

This finding was confirmed in very important work¹ that was recently published which compared around 200 nationally ranked female athletes from each of these two ethnic groups. Researchers established that black females selected from across 10 sporting disciplines exhibited a greater magnitude of LVH than their white counterparts. 3% of them showed a left ventricle wall thickness of >11mm (typically 12 to 13mm) whereas none of the white athletes exceeded 11mm. 15% of black athletes demonstrated re-polarisation changes compared with just 2% of the white athletes. The study concluded that standardised criteria derived from white athletes could unfairly discriminate against black athletes by leading to unnecessary investigation or even disqualification. 



Ethnic Differences in Physiological Cardiac Adaptation to Intense Physical Exercise in Highly Trained Female Athletes; J. Rawlins, F. Carre, G. Kervio, M. Papadakis, N. Chandra, C. Edwards, G.P. Whyte, and S. Sharma; Circulation (Journal of the American Heart Association); March 2010

Notes to editor

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 62,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

About ESC Congress 2010
ESC Congress 2010 will take place from 28 August to 1 September at the Stockholmsmässan, Stockholm. Information on the scientific programme is available at More information on ESC Congress 2010 is available from the ESC's press office at

This press release accompanies both a presentation and an ESC press conference given at the ESC Congress 2010. The press release has been written and/or edited by the ESC from information provided by the investigator and does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the investigator.