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Aspects of regular long-term endurance exercise in adolescents, with focus on cardiac size and function, hormones, and the immune system
Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The long-term effects of starting high-intensity training at younger ages are largely unknown. The present studies focused on adolescents who had performed regular endurance exercise for several years at an elite level and compared those subjects with a control group of adolescents of similar age and sex who had not engaged in regular exercise. The knowledges generated by this research will contribute to further understanding of some of the physiological effects of strenuous regular exercise during adolescence.

Aim: The overall aim of this research was to investigate endurance-trained adolescents, focusing on cardiac size and function, hormones associated with growth and metabolism, and impact on the immune system.

Methods: All participants underwent echocardiography at rest as well as immediately and 15 minutes after amaximal cardiopulmonary exercise test. Blood samples were taken at rest and analyzed for biomarkers such as hormones, immune cell surface markers, and secreted cytokines and chemokines. The study design was crosssectional (Papers I, III, and IV) and comparative, with a quantitative approach in all four studies. The evaluationin Paper II used a pre-post test design with measurements of cardiac parameters before and after a maximal treadmill test. The studies in Papers I–III compared endurance-trained (active group) and untrained (controls) adolescents matched by age and sex, whereas the analysis in Paper IV considered differences between the sexes in the endurance-trained adolescents.

Results: Compared with controls, the endurance-trained adolescents showed increased size of all four heart chambers, as well as improved cardiac systolic function at rest. Considering cardiac changes from baseline to immediately after exercise, the systolic and diastolic patterns were similar in both groups, although the diastolic function was more enhanced in the active group. Strong associations between peak oxygen uptake and cardiac size and function could be seen both at rest and after exercise. Circulating hormones at rest did not differ between the two groups. No correlation between insulin-like growth factor 1 and cardiac size was found among the endurance-trained adolescents. Compared with endurance-trained girls, endurance-trained boys exhibited an elevated response to a potent type 1 diabetes-related autoantigen. Conversely, compared with the trained boys, the trained girls showed an increased number of circulating immune cells and increased secretion of C-peptide and proinsulin.

Conclusions: There are many benefits associated with regular exercise, and the present research did not provide any data to oppose that statement. Factors such as increased cardiac size at rest and exercise-related effects on cardiac functions do occur and therefore should be expected in endurance-trained adolescents with high peak oxygen uptake. Indeed, this should be interpreted as a sign of physiological adaptation and not as pathophysiology. The greater cardiac dimensions observed in these subjects could not be related to increased resting levels of hormones associated with growth and metabolism. The endurance-trained adolescents did show some sex-related differences with regard to their immune response at rest.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2019. , p. 114
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 098
Keywords [en]
adolescence, endurance-trained, cardiac dimension, cardiac systolic function, cardiac diastolic function, growth hormone, immune response, echocardiography, biomarkers, cytokines, chemokines, insulin-like growth factor 1, type 1 diabetes-related autoantigen, proinsulin
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:hj:diva-43516ISBN: 978-91-85835-97-3 (print)OAI: oai:DiVA.org:hj-43516DiVA, id: diva2:1306402
Public defence
2019-06-05, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (English)
Opponent
Supervisors
Funder
Medical Research Council of Southeast Sweden (FORSS)Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-04-23Bibliographically approved
List of papers
1. Regular endurance training in adolescents impacts atrial and ventricular size and function
Open this publication in new window or tab >>Regular endurance training in adolescents impacts atrial and ventricular size and function
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2017 (English)In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 18, no 6, p. 681-687Article in journal (Refereed) Published
Abstract [en]

Aims: The aims of the study were to explore the effects of long-term endurance exercise on atrial and ventricular size and function in adolescents and to examine whether these changes are related to maximal oxygen uptake (VO2max).

Methods and results: Twenty-seven long-term endurance-trained adolescents aged 13–19 years were individually matched by age and gender with 27 controls. All participants, 22 girls and 32 boys, underwent an echocardiographic examination at rest, including standard and colour tissue Doppler investigation. VO2max was assessed during treadmill exercise. All heart dimensions indexed for body size were larger in the physically active group compared with controls: left ventricular end-diastolic volume 60 vs. 50 mL/m2 (P <0.001), left atrial volume 27 vs. 19 mL/m2 (P <0.001), and right ventricular (RV) and right atrial area 15 vs. 13 and 9 vs. 7 cm2/m2, respectively (P <0.001 for both). There were strong associations between the size of the cardiac chambers and VO2max. Further, we found improved systolic function in the active group compared with controls: left ventricular ejection fraction 61 vs. 59% (P= 0.036), tricuspid annular plane systolic excursion 12 vs. 10 mm/m2 (P= 0.008), and RV early peak systolic velocity s′ 11 vs. 10 cm/s (P = 0.031).

Conclusion: Cardiac remodelling to long-term endurance exercise in adolescents is manifested by an increase in atrial as well as ventricular dimensions. The physically active group also demonstrated functional remodelling with an increase in TAPSE and systolic RV wall velocity. These findings have practical implications when assessing cardiac enlargement and function in physically active youngsters.

Place, publisher, year, edition, pages
Oxford University Press, 2017
Keywords
Echocardiography; Heart; Athlete; Atria; Adolescent; Exercise
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-34670 (URN)10.1093/ehjci/jew150 (DOI)000405182500014 ()27406576 (PubMedID)2-s2.0-85029069005 (Scopus ID)
Note

Editor's Choice

Available from: 2017-01-11 Created: 2017-01-11 Last updated: 2019-08-29Bibliographically approved
2. Left ventricular diastolic function is enhanced after peak exercise in endurance-trained adolescents as well as in their non-trained controls
Open this publication in new window or tab >>Left ventricular diastolic function is enhanced after peak exercise in endurance-trained adolescents as well as in their non-trained controls
2018 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 38, no 6, p. 1054-1061Article in journal (Refereed) Published
Abstract [en]

The aims of the study were to explore the temporal change of cardiac function after peak exercise in adolescents, and to investigate how these functional changes relate to maximal oxygen uptake (VO2max ). The cohort consisted of 27 endurance-trained adolescents aged 13-19 years, and 27 controls individually matched by age and gender. Standard echocardiography and colour tissue Doppler were performed at rest, and immediately after as well as 15 min after a maximal cardio pulmonary exercise test (CPET) on a treadmill. The changes in systolic and diastolic parameters after exercise compared to baseline were similar in both groups. The septal E/e'-ratio increased immediately after exercise in both the active and the control groups (from 9·2 to 11·0; P<0·001, and from 8·7 to 10·2; P = 0·008, respectively). In a comparison between the two groups after CPET, the septal E/e'-ratio was higher in the active group both immediately after exercise and 15 min later compared to the control group (P = 0·007 and P = 0·006, respectively). We demonstrated a positive correlation between VO2max and cardiac function including LVEF and E/e' immediately after CPET, but the strongest correlation was found between VO2max and LVEDV (r = 0·67, P<0·001) as well as septal E/e' (r = 0·34, P = 0·013). Enhanced diastolic function was found in both groups, but this was more pronounced in active adolescents. The cardiac functional response to exercise, in terms of LVEF and E/e', correlates with the increase in VO2 uptake. These findings in trained as well as un-trained teenagers have practical implications when assessing cardiac function.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
E/e′, diastolic function, echocardiography, heart, systolic function, training, youngster
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-41801 (URN)10.1111/cpf.12534 (DOI)000446073500019 ()29947056 (PubMedID)2-s2.0-85054186924 (Scopus ID)PP HHJ 2019 embargo 12 (Local ID)PP HHJ 2019 embargo 12 (Archive number)PP HHJ 2019 embargo 12 (OAI)
Available from: 2018-10-10 Created: 2018-10-10 Last updated: 2019-06-26Bibliographically approved
3. Resting level of insulin-like growth factor 1 is not at play in cardiac enlargement in endurance-trained adolescents
Open this publication in new window or tab >>Resting level of insulin-like growth factor 1 is not at play in cardiac enlargement in endurance-trained adolescents
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(English)Manuscript (preprint) (Other academic)
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-43514 (URN)
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-04-23
4. Enhanced immune response to a potent type 1 diabetes-related autoantigen is observed in endurance-trained boys
Open this publication in new window or tab >>Enhanced immune response to a potent type 1 diabetes-related autoantigen is observed in endurance-trained boys
(English)Manuscript (preprint) (Other academic)
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hj:diva-43515 (URN)
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-04-23

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