Physical Activity, Blood Pressure, and Cardiac Structure and Function

Peter Kokkinos, Puneet Narayan, Andreas Pittaras

Research output: Chapter in Book/Report/Conference proceedingChapter

3 Scopus citations


Increased cardiac wall thickness, left ventricular (LV) chamber enlargement, and left ventricular hypertrophy (LVH) are characteristics of chronic, vigorous exercise endured by athletes and commonly referred to as “the athlete’s heart.” These cardiac structural and functional adaptations are specific to the workload demands imposed upon the myocardium, are considered normal physiologic responses, and are not associated with adverse prognosis. However, in young athletes, a thorough examination should be performed by a cardiologist to differentiation between physiological LVH (athlete’s heart) and hypertrophic cardiomyopathy, the commonest cause of non-traumatic exercise-related sudden cardiac death. Perhaps exercise-induced cardiac structural adaptations that improve cardiac efficiency and ultimately accommodate the imposed physiologic demand should be referred to as eutrophic. Conversely, hypertrophic cardiac adaptations should be considered exclusively those imposed by pathophysiologic and encroach upon cardiac efficiency, ultimately leading to compromised cardiac dysfunction and even death. Systolic blood pressure (BP) during daily activities may present the strongest impetus for cardiac adaptations. Exercise systolic BP ≥150 mmHg at the workload of approximately 4-5 METs (first stage of the Bruce protocol) closely represents the daily hemodynamic load threshold for cardiac adaptations. Moderate-intensity aerobic training lowers exercise systolic BP at absolute and maximal workloads, leading to a relatively lower hemodynamic load during daily activities and ultimately lowering the stimulus for increase in LV mass. This is in line with the LVH regression reported by aerobic exercise intervention studies.

Original languageEnglish (US)
Title of host publicationCardiorespiratory Fitness in Cardiometabolic Diseases
Subtitle of host publicationPrevention and Management in Clinical Practice
PublisherSpringer International Publishing
Number of pages10
ISBN (Electronic)9783030048167
ISBN (Print)9783030048150
StatePublished - Jan 1 2019
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Medicine(all)


  • Athletes
  • Cardiac structure and function
  • Exercise
  • Left ventricular hypertrophy
  • Physical activity


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