Heart of the athlete Allan

When sports medicine was in its infancy in the early 1900s, and before anyone had heard of an exercise physiologist, some physicians had been concerned about the effects of vigorous exercise on the heart. Among them where Schott', Henschen2, Kienbock3, Barach, and Lee5 who had made and recorded observations on swimmers, cross-country skiers and wrestlers. With the general increase in sports activity that followed World War I, many physicians expressed concerns about the long-term effects of sports participation on the adolescent heart. Their apprehension was embodied in a concept of 'athlete's heart' that stemmed back to an erroneous calculation of the German cardiologist Beneke6, published in 1879, that resulted in his statement that the growth of the left ventricle was disproportionate to the increase in diameter of the ascending aorta during adolescence. This error was pointed out by Karpovich7, but the concept and the term lingered on. Studies of the trainability of athletes by cardiologists and physiologists following World War II demonstrated the relationships between the heart rate attained during exercise and oxygen consumption, giving rise to the concept of maximal oxygen consumption V62, max8* Aerobic and anaerobic performance were defined and differentiated. Maximum attainable heart rates were related to chronological age. Training schedules to help individuals reach and sustain rates close to the maximum were described. Retrospective and prospective studies of different populations indicated that regular vigorous physical exercise that resulted in training the cardiovascular system not only improved its ability to perform more efficiently but enabled individuals to continue to be physically active longer in their lives, and perhaps to be able to extend their lives. This, in turn, led to the development of physical training for persons who had suffered myocardial damage from arteriosclerotic cardiovascular disease, the so-called cardiovascular rehabilitation programmes9. Improvement in myocardial function, reduction in second myocardial infarctions and increased longevity were reported widely. One voice of caution came from Hellersteinl' who showed that some victims of this disease who survived the initial attack had sustained a level of muscle damage that prevented any increase of maximum V02 by training. Attempts to train these persons beyond levels of basic activity might shorten their lives. The generally optimistic feeling generated by all this activity suggested that anyone who had an apparently normally functioning heart, as demonstrated, for example, by electrocardiography and a cycle ergometer and treadmill test, could train his/her heart to perform feats of endurance formerly not believed to be possible for the average individual by prolonged and intensive training. The concept that you could not damage but only strengthen such a heart by that type of training was encouraged by exercise physiologists and others in the coaching and training professions. What was lost from view were the well documented observations on differences between individuals in their capacities for increasing strength in skeletal muscle, which was apparently based chiefly on their genetic potential. Would it not seem likely that similar differences in the potential of heart muscle between individuals might also be present? Strong patterns of achievement in different sports among certain families from generation to generation appear to bear this out. Early studies of the effects of vigorous exercise on the heart reached a peak with the publication in 1924 of Heart and Athletics by Deutsch and Kauflt. The Heart Station in Vienna had been for many years the central place for the examination of the hearts of Austrian athletes, and these two physicians based their observations on the examinations of thousands of athletes of both sexes and a range of ages. In their introduction they stated: