For more than a century, it has been well known that athletes benefit from hearts that are larger. Indeed, Sir William Osler appropriately recognized the importance of both genetic endowment and physical training in creating a heart that conferred advantage in athletic competition when he opined in 1892: "In the process of training, the getting of wind as it is called, is largely a gradual increase in the capability of the heart The large heart of athletes may be due to the prolonged use of their muscles, but no man becomes a great runner or oarsman who has not naturally a capable if not large heart." Unfortunately, at the turn of the past century, many believed that the cardiac changes that resulted from vigorous exercise were potentially deleterious to the athlete's health.
These misconceptions were eventually dispelled, and work in the early 20th century by Deutsch and Kauf6 helped ground our understanding of the athletic heart. They systematically studied the radiographic dimensions of thousands of hearts of athletes of all ages at the Vienna Heart Station by measuring the transverse diameter of the hearts of male and female competitors in 16 sports and compared them to published norms. Not surprisingly, the average heart size for male competitors exceeded norms by 30% to 40%, and the average heart size for female competitors exceeded norms by 4% to 12%. Older athletes and those who had trained longer had the largest transverse diameters.
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