Study finds female elite athletes’ hearts adapt differently to training than males’
A new study led by Amsterdam UMC in collaboration with NOC*NSF, the Dutch Olympic Committee and Sports Federation, reveals that the hearts of female elite athletes adapt differently to intensive training than those of male athletes.
The findings, based on detailed MRI scans of 173 female elite athletes, show that women’s hearts primarily develop wider heart chambers rather than the thickened heart muscles typically seen in male athletes. This discovery could improve early detection of heart disease in female athletes by helping doctors better distinguish between normal sports-related heart changes and potential heart conditions.
Despite growing awareness of biological differences between men and women in healthcare, women have historically been underrepresented in medical research, especially in sports cardiology. Harald Jorstad, a sports cardiologist at Amsterdam UMC and lead researcher on the study, said, “Women still rarely appear in heart research, especially regarding the athlete’s heart. Thanks to our collaboration with NOC*NSF, we have now gained knowledge about anatomical adaptations in the hearts of female elite athletes.”
The study used MRI scans to examine the hearts of female elite athletes at the tissue level. These were compared to the hearts of women who do not engage in elite sports. Jorstad explained, “We observed that in female athletes, the heart chambers widen significantly while the heart muscle thickens only slightly, and the heart tissue retains normal characteristics. This differs from male athletes, where the heart muscle frequently becomes both thicker and wider than in non-athletes, a feature also seen in heart disease.”
This difference is critical because a thickened heart muscle in female athletes may indicate heart disease rather than a normal adaptation to training. “Previously, a thickened heart muscle in a female athlete was often attributed to elite sports,” Jorstad said. “Now we know it requires extra scrutiny as it could be a sign of disease.” He stressed the importance of understanding sex-specific heart adaptations to prevent misdiagnoses: “It is vital to know what is normal in both male and female athletes to properly identify heart disease.”
The study also found that the heart’s adaptation varies depending on the type of sport. Maarten van Diepen, a sports cardiology researcher at Amsterdam UMC, noted, “Female endurance athletes, such as cyclists, had the largest heart chambers and most heart muscle mass compared to strength athletes like gymnasts. This shows that the heart adapts differently depending on the type of physical load.”
The research highlights the necessity of incorporating both the athlete’s sex and their sporting background into cardiac evaluations. Jorstad said, “This prevents missing heart disease in women or wrongly diagnosing a healthy female athlete’s heart as diseased, which could unnecessarily end her career.” He added, “Better knowledge about the female athlete’s heart helps doctors determine whether the heart changes are normal adaptations or require further examination. Ultimately, this can improve guidance and protection for female athletes at all levels, from professionals to recreational sportswomen.”
