Sex differences in cardiovascular adaptations in recreational marathon runners

Jacqueline A. Augustine, Wesley K. Lefferts, Jacob P. DeBlois, Tiago V. Barreira, Beth A. Taylor, Kan Liu, Kevin S. Heffernan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: There are well-established sex differences in central hemodynamic and cardiac adaptations to endurance exercise; however, controversial evidence suggests that excessive endurance exercise may be related to detrimental cardiovascular adaptations in marathoners. Purpose: To examine left ventricle (LV) structure, LV function, 24-h central hemodynamics and ventricular–vascular coupling in male and female marathoners and recreationally active adults. Methods: 52 marathoners (41 ± 5 years, n = 28 female, completed 6 ± 1 marathons/3 years) and 49 recreationally active controls (42 ± 5 years, n = 25 female) participated in the study. Three-Dimensional Echocardiography (3DE) was used to measure LV mass index and LV longitudinal (LS) circumferential (CS), area (AS), and radial strain (RS). An ambulatory blood pressure (BP) cuff was used to measure 24-h central hemodynamics (BP, pulse wave velocity, PWV, wave reflection index, RIx). Hemodynamic and 3DE measures were combined to derive the ratio of arterial elastance (Ea) to ventricular elastance (Elv) as a global measure of ventricular–vascular coupling. Results: There were no sex or group differences in LS, CS, AS, and RS (p > 0.05). Females marathoners had similar aortic BP (116 ± 9 vs. 113 ± 1 mmHg), and PWV (5.9 ± 0.5 vs. 5.9 ± 1.1 m/s) compared to female controls but lower aSBP (116 ± 9 vs. 131 ± 10 mmHg) and PWV (5.9 ± 0.5 vs. 6.2 ± 0.5 m/s) compared to male marathoners (p < 0.05). Female marathoners had lower Ea/Elv than female controls (0.67 ± 0.20 vs. 0.93 ± 0.36) and male marathoners (0.67 ± 0.20 vs. 0.85 ± 0.42, p < 0.05). Conclusions: Women that have completed multiple marathons do not have reduced LV function or increased aortic stiffness and may have better ventricular–vascular coupling compared to male marathoners and their female untrained counterparts.

Original languageEnglish (US)
Pages (from-to)3459-3472
Number of pages14
JournalEuropean Journal of Applied Physiology
Issue number12
StatePublished - Dec 2021


  • Hemodynamics
  • Left ventricle
  • Marathons
  • Vascular stiffness
  • Women

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Public Health, Environmental and Occupational Health
  • Physiology (medical)


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