{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T21:48:28Z","timestamp":1793656108645,"version":"4.5.1"},"reference-count":252,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation Research"],"published-print":{"date-parts":[[2025,7,7]]},"abstract":"<jats:p>The athlete\u2019s heart, formally introduced by Henschen and Darling in 1899 through observations of cardiac enlargement in endurance athletes, has evolved from a clinical curiosity to a recognized physiological adaptation. Even before this naming, similar constructs such as the soldier\u2019s heart in military recruits and the runner\u2019s heart in distance athletes suggested early observations of exercise-associated cardiac remodeling\u2014often pathologized or mischaracterized. Today, this phenomenon is understood as exercise-induced cardiac remodeling, comprising structural, functional, and electrical changes that support the demands of sustained athletic performance. This compendium review examines the full spectrum of exercise-induced cardiac remodeling. We begin by tracing the historical context of how the athlete\u2019s heart was discovered and progressively understood. We then explore the morphological and functional adaptations that arise with different exercise modalities, distinguishing between endurance and resistance training effects. The review further investigates the molecular and genetic underpinnings of exercise-induced cardiac remodeling, leveraging data from both human subjects and experimental animal models. We also address the clinical challenges posed by exercise-induced cardiac remodeling, including its phenotypic overlap with cardiomyopathies, such as hypertrophic, dilated, and arrhythmogenic right ventricular cardiomyopathy. These overlaps complicate athlete evaluation and risk stratification, particularly in preparticipation screening and return-to-play decisions. Finally, we explore concerns regarding the long-term effects of high-volume endurance training, including potential maladaptation. Together, this review offers a synthesis of current knowledge and a window into the athlete\u2019s heart. By integrating perspectives from history, physiology, molecular biology, and clinical cardiology, we aim to highlight the distinctiveness of this phenotype and why it warrants focused scientific inquiry.<\/jats:p>","DOI":"10.1161\/circresaha.125.325638","type":"journal-article","created":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T14:00:17Z","timestamp":1751551217000},"page":"231-254","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Athlete\u2019s Heart Revisited: Historical, Clinical, and Molecular Perspectives"],"prefix":"10.1161","volume":"137","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0899-2029","authenticated-orcid":true,"given":"Paishiun Nelson","family":"Hsieh","sequence":"first","affiliation":[{"name":"Cardiovascular Performance Program, Mass General Brigham Heart and Vascular Institute (P.N.H., M.I.C., T.W.C., K.M.S., R.B.W., J.S.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siman","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine (S.S., H.L.)"},{"name":"Massachusetts General Hospital, Boston, MA (S.S., H.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3515-5432","authenticated-orcid":true,"given":"Marius I.","family":"Chukwurah","sequence":"additional","affiliation":[{"name":"Cardiovascular Performance Program, Mass General Brigham Heart and Vascular Institute (P.N.H., M.I.C., T.W.C., K.M.S., R.B.W., J.S.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0215-3049","authenticated-orcid":true,"given":"Timothy W.","family":"Churchill","sequence":"additional","affiliation":[{"name":"Cardiovascular Performance Program, Mass General Brigham Heart and Vascular Institute (P.N.H., M.I.C., T.W.C., K.M.S., R.B.W., J.S.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie M.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Cardiovascular Performance Program, Mass General Brigham Heart and Vascular Institute (P.N.H., M.I.C., T.W.C., K.M.S., R.B.W., J.S.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7514-627X","authenticated-orcid":true,"given":"Eugene H.","family":"Chung","sequence":"additional","affiliation":[{"name":"Demoulas Center for Cardiac Arrhythmias, MGB Heart and Vascular Institute (E.H.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rory B.","family":"Weiner","sequence":"additional","affiliation":[{"name":"Cardiovascular Performance Program, Mass General Brigham Heart and Vascular Institute (P.N.H., M.I.C., T.W.C., K.M.S., R.B.W., J.S.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5660-7835","authenticated-orcid":true,"given":"Haobo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Critical Care, and Pain Medicine (S.S., H.L.)"},{"name":"Massachusetts General Hospital, Boston, MA (S.S., H.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0992-5635","authenticated-orcid":true,"given":"James Sawalla","family":"Guseh","sequence":"additional","affiliation":[{"name":"Cardiovascular Performance Program, Mass General Brigham Heart and Vascular Institute (P.N.H., M.I.C., T.W.C., K.M.S., R.B.W., J.S.G.)"},{"name":"Cardiovascular Research Center, Massachusetts General Hospital, Boston (J.S.G.)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","first-page":"15","article-title":"Skidlauf und skiwettl auf. eine medizinische sportstudie.","volume":"2","author":"Henschen S","year":"1899","unstructured":"Henschen S. 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