IJCS | Volume 31, Nº3, May/ June 2018

216 1. Henschen S. Skilanglauf und skiwettlauf: EineMedizinische Sportstudie. Mitt Med Klin Upsala (Jena). 1899;2:15-8. 2. MaronBJ,PellicciaA.Theheartoftrainedathletes:cardiacremodelingand the risk of sports, including sudden death. Circulation. 2006;114(15):1633- 44. doi: 10.1161/CIRCULATIONAHA.106.613562. 3. Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med. 1975;82(4):521-4. doi: 10.7326/0003-4819-82-4-521. 4. Dores H, Freitas A, Malhotra A, Mendes A, Sharma S. The hearts of competitive athletes: An up-to-date overview of exercise-induced cardiac adaptations. Rev Port Cardiol. 2015;34(1):51-64. doi: 10.1016/j. repc.2014.07.010. 5. Paterick TE, Gordon T, Spiegel D. Echocardiography: profiling of the athlete’s heart. J Am Soc Echocardiogr. 2014;27(9):940-8. doi: 10.1016/j. echo.2014.06.008. 6. Grazioli G, Sanz M, Montserrat S, Vidal B, Stiges M. Echocardiography in the evaluation of athletes. F1000Res. 2015 Jun 15;4:151. doi: 10.12688/ f1000research.6595.1. 7. Arbab-ZadehA, PerhonenM, Howden E, Peshock RM, Zhang R, Adams- Huet B, et al. Cardiac remodeling in response to 1 year of intensive endurance training. Circulation. 2014;130(24):2152-61. doi: 10.1161/ CIRCULATIONAHA.114.010775. 8. KemiOJ,HaramPM,LoennechenJP,OsnesJB,SkomedalT,WisloffU,etal. Moderate vs. high exercise intensity: differential effects on aerobic fitness, cardiomyocyte contractility, and endothelial function. Cardiovasc Res. 2005;67(1):161-72. doi: https://doi.org/10.1016/j.cardiores.2005.03.010. 9. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al; American College of Sports Medicine. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-59. doi: 10.1249/ MSS.0b013e318213fefb. 10. Mancia G, Fagard R, Narkiewicz, Redón J, Zanchetti A, Bohm M, et al. 2013 ESH/ESCGuidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology. J Hypertens. 2013;31(7):1281-357. doi: 10.1097/01. hjh.0000431740.32696.cc. 11. Sheikh N, Papadakis M, Ghani S, Zaidi A, Gati S, Adami PE, et al. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation. 2014;129(16):1637-49. doi: 10.1161/CIRCULATIONAHA.113.006179. 12. Evangelista A, Flachskampf F, Lancellotti P, Badano L, Aguilar R, Monaghan M, et al; European Association of Echocardiography. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr. 2008;9(4):438-48. doi: 10.1093/ejechocard/jen174. 13. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendationsforcardiacchamberquantificationbyechocardiography inadults:anupdatefromtheAmericanSocietyofEchocardiographyandthe European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003. References in activities and evaluations in which the physical component is central, in addition to conventional or scheduled physical exercise practice. Fifthly, the study protocol did not include the hydration level assessment of the evaluated individuals to verify whether it was similar at both moments of the evaluation and, finally, although they denied taking any stimulants, this fact was not proven either. Conclusion Intense military physical training causes additional cardiac remodeling in athletes of competitive level, both structural and functional. The characteristics of the physical exercise are conditioning factors of cardiac remodeling, and should be considered during the evaluation of these individuals. Author contributions Conception and design of the research: Dinis P, Dores H, Teixeira R. Acquisition of data: Dinis P, Moreno L, Mónico J, Bergman M, Lekedal H. Analysis and interpretation of the data: Dinis P. Statistical analysis: Dinis P. Writing of the manuscript: Dinis P, Dores H, Teixeira R. Critical revision of the manuscript for intellectual content: Dinis P, Dores H, Teixeira R, Cachulo MC, Cardoso J, Gonçalves L. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This article is part of the thesis of master submitted by Paulo Dinis, from Universidade de Coimbra. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Faculty of Medicine of the University of Coimbra under the protocol number 087/2015. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. Dinis et al. Cardiac Remodeling Induced by MilitaryTraining International Journal of Cardiovascular Sciences. 2018;31(3)209-217 Original Article