Howden · Journal of applied physiology (Bethesda, Md. : 1985) 2015 · prospective non-randomized comparative cohort study · n=12

Females have a blunted cardiovascular response to one year of intensive supervised endurance training.

Cited 140 times in the scientific literature.

Level 3 - non-randomized controlled study

Prospective non-randomized comparative cohort study evaluating longitudinal physiological adaptations.

PubMed 25930024 · doi:10.1152/japplphysiol.00092.2015 · record verified 2026-08-29

What was done

Twelve previously sedentary adults (7 males aged 26 ± 7 years; 5 females aged 31 ± 6 years) completed a 1-year progressive endurance training program matched for exercise volume and intensity. Every 3 months, participants were evaluated for maximal oxygen uptake (VO2max) and left ventricular (LV) morphology and function using cardiac magnetic resonance imaging. Pulmonary artery catheterization was performed before and after training to assess pressure-volume and Starling curves under lower-body negative pressure and saline infusion.

What was found

Males showed progressive increases in VO2max, LV mass, and mean LV wall thickness, plateauing between months 9 and 12. In females, increases in VO2max, LV mass, and mean wall thickness plateaued after 3 months. Left ventricular end-diastolic volume increased similarly in both groups (+20% in males vs. +18% in females). Starling curves shifted upward and to the left post-training, with a trend toward a greater effect in males (interaction P = 0.06).

Why it matters

This study suggests that males and females have divergent cardiac remodeling trajectories during long-term endurance training, with females experiencing earlier plateaus in ventricular hypertrophy and VO2max gains despite identical training volume and intensity.

Limits

The sample size was very small (n = 12 total, including only 5 females). Absolute values and effect sizes for VO2max, LV mass, and wall thickness were not reported in the abstract. There was no non-exercising control group.

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