Structural Differences in Physiological Cardiac Hypertrophy Induced by Endurance and Resistance Exercise: A Systematic Review

Jennifer Natalia, Putri Karisa, Akhbar Dwi Aprilliyanto, Nova Sylviana, Leonardo Lubis

Abstract


Regular physical exercise induces physiological cardiac hypertrophy, although the structural remodeling pattern differs according to exercise modality. This systematic review compared the structural characteristics of exercise-induced cardiac hypertrophy following endurance and resistance training in healthy humans and animal models. A systematic search of PubMed, ScienceDirect, and SpringerLink was conducted to identify studies published between 1 January 2020 and 10 March 2026, in accordance with the PRISMA 2020 guidelines. Eligible studies included randomized controlled trials and longitudinal interventions involving at least four weeks of endurance or resistance exercise with structural cardiac outcomes. Risk of bias was assessed using the ROBINS-I tool for human studies and the SYRCLE tool for animal studies. Findings were synthesized narratively because of methodological heterogeneity. Nine studies were included in this systematic review, comprising three human studies and six animal studies. All studies evaluating resistance training were conducted in human longitudinal cohorts. Endurance training predominantly induced eccentric remodeling, characterized by increased left ventricular mass and chamber dimensions with preserved relative wall thickness, although concentric and mixed phenotypes were also observed, particularly with higher training intensities. Resistance training generally produced concentric or mixed hypertrophy associated with pressure overload. Among studies reporting cardiac functional outcomes, systolic function was generally preserved. These findings provide preliminary evidence that exercise modality and intensity may influence cardiac remodeling and may help guide future research on individualized exercise prescriptions, particularly in human populations.

Keywords


cardiac remodeling, endurance exercise, physiological cardiac hypertrophy, resistance exercise

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DOI: https://doi.org/10.17509/jpjo.v11i2.104332

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