Summary • Three primary physiological factors have been associated with success in elite endurance events: V02max the anaerobic/lactate threshold, and efficiency. • Athletes and coaches should not overlook the importance of a high VO2max for optimal endurance performance. • Recent evidence has re-established V02max as important indicator of potential for success in elite endurance sports. • Cardiac function, through its central role in oxygen delivery, is a key determinant of aerobic capacity and performance in elite endurance athletes. • Cardiac output plays a central role in the determination of V02max and the separation of elite athletes from moderately trained, untrained, and clinical populations. • The major cardiac adaptation to endurance training appears to be an enhanced capacity for ventricular filling and ability to use the Frank-Starling mechanism during exercise conditions. • Key factors responsible for this capacity include enhancements in LV compliance, increased cardiac dimensions, reduced pericardium-mediated diastolic ventricular interaction, enhanced diastolic suction, and changes in vascular volumes. • Endurance-trained athletes demonstrate marked improvements in exercise diastolic filling, EDV, and SV. • The enhanced cardiovascular function of elite endurance athletes is related to a series of factors including (but not exclusive to) increased ventricular compliance, reduced diastolic ventricular interaction and pericardial constraint, increased cardiac dimensions, increased diastolic filling, enhanced diastolic suction, training-induced hypervolemia, increased rate of LV pressure decline (-dP/dt), and/or increased rate of calcium uptake within the sarcoplasmic reticulum. • The cardiac adaptations to endurance training are interrelated allowing for the enhanced cardiovascular function and endurance performance of elite endurance athletes.
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