Earlier in this century there was considerable debate about whether the enlarged hearts of athletes were in fact unhealthy hearts. Today, athlete's heart is recognized as a benign condition with no dangerous consequences. In fact, the health benefits of exercise are well-established, the primary one being a reduced risk of developing cardiovascular disease. A long-term study of more than 17,000 middle-aged men released last year by the Harvard School of Public Health concluded that the harder a person works out, the healthier he will be and the longer he will live.
The role of the heart in sports is the ultimate inside story, if you will, and viewing an event or a game from the heart's perspective can cast an intriguing light on a familiar spectacle. Take basketball, which experts agree is the most demanding of the three major U.S. team sports in terms of the load it puts on the heart and the level of cardiovascular fitness it requires. While the hearts of elite basketball players may not compare with the hearts of elite runners or cyclists, they are still mighty engines. And a basketball game, especially when played by professional or top college teams, is a virtual showcase for the heart. It is 10 hearts, in fact, engaged in a grueling combination of aerobic and anaerobic exercise. Ten hearts pumping, 10 heartbeats rising and falling with the flow of the action, faster as the pace of play suddenly accelerates and the teams charge from basket to basket in an intense flurry of scoring, then slower as the action ebbs. Faster and slower, faster and slower; the highly tuned hearts smoothly adjust, and the blood and oxygen flow to the hungry muscles.
A man who understands the importance of cardiac fitness in big-time basketball as well as anyone is cardiologist Larry Rink. For the past 18 years Rink has been a physician for the Indiana basketball team, and he has accumulated a mountain of data concerning the cardiopulmonary function of college basketball players. In 1978 Hoosiers coach Bobby Knight asked Rink to take a look at a player who was experiencing fatigue and shortness of breath during games and workouts. After an elaborate series of tests, all of which came up negative, Rink concluded that the athlete's problem wasn't medical—he simply didn't have the physical capacity to excel at the major college level.
"We did not know much about elite college basketball players," Rink says. "We really didn't know what they should be able to do. And that led to my interest in exercise physiology."
Working with Knight and the Indiana basketball staff, Rink developed a program to assess the condition of the hearts and lungs of all the Hoosiers players. "It's a detailed method to look at the athlete's cardiopulmonary function, relate it to what he's doing on the court, create a specific training program for him and compare his performance with that of other elite athletes who are of similar size and weight," the doctor explains. More important, Rink's program enables him to screen athletes for a whole range of health problems, from life-threatening diseases and abnormalities of the heart to less serious conditions such as exercise-induced asthma.
As a means of enhancing the Hoosiers' performance, Rink's system has evolved into a secret weapon of sorts. Rink politely declines to elaborate on certain details, because he doesn't want to reveal what he calls "proprietary information." But he describes the basics of his system, which include measuring aerobic capacity (the ability to consume oxygen), anaerobic threshold (the point during exercise at which muscles begin to produce significant amounts of lactic acid, causing discomfort such as cramps) and "peak flow" (the rate at which air enters the lungs at peak exercise).
In addition, Rink, who was the head physician for the '92 U.S. Olympic track and field team, does echocardiograms on all the Hoosiers players, and the echo data he has accumulated since 1978 confirms that the Indiana basketball training program leads to the development of athlete's heart. "Our basketball players' left ventricular muscle mass increases 10 percent to 15 percent from the time they enter school until the start of their second year," Rink says. "Then it seems to stay stable for the rest of their time in school. Rarely, when we get a freshman in basketball, does his heart look any different from the heart of a guy on the street."
In the 1980s Rink did a study that compared freshman basketball players with classmates who were not athletes. He found that while the two groups' hearts were equivalent in size at the start of their first year on campus, by the beginning of their second year the players' heart muscles were thicker. Rink says other elite Division I basketball programs probably produce players with athlete's heart: "Though our program may be more scientific, I don't think we have any magic formula here."
It may not be magic, but it is definitely a formula. Rink processes certain test results and comes up with an overall cardiopulmonary score for each player. Using these scores, Rink and Knight compared Indiana teams from various years and made a remarkable finding. "The three best teams we ever tested," says Rink, "were the 1981 team, which won the national championship; the 1987 team, which won the championship; and the 1992-93 team, which was ranked Number 1 in the nation until Alan Henderson blew out his knee. I feel quite confident we would have won the national championship that year as well." Such a strong link between the lab and the real world is rare in medical science, as Rink acknowledges: "The correlation is amazing."
Whether a similar relationship exists between heart size and athletic achievement is a subject of some speculation among experts. "There have been suggestions in the medical literature that the more elite the athlete, the greater the changes in the athlete's heart," says Rink. His work with 166 U.S. Olympic athletes in Barcelona "certainly conformed with that," he adds. "These guys were at the upper end in all the measurements."