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Influence of Body Composition, Hemoglobin Concentration, and Cardiac

Size and Function of Gender Differences in Maximal Oxygen Uptake in
Prepubertal Children

Article in Chest · November 2003

DOI: 10.1378/chest.124.4.1494 · Source: PubMed

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 Influence of Body Composition,
Hemoglobin Concentration, and Cardiac
Size and Function of Gender
Differences in Maximal Oxygen Uptake
in Prepubertal Children*
Agnès Vinet, PhD; Stéphane Mandigout, PhD; Stéphane Nottin, PhD;
LongDang Nguyen, MD; Anne-Marie Lecoq, MD; Daniel Courteix, PhD; and
Philippe Obert, PhD

Objective: To determine the relative contribution of the gender difference in body composition,
blood hemoglobin concentration, and cardiac dimension and function at rest and exercise of the
gender difference in maximal oxygen uptake (V̇O2max) in 10- to 12-year-old children.
Subjects: Thirty-five healthy children (17 girls and 18 boys; mean ! SD age, 10.5 ! 0.4 years).
Experimental design: An anthropometric evaluation (body surface area, body fat content, and lean
body mass [LBM]), assessment of hemoglobin concentration, echocardiographic evaluation at
rest (left ventricular dimensions, and diastolic and systolic indexes at rest), and cardiovascular
evaluation during a maximal cycle exercise (stroke volume [SV], total peripheral resistance).
Results: The boys exhibited a higher mass-relative V̇O2max than the girls (47.9 mL/kg/min vs 40.9
mL/kg/min, respectively); but when normalized for LBM (allometric equation), the difference
totally disappeared (19.0 mL/kg LBM1.33/min vs 18.9 mL/kg LBM1.33/min, respectively). No
significant gender differences were seen in maximal heart rate and arteriovenous oxygen
difference; however, maximal SV (SVmax) was significantly higher in boys than in girls, but when
expressed relative to LBM, the difference was no longer significant.
Conclusions: These findings demonstrate that contrary to adults, the sole limiting factor of V̇O2
that distinguished boys from girls was a lower SVmax in the latter; however, this gender
difference totally disappeared when normalized for LBM. Consequently, the gender difference
in heart size and cardiac function during exercise should be interpreted as only one aspect of the
lower LBM in girls and not as reflective of a more basic functional gender difference.
(CHEST 2003; 124:1494 –1499)

Key words: cardiac size; children; maximal oxygen uptake; stroke volume

Abbreviations: A ! peak velocity of atrial contraction filling; BSA ! body surface area; DAVO2 ! arteriovenous
oxygen difference; E ! peak velocity of early diastolic rapid inflow; EF ! ejection fraction; HR ! heart rate;
IVST ! interventricular septal thickness; LBM ! lean body mass; LVID ! left ventricular end-diastolic dimension;
LVM ! left ventricular mass; PWT ! posterior wall thickness; Q ! cardiac output; SF ! shortening fraction;
SV ! stroke volume; SVmax ! maximal stroke volume; TPR ! total peripheral resistance; V̇o2 ! oxygen uptake;
V̇o2max ! maximal oxygen uptake; VTI ! velocity curve over time

*From Laboratoire de Physiologie des Adaptations Cardiovascu-

laires à l’exercice (Drs. Vinet, Nottin, and Obert), Avignon;
I (V̇o
n the exercising human, maximal oxygen uptake
max) can be potentially limited by each step
2

Laboratoire de la Performance Motrice (Drs. Mandigout and

Courteix), Orléans; and Laboratoire d’Exploration Fonctionnelle
Respiratoire (Drs. Nguyen and Lecoq), Orléans, France.
Manuscript received April 30, 2002; revision accepted March 27,
2003.
Reproduction of this article is prohibited without written permis-
sion from the American College of Chest Physicians (e-mail:
permissions@chestnet.org).
Correspondence to: Agnès Vinet, PhD, Laboratoire de Physiologie
des adaptations cardio-vasculaires à l’exercice, Département
STAPS, Faculté des Sciences, 33 Rue Louis Pasteur, 84000
Avignon, France; e-mail: agnes.vinet@univ-avignon.fr
of the oxygen pathway from the atmosphere to the
mitochondria: (1) the pulmonary diffusing capacity,
(2) the cardiovascular system, (3) the oxygen-carry-
ing capacity of the blood, and (4) the muscle oxida-
tive characteristics. Of particular importance is the
cardiac system (function and/or size).1
In adults, gender difference in V̇o2max is usually
reported with higher values in men than in women
whether V̇o2max is expressed in absolute terms or
relative to body mass. Expressing V̇o2max relative

1494 Clinical Investigations

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 to fat-free mass or lean body mass (LBM) re-
duces but does not eliminate this difference.2
Other factors mainly linked to the oxygen-carrying
capacity and cardiac size have been shown to
contribute significantly to this gender-related dif-
ference.2–5
In prepubertal children, results in the literature
are much more controversial than in adults. When
body size is taken into account, few studies re-
ported similar V̇o2max in boys and girls6; however,
V̇o2max was reported as being lower in the lat-
ter.7–9 A difference in body composition and espe-
cially in body fat mass content could explain these
results. Sunnegardh and Bratteby10 and Rowland
et al9 reported V̇o2max relative to fat-free mass
(estimated from the indirect method of skinfold
thickness) statistically higher in boys than in girls.
Whether the same factors as those reported in
adults in order to explain the gender-related dif-
ference in V̇o2max are involved in children re-
mains to be elucidated. According to the Fick
equation, gender differences must be explained by
variance in heart rate (HR), stroke volume (SV),
and arteriovenous oxygen difference (DAVO2).
Cardiac output (Q̇) at a given submaximal work
rate has been reported to be higher,11 lower,12 or
the same6,13 in boys compared to girls. Most
literature studies reported that SV was higher and
HR was lower in boys than in girls at a given
absolute submaximal rate. At maximal exercise,
only SV differentiated boys from girls.6,9 Such a
gender effect was attributed by certain authors to
a higher left ventricular mass (LVM) in boys,6
whereas others9 did not observe any difference in
resting echocardiographic measures. To the best
of our knowledge, only Rowland et al9 focused on
the impact of cardiac function and size as well as
body composition on the gender-related differ-
ence in V̇o2max in children. These authors showed
that cardiac functional capacity (ie, SV) as well as
body composition account for the differences in
V̇o2max between prepubertal boys and girls.
Thus, it is not clear how the gender differences in
overall cardiac dimension are related to the gender
difference in V̇o2max, and it is unknown whether
heart size differences between boys and girls reflects
only the general body size (in particular of LBM), or
if more fundamental functional differences exists.
This study was therefore designed to determine the
relative contribution of the potential gender differ-
ence in body composition, blood hemoglobin con-
centration, and cardiac dimension and function at
rest and exercise to the gender difference in V̇o2max
in 10- to 12-year-old children.
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Materials and Methods
Subjects
Thirty-five healthy children (17 girls and 18 boys) participated
in the entire experiment. All were volunteers from a local school
who were examined clinically on the day of the test, and their
pubertal status was assessed.14 Any child exhibiting signs of
pubertal development was excluded from taking part. This study
received approval from the local ethics committee, and written
informed consent was obtained from all the children’s parents.
All children were active but not participating in formal training or
organized sports.
Experimental Procedures
Firstly, an anthropometric evaluation, a capillary blood sample
for the measurement from blood hemoglobin concentration, and
M-mode, two-dimensional, and pulsed-wave Doppler echocardi-
ography analyses were conducted at rest in the supine position.
Then, cardiovascular and bioenergetic data were evaluated dur-
ing an upright maximal exercise test.
Anthropometric Variables: Body height and mass were mea-
sured with a wall stadiometer and a calibrated foot balance,
respectively. In addition, percentages of body fat mass and LBM
were assessed by means of dual radiograph absorptiometry on a
Hologic QDR-1000/W (Hologic; Waltham, MA).
Doppler Echocardiographic Measurements: At rest, the chil-
dren were examined by M-mode, two-dimensional, and Doppler
echocardiographic analyses on a Kontron Sigma HVD44 ultra-
sound imaging system (Kontron Medical; Plaisir, France), incor-
porating a 3.5-MHz annular array transducer. Investigations were
performed at rest with subjects in a supine position. Subjects
remained in this position for at least 15 min prior to the
examination. All echocardiographic measurements and calcula-
tions were obtained according to standard procedures recom-
mended by the American Society of Echocardiography, using the
leading-edge-to-leading-edge method. Methodology used was
previously described in Obert et al.15 The echocardiographic
parameters measured or derived included the following: left
ventricular end-diastolic dimension (LVID), posterior wall thick-
ness (PWT) at end diastole, interventricular septal thickness
(IVST) at end diastole, left ventricular shortening fraction (SF),
and ejection fraction (EF). LVM was calculated according to the
formula of Devereux et al.16
Moreover, the following measurements and calculations were
made: peak velocity of early diastolic rapid inflow (E), peak
velocity of atrial contraction filling (A), and E/A ratio. Where
appropriate, measurements were expressed relative to the indi-
vidual subject’s body surface area (BSA)17 according to the
recommendation of Daniels et al.18 The maximal systolic diam-
eter of the ascending aorta was also measured at rest before each
test by two-dimensional echocardiography in the parasternal
long-axis view with the subject in a pedaling position. The
measurement was recorded from inner to inner edge at the level
of the insertion of the aortic valve leaflets. The resting value,
assuming not to change during exercise, was used for all resting
and exercise SV calculations.19
During exercise, SV and Q̇ were estimated using the standard
Doppler echocardiography technique, according to the method-
ologic procedure used by Rowland et al.20 The feasibility and
accuracy of this technique as a method for noninvasively mea-
suring SV and Q̇ during exercise was previously investigated in
children in our laboratory.21 Briefly, SV was estimated as the
product of the aortic root area and integral of ascending blood
velocity and time. The velocity of blood in the ascending aorta
was recorded with a 2.0-MHz continuous-wave Doppler trans-
CHEST / 124 / 4 / OCTOBER, 2003 1495
 ducer (Pedof; Kontron Medical) directly from the suprasternal
notch. The outline contour of the velocity curve over time (VTI)
was traced manually. The end of each VTI was taken as the
observed closure of the aortic valve. Values for VTI were
averaged from five to seven curves, with the highest values
demonstrating crisp spectral envelopes. The cross-sectional area
of the ascending aorta was calculated from the mean diameter,
considering the aorta to be circular. The following derived
variables were calculated from primary measurements:
SV ! VTI " aortic root area; Q̇ ! SV " HR. DAVO2 was calcu-
lated as V̇o2Q̇.
All records were analyzed blindly on 2 separate days by an
experienced operator as well as on another day by a different
cardiologist in order to assess intraobserver and interobserver
variability, respectively. Since both intraobserver and interob-
server variability for the overall cardiac variables were low
(# 6%), values presented were those obtained by the first
cardiologist.
Maximal Exercise Protocol: Each child performed a continuous
and progressive exercise test to exhaustion on a bicycle ergometer
(Ergomeca; Toulon, France). During the test, the pedaling rate
was maintained constant at 70 revolutions per minute. After a
resting period sitting on the bicycle and a 3-min, 35-W warm-up
period, 17.5-W increments were applied in 3-min stages until the
pedaling rate could no longer be sustained. Cardiovascular
evaluation was performed during the final minute of each
workload and during the last minute of the test. During the first
30 s of the final minute of each workload, BP was measured.
Then, during the following 30 s, Q was assessed by the Doppler
technique.
Expired Gas Analysis: Oxygen uptake (V̇o2), ventilation, and
respiratory exchange ratio were determined continuously by
means of a gas analysis system (MedGraphics CPXD; Medical
Graphics Corporation; St. Paul, MN); inspired and expired gas
flow were monitored by means of a pneumotachograph con-
nected to a MedGraphics respiratory flow transducer. Gas con-
centrations were evaluated using rapidly responding gas analyz-
ers. Before each test, the gas analyzers were calibrated against
precision analyzed gas mixture (CO2, 4%; O2, 15%; precision,
0.1% certified by the manufacturer). V̇o2max was achieved when
three of the following criteria were respected: (1) a HR at a value
close to the theoretical maximal HR (210 $ 0.65 " age), (2) the
stability of V̇o2 in spite of the increase in workload, (3) the
impossibility for the subject to maintain the pedaling rate, and
(4) a respiratory exchange ratio % 1.1.
BP Measurements: Auscultatory cuff BP was obtained in
the left arm using manual sphygmomanometry according to the
report of the second task force on BP control in children.22 The
first Korotkoff sounds defined systolic pressure, and the fourth
Korotkoff sounds (muffling of the sound) defined diastolic pres-
sure. Mean arterial pressure was calculated as one third of the
pulse pressure plus the diastolic pressure. Total peripheral
resistance (TPR) was calculated as the quotient of mean arterial
pressure divided by Q̇.
Statistical Analysis
(mass, BSA or LBM), and a is a constant multiplier. To obtain b,
log transformation of both the Y and the X was performed,
and least-squares regression identified b in the equation
log(Y) ! log(a) ' blog(X). Differences between maximal cardio-
vascular variables were determined by analysis of covariance with
LBM as covariate. The comparison of cardiac variables in the
boys and the girls during rest and exercise was performed by a
two-way analysis of variance (sex, intensity) with repeated mea-
sures. When a significant interaction was found, a post hoc
Scheffe test was used. Regression equations between Q̇ and V̇o2
were calculated from submaximal values, and the differences in
terms of the slopes and intercepts were evaluated by a covariance
of heterogeneous regression lines (SPSS; Chicago, IL). Statistical
significance for all analyses was defined as p # 0.05.
Results
The physical characteristics of the children are
reported in Table 1. No significant differences were
observed between the boys and girls in height and
body mass. Girls tended to have higher body fat mass
content, but the difference failed to reach statistical
significance; however, LBM was higher in the boys
than in girls. Hemoglobin concentration was similar
in both groups.
Resting echocardiographic data are outlined in
Table 2. The aortic diameter was higher in the boys
than in the girls, but when expressed relative to
LBM0.208, the difference was no longer significant
between groups. The systolic function index, as
estimated from SF and EF, and the diastolic func-
tion index, as evaluated from E and A, and E/A ratio
were similar in the two groups. The boys had
significantly higher LVID, PWT, IVST, and LVM
expressed in absolute terms and relative to BSA than
the girls; however, when expressed relative to LBM
(allometric equation), all the above variables were no
longer significantly different between groups.
Physiologic variables at maximal exercise are pre-
sented in Table 3. No significant differences were
observed either in maximal HR, maximal DAVO2, and
maximal TPR between the boys and girls. Mean
V̇o2max expressed in absolute terms and relative to
body mass were significantly higher in the boys than in
Table 1—Physical Characteristics of the Subjects
Boys (n ! 17) Girls (n ! 18)

The results are presented as mean & SD. Two submaximal Variables Mean SD Mean SD
exercise intensities were chosen at approximately 60% and 80%
Age, mo 126.9 3.8 126.6 5
of V̇o2max. Nonparametric test comparisons of physical charac-
Height, cm 143.6 4.6 139 5.8
teristics and cardiovascular variables between boys and girls were
Body mass, kg 37.9 5.4 34.5 5.5
performed after values were adjusted to body size by traditional
Body fat mass, % 20.05 7.9 23.4 5.8
anthropometric measures (body mass, BSA) and by allometric-
LBM, kg 30.5* 1.9 25.7 2.8
derived anthropometric variables calculated from these specific
BSA, m2 1.22 0.12 1.19 0.12
subject populations. In the latter analysis, the scaling exponent b
Hemoglobin, g/dL 13.4 1.5 13.9 1.3
was identified in the allometric equation Y ! aXb, where Y is the
physiologic variable, X is the anthropometric scaling variable *Significant difference (p # 0.05) between boys and girls.

1496 Clinical Investigations

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 Table 2—Echocardiographic Data* Table 3—Physiologic Variables at Maximal Exercise

Boys Girls Boys Girls

Variables Mean SD Mean SD Variables Mean SD Mean SD

Aortic diameter HR, beats/min 200 8 203 6

mm 16.5† 0.7 15.8 0.8 V̇o2
mm BSA0.5 18.3† 1.3 17.0 1.3 mL/min 1801* 279 1422 273
mm/kg 8.2 0.3 8.1 0.4 mL/kg/min 47.9* 7 41.7 7.4
LBM0.208 mL/kg LBM/min 58.7 8 55.1 6.7
LVIDd mL/kg LBM1.33/min 19.0 2.5 18.9 2.2
mm 43† 3 40.3 2 SV
mm BSA0.5 37.5† 1.5 38.8 1.6 mL 64.1* 10.1 53.9 6.8
mm/kg 11.1 0.5 10.9 0.5 mL/m2 52.1* 6.1 47 6.6
LBM0.401 mL/kg LBM0.792 4.4 0.6 4.2 0.4
IVSTd Q̇
mm 6.8† 1.1 5.8 0.7 L/min 12.8* 2.3 10.9 1.4
mm BSA0.5 6.1† 0.9 5.4 0.7 L/min/m2 10.4* 1.4 9.5 1.4
mm/kg 0.9 0.1 0.9 0.1 L/min/kg LBM0.763 0.97 0.16 0.94 0.1
LBM0.572 DAVO2, mL/100 mL 14.2 2.2 13 2.1
PWTd TPR, U 7.1 1.1 7.4 1.1
mm 6.3† 0.7 5.5 0.8
*Significant difference (p # 0.05) between boys and girls.
mm BSA0.5 5.7† 0.6 5.1 0.7
mm/kg 0.7 0.1 0.6 0.1
LBM0.651
LVM
g 83.1† 20.8 61.5 10.4 SV kinetics from rest to maximal exercise are pre-
g BSA1.5 55.1† 11.1 42.0 9.1 sented in Figure 1. For both boys and girls, SV
g/kg 0.59 0.1 0.54 0.1 increased significantly from rest to moderate intensity
LBM1.455 and then reached a plateau; however, the SV pattern in
EF, % 72.1 5.8 71.9 5.04
SF, % 35.0 5.0 34.7 4.1
boys was displaced upward when compared to girls.
E, cm/s 93.4 9.1 96.3 15 Moreover, the maximal SV (SVmax)/SV at rest ratio was
A, cm/s 46.4 1.1 48.3 8.4 similar in the two groups (boys, 1.39 & 0.19; girls,
E/A ratio 2.1 0.1 2.04 0.4 1.40 & 0.21; not significant). The regression equations
TVI-T, cm/s 21.5 3.1 20.9 4.2 between Q̇ (liters per minute) and V̇o2 (liters per
*LVIDd ! left ventricular internal diameter in diastole; minute) were as follows:
IVSTd ! IVST at end diastole; PWTd ! posterior wall thickness at
end distaole; TVI-T ! TVI of the total diastolic filling period. Boys Q̇ ! 3.04 ' (6.14 " V̇o2)
†Significant difference (p # 0.05) between boys and girls.
Girls Q̇ ! 2.27 ' (7.12 " V̇o2)
The slopes as well as the intercepts of these two
the girls. When normalized to LBM, V̇o2max was no relationships were not significantly different be-
longer significantly different between groups. More- tween the two groups.
over, when LBM was statistically controlled as covari-
ate, mean absolute V̇o2max was similar in both groups.
At rest, the boys and the girls exhibited similar Q Discussion
with, however, higher HR and lower SV in girls than
in boys. Moreover, when HR was statistically con- The major finding of the present study was that
trolled as covariate, SV was still significantly different gender differences in V̇o2max in children were due
between the boys and girls. principally to absolute SV differences given that HR
During exercise, whatever the relative intensity and DAVO2 were similar in boys and girls. However,
(ie, 60%, 80%, and maximum), the boys demon- allometric normalization of absolute SV for LBM
strated larger absolute and BSA relative values for totally eliminated this gender difference, and accord-
SV than girls; however, HR values were similar in ing to power calculation the group size was suffi-
the two groups. Consequently, absolute and BSA- cient. Consequently, gender difference in V̇o2max in
relative Q̇ at high intensity (ie, 80%) and maximal children only appears to be a reflection of differ-
intensities were higher in boys than in girls. When ences in body composition but not in cardiac func-
expressed relative to LBM (allometric equation), tional capacity.
both SV and Q̇ were no longer different between the The magnitude of gender difference in aerobic
boys and girls. Such results were confirmed by the fitness in this sample of subjects reflects that ob-
analysis of covariance using LBM as covariate. served in previous studies in children. The boys

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 Figure 1. Mean (SD) SV at rest, and during submaximal and maximal exercise in boys and girls.
*Significant difference (p # 0.05) between boys and girls.
exhibited a higher mass-relative V̇o2max than girls
(47.9 mL/kg/min vs 40.9 mL/kg/min, respectively).
Higher V̇o2max in 11- to 12-year-old boys than in
girls was already reported by Miyamura and Honda23
(46.8 mL/kg/min vs 41.6 mL/kg/min, respectively) and
by Rowland et al9 (47.2 mL/kg/min vs 40.4 mL/kg/min,
respectively) on cycle testing. In the present study,
differences in body composition were essentially
responsible for this gender difference. Indeed, after
allometric normalization of absolute V̇o2max for
LBM (Table 3), differences between our boys and
girls totally disappeared (1%, not significant). Such
an influence of body composition on gender differ-
ences in V̇o2max has been already reported in
previous studies.9,10
In the present work, among the limiting physio-
logic factors of V̇o2max, only SV was significantly
different in the boys and girls. Indeed, hemoglobin
concentration was similar between both genders
(13.4 g/dL and 13.9 g/dL, respectively), which agrees
with previous studies in children6,12 and could ex-
plain in part the similar submaximal and maximal
DAVO2 in these two groups. Maximal HR was
similar in the boys and girls; consequently, the
gender difference in SVmax was responsible for
virtually all of the effect of gender on maximal Q̇ and
then V̇o2max. These results differ from those in
adults showing that both central cardiac factors and
peripheral ones, mainly associated with the dimin-
ished oxygen-carrying capacity in women, are in-
volved in order to explain the gender-related differ-
ence in V̇o2max.2 However, our results are in
accordance with the only study9 that investigated the
1498
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impact of body composition and cardiac size and
function in prepubertal boys and girls.9 Rowland et
al9 also reported that gender-related difference in
V̇o2max in children was only a reflection of higher
SVmax in boys than in girls. They reported, however,
that cardiac functional capacity as well as body
composition account for the differences in V̇o2max
between prepubertal children. Indeed, differences
between boys and girls regarding SVmax were re-
duced but still persisted after body size and compo-
sition (ie, fat-free mass) were taken into account,
which disagree therefore with the results of our
experiment.
SV depends largely on cardiac size and function.
In our study, girls exhibited reduced cardiac dimen-
sions (LVID, IVST, and PWT) and LVM when
compared to boys. Similar results were reported by
Turley and Wilmore6 (78.8 g vs 66 g, respectively). In
our work, LVM was moreover significantly corre-
lated with SVmax (r ! 0.44, p # 0.05). Thus, it is
likely that differences in cardiac size may mainly
contribute to the lower SV at rest and during exercise
in girls. The reduced cardiac size in our girls,
however, seems to be principally a reflection of their
reduced overall body size and especially LBM. In-
deed, when SV, left ventricular dimensions, and
LVM were expressed relative to LBM (allometric
equation), differences between boys and girls were
no longer significant. Batterham et al5 already re-
ported reduced but still significant differences in
LVM values when expressed relative to LBM (allo-
metric equation) in adults. Rowland et al9 did not
observe any differences in resting left ventricular
Clinical Investigations
 dimensions as well as SV at rest in their boys and
girls. In the present study, the patterns of SV
response from rest to maximal exercise were similar
in both groups. Moreover, contrary to Rowland et
al,9 no significant differences were observed be-
tween the boys and the girls in the ratio of peak to
resting SV. These results would suggest that vari-
ables influencing the increase in SV at rest are
probably critical in determining SVmax and rein-
forced the predominant effect of cardiac size on
gender-related difference in SV. Beside cardiac size,
SV depends on other factors, such as left ventricular
relaxation and compliance properties, as well as
preload and afterload conditions. In our study, in
accordance with Turley and Wilmore,6 no difference
existed between boys and girls in submaximal and
maximal TPR, which suggested similar afterload
conditions during exercise. Even if obtained during
resting conditions and consequently not transposable
to exercise, our data also indicated no significant
gender differences in all diastolic function indexes
(E, A, E/A ratio) as well as SF and EF, which suggest
similar left ventricular filling and overall myocar-
dium contractility characteristics between the boys
and the girls. Preload can influence cardiac filling
and therefore SV. In our study, E, a diastolic func-
tion index largely influenced by preload,24 was sim-
ilar between boys and girls. Thus, it is unlikely that
overall cardiac contractility, relaxation, and compli-
ance properties as well as loading conditions may
have contributed to the gender-related difference in
SVmax. Therefore, it appears that cardiac size rather
than function explain the gender difference in SV.
To conclude, the findings of the present study
demonstrate that contrary to adults, the sole limiting
factor of V̇o2max that distinguished boys from girls
was a lower SVmax in the latter. However, this
gender difference totally disappeared when normal-
ized for LBM. Consequently, the gender difference
in heart size and cardiac function during exercise
should be interpreted as only one aspect of the lower
LBM in girls and not as reflective of a more basic
functional gender difference.
ACKNOWLEDGMENT: We thank Mrs. Margaret Manson for
her assistance with the English.
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