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Cardiac Adaptations Among Universiti Putra Malaysia Rugby 7’s Athletes
Afiqah JAMALI1, Azhar YAACOB1, Safuraa SALIHAN2, Mohamed Hanief KHALID3, Muhammad Zyuraidi ABDUL MAJID4
1Department of Sport Studies, Faculty of Educational Studies, UPM, Malaysia
2Department of Human Anatomy, Faculty of Medicine and Health Sciences, UPM, Malaysia
3Faculty of Medicine and Health Sciences, USIM, Malaysia
4Sports Academy, UPM, Malaysia
azhar_y@upm.edu.my
Abstract
Electrocardiography (ECG) is a crucial diagnostic instrument in sports medicine for identifying physiological cardiac adaptations and possible pathologies in athletes. Rugby 7's is a high-intensity contact sport that puts a lot of stress on the heart and lungs, which could change the rhythms of the ECG. The objective of this study was to investigate ECG findings in Universiti Putra Malaysia Rugby 7's athletes. Nineteen athletes (8 males, 11 females) performed a conventional resting 12-lead ECG evaluation. The results were divided into normal sinus rhythm, sinus bradycardia, sinus tachycardia, benign early repolarization (BER), and left ventricular hypertrophy (LVH). All subjects exhibited normal sinus rhythm. BER was found in 36.8% of athletes, with a higher prevalence in males (62.5%) compared to females (18.2%). One male athlete (5.3%) had LVH. There were no recorded instances of sinus bradycardia or tachycardia. Most of the Universiti Putra Malaysia Rugby 7's athletes had normal resting ECG patterns, with some benign variations that were compatible with how their bodies adjust to intense training. The results show how important it is to have regular ECG screenings to tell the difference between normal athletic remodeling and possible underlying heart problems. This will keep athletes safe and help them perform better for longer.
Keywords: ECG, cardiac adaptation, left ventricular hypertrophy, benign early repolarization
1. Introduction
Electrocardiography (ECG) is a non-invasive diagnostic method that captures the heart's electrical activity, yielding essential data on rhythm, pace, and overall cardiac function. In sports medicine, ECG is very significant for telling the difference between normal changes in the heart that happen during training and any pathological disorders that could make competition more dangerous (Melekoğlu et al., 2019). Regular intensive training, as practiced by rugby athletes, frequently results in benign ECG changes, including sinus bradycardia and elevated voltage criteria for left ventricular hypertrophy—characteristics of the “athlete’s heart” phenomenon (Basu & Malhotra, 2018; Sokunbi et al., 2021). Nevertheless, such patterns might occasionally obscure first indications of severe illnesses like cardiomyopathies, which, if unrecognized, may render athletes susceptible to abrupt cardiac death (McClean et al., 2018).
Rugby is a high-intensity contact activity that requires a lot of endurance, strength, and speed. This puts a lot of strain on the heart and causes structural and electrical changes (Iso et al., 2023). Consequently, ECG screening is advised as an integral component of pre-participation assessments to guarantee athlete safety and the sustainability of performance (Caramoci et al., 2025).
The aim of this study was to investigate ECG findings among Universiti Putra Malaysia Rugby 7's athletes, offering insights into the prevalence and types of cardiac adaptations within this particular athletic cohort.
2. Methods
2.1 Research Design
This study is a quantitative cross-sectional design study. ECG reading was only taken once during athlete’s preparation phase before a tournament.
2.2 Participants and Procedures
The study included Universiti Putra Malaysia (UPM) Rugby 7’s athletes, consisting of 8 males and 11 girls, who officially represented UPM in the Malaysian University Games (MASUM) event. The final team roster sent to the UPM Sports Academy included the names of all the players, making sure that they had gone through the formal selection procedure and were actively training for competition.
2.3 ECG reading method
The subjects were comfortably lying on their backs, and their skin was prepared to make sure the electrodes made contact. The Cosmed Quark CPET machine was used to set up a typical 12-lead ECG. Before recording, athletes stayed still for five minutes. To get a baseline for heart activity, ECG data were acquired when the person was resting. This meant that there was little movement and normal breathing during the assessment.
2.4 Data Analysis
Descriptive analysis was used in this study.
2.5 Ethical Considerations
This study was approved by Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia. The approval reference is JKEUPM-2024-1165.
3. Results and Discussion
There were 19 Universiti Putra Malaysia Rugby 7's athletes who took the ECG test, 8 men and 11 women. All of the athletes have a normal sinus rhythm. Benign early repolarization (BER), a frequent ECG variant in athletes, was more common in male athletes (62.5%) than in female athletes (18.2%). Only one male athlete (12.5%) had left ventricular hypertrophy (LVH), and none of the female athletes had LVH. There were no cases of sinus bradycardia or sinus tachycardia found in either group. These results indicate that most of the athletes exhibited normal resting ECG patterns, with sporadic benign alterations that align with physiological responses to constant rigorous training.
Table 1: ECG Findings Among Universiti Putra Malaysia Rugby 7’s Athletes
ECG Finding Men (n=8) Women (n=11) Total (n=19) Percentage (%)
Normal sinus rhythm 8 11 18 94.7
Sinus bradycardia 0 0 0 0.0
Sinus tachycardia 0 0 0 0.0
Benign early repolarization 5 2 7 36.8
Left ventricular hypertrophy 1 0 1 5.3
This study revealed that all Universiti Putra Malaysia Rugby 7’s participants displayed normal sinus rhythm, consistent with prior literature suggesting that the majority of well-trained athletes have normal resting ECG patterns (Melekoğlu et al., 2019). No instances of sinus bradycardia were noted, which is in contrast to previous research indicating a significant occurrence of this benign adaptation in rugby athletes attributed to enhanced vagal tone from endurance training (Khalili et al., 2012; Sokunbi et al., 2021). This difference could be due to differences in the degree of training, the timing of the examination, or how each person's heart responds.
Benign early repolarization (BER) was observed in 36.8% of participants, with a greater incidence in males (62.5%) compared to females (18.2%). This sexual disparity aligns with findings indicating that ER patterns are more prevalent among male athletes, potentially reflecting training-induced electrophysiological changes (Tanguturi et al., 2012; Warrington et al., 2025). While historically regarded as benign, various ER topologies have been associated with heightened arrhythmic risk in specific populations (Elenizi, 2024; Roberts & Gollob, 2013), highlighting the necessity for meticulous interpretation.
Only one male athlete (5.3%) had left ventricular hypertrophy (LVH). This low prevalence stands in contrast to other rugby cohorts, where LVH is commonly documented as a component of "athlete's heart" remodeling (Iso et al., 2023; Forsythe et al., 2018). The result may be due to variances in how much training, where they play, or how their bodies are made up.
4. Conclusion
In conclusion, the athletes from Universiti Putra Malaysia Rugby 7's mostly had normal sinus rhythm, with few benign ECG abnormalities such BER and LVH. The lack of abnormal patterns indicates that these athletes have healthy cardiac responses associated with advanced training. However, because physiological and pathological ECG alterations can sometimes be the same, regular screening is still very important for finding those who are at risk early and making sure that athletes are safe during competitions.
Acknowledgment
This study was conducted under the Geran Putra Berfokus initiative with the title ‘The Difference in Electrocardiogram Screening Between Athletes and Non-Athletes' Students in UPM’.
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