When athletes are not sufficiently categorized, exercise training appears to have little effect on cardiac strain and twist mechanics, but traditional and contemporary methods of sporting categorization can identify subtle differences in twist mechanics between athletes and controls.

Elite-level endurance athletes demonstrated reduced left ventricular twist and apical rotation, whereas competitive resistance athletes showed greater left ventricular twist and peak untwisting velocity than controls. Athletes also show greater untwisting rates than controls.

The lack of effect of exercise training on global longitudinal strain may suggest this parameter has potential for distinguishing pathological from physiological remodeling in athletes.