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Open Access Journal of Kinesiology and Sports Medicine Research Article 19 min read

Echocardiographic Insights into Left Ventricular Functional Adaptation in Track and Field Athletes: A Comprehensive Review

Sharma B, Gupta S and Mukhopadhyay K*
* Corresponding author
ISSN: 2995-0155  10.23880/oajksm-16000113  Received: June 07, 2024  Published: June 24, 2024
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Keywords
Track and Field Athletes Echocardiography and Left Ventricular Functional Adaptation
Abstract

Scientific sports training is perquisite for excel in track and field athletes, which effects the changes of functional capacity of heart as well as circulatory system. The study investigates the intricate process of functional adaptation of the left ventricle in track and field athletes. Echocardiography is a vital tool for a non-invasive assessment of cardiac anatomy and function that can differentiate between normal and abnormal cardiac changes. In general, the athletes who participates in endurance events have bigger hearts, which aids in the assessment of left ventricular functional adaptation. Heart rate adaptation in athletes is influenced by age, gender, ethnicity, and level of sport. Exercise that is high in intensity alters the heart's structure, electrical activity, and overall functionality. The volume and intensity of endurance exercise influences the functional adaptations of the left ventricle. The present study systematically discussed the effects of different track and field events (isometric or isotonic training) on cardiac left ventricle of athletes and it focus the necessity of customized training and coordinated healthcare for the best possible cardiovascular health.

Introduction

Athletes perform a variety of activities such as throwing, jumping and running which requires a good amount of physical fitness. The main elements of fitness are speed, agility, muscular strength, muscular endurance, and cardiovascular fitness [1]. The dynamic interaction between physical activity and cardiovascular adaptation is an important factor influencing sports performance, especially in track and field. Acute exercise can cause anatomic and functional changes in the left ventricle (LV) of the heart. The increased need for oxygen supply as a result of physical activity can be compensated by our physiological system. A thorough understanding of the complex physiological changes that occur in the human body is necessary for the achievement of athletic performance. One of the main factors contributing to heart health is left ventricular function [2]. The adaptation of the cardiovascular system is one of the most important results of regular physical training. Competitive sports and public health are two areas that express the true meaning of the “athlete’s heart” [3].

In the cardiovascular system, the left ventricle plays an important role in pumping blood throughout the body. Alteration of left ventricular function is necessary to improve athletic performance and cardiovascular fitness in track and field athletes [2]. Adaptive hypertrophy, or increased mass and size of the left ventricle, is a result of the left ventricle’s response to exercise [3]. Training and stress can change the body and make it work better. Training based on training principles requires more work and results in greater adaptation to increased load. These adaptations include decreased resting heart rate, increased stroke volume, increased haemoglobin levels, increased oxygen consumption, muscle hypertrophy, and intramuscular changes [4]. Although there are many cardiovascular adaptation benefits from physical activity, there are still concerns about possible health effects, especially when engaging in vigorous or prolonged physical activity. Intensive training programs are associated with increased ventricular hypertrophy and other structural changes, which increases more concerns about the long-term effects and cardiovascular damage of maintaining high levels of exercise training [5]. Because echocardiography is non- invasive, accurate, and highly reproducible, it is an important method for assessing left ventricular function adaptation in track and field athletes. It assesses heart pain, ventricular size, wall thickness, systolic and diastolic function and provides suggestions for long-term health management and performance improvement [6].

The purpose of the study was to discuss critically the effects of different types of track and field events on left ventricular functional adaptations of athletes based on the echocardiographic findings of other researchers i.e. a review study was conducted.

Echocardiography and Sports

In contemporary sports, echocardiography is essential for non-invasively evaluating cardiac shape and function, helping to differentiate between normal and pathological alterations in the heart of the athletes, and improving medical assessments [7]. Echocardiography is a diagnostic cardiac ultrasound procedure that uses high-frequency ultrasound technology to produce images of the heart. These images show information about the anatomy and physiology of the heart, such as size, shape, wall motion, and valve function [8]. An athlete’s left ventricular functional adaptation may be evaluated by echocardiographic screening; those who engage in endurance activity have the greatest dimensions and highest functionality, which are correlated with increased LV volume [9]. Before the development of new imaging techniques, the physiological consequences of cardiac adaptation in athletes were well documented. Morganroth and colleagues described the assessment of cardiac adaptation using current imaging techniques such as echocardiography to measure ventricular size and wall thickness [10]. According to Urhausen, et al. [11], sports activity, training volume, and body size should be considered when collecting ultrasound heart measurements in athletes. To evaluate the state and function of the athlete’s heart, multi-imaging techniques such as cardiac CT, cardiac MR, and complex echo technology were introduced in 2014. On the other hand, sensors Wearables, compact trackers, and implantable devices make monitoring easy during training and competition, it is easier to assess electrophysiological changes in athletes [12].

Left Ventricular Functional Adaptations

Adaptation is the process by which physical and psychological functional systems respond to training loads. Getting used to stress will lead to improved performance. Through the adaptation process, athletes’ performance improves [13]. In sports, training adaptations refer to physiological and functional changes caused by physical training that are influenced by the amount of exercise, type of activity, and method. Adaptation involves a gradual increase in stress to maintain tissue overload and facilitate adaptation [14]. However, illness or injury can hamper the training program and require adjustments. Physiological adaptations are always specific to training and stress on the body. It is the adaptations that lead to improved performance after training. Adaptations in response to exercise include a decrease in resting heart rate, an increase in stroke volume and cardiac output, an increase in oxygen uptake, an increase in blood haemoglobin levels, muscle hypertrophy, and other changes in the muscles. These include a variety of changes: increased myoglobin, increased mitochondrial number, and increased aerobic fitness or use anaerobic enzymes depending on training specificity, increased lactate threshold, etc. [15].

Regular, intense physical training causes an increase in the mass, cavity size, and wall thickness of the left ventricle (LV), which is referred to as “athlete’s heart.” Depending on the type of exercise, strength, or endurance, these modifications can vary in degree [16]. Male middle-distance runners have alterations in their adaptive body responses to exercise, including variations in blood haemoglobin concentration and functional capacity of the body [17]. Adolescent male track and field athletes have varying performance characteristics across different sports, with boys beginning in early adolescence to perform better than girls [18].

Exercise and training-induced modifications to left ventricular mass (LVM), end-diastolic volume (EDV), stroke volume (SV), heart rate and cardiac output, are all part of the process of left ventricular functional adaptation. Extended periods of high-intensity exercise regimens induce cardiac adaptations, which raise the LVM and cavity width and satisfy the requirements for left ventricular hypertrophy (LVH) [19].

Marsh, et al., [20] reported that the effects of various exercise modalities on cardiac adaptation vary; for example, resistance training (RES) does not increase LVM and end diastolic volume (EDV), but endurance training (ET) does.

Men experience higher increases in left ventricular systolic volume (LVEDV) and SV as a result of ET, although LVM augmentation is equivalent in both sexes [21]. These results emphasize the significance of exercise duration, type, and intensity in influencing functional adaptations of the left ventricle.

Cardiac muscles adjust functionally in response to sporting activity. These adaptations include alterations in left ventricular (LV) function during exercise, such as higher stroke index (SVI) and cardiac index (QI) in highly trained young athletes compared to their recreationally active contemporaries [19]. Diastolic function improves in young athletes during exercise, most likely because to improved preload determinants [22]. Aerobic training at a moderate level can contribute to left ventricular hypertrophy (LVH) by reducing the hemodynamic strain during daily activities [23]. Individuals with high aerobic fitness exhibit decreased LV strain at rest and during exercise, indicating improved systolic function [24].

SL
No		Study/Topic
Name & Authors		ObjectiveMethodsFindings
1Left ventricular
adaptations
following short-
term endurance
training [25].		The study
investigated the
impact of short-
term endurance
training (ET) on
left ventricular
adaptation and
functional response
to exercise
challenges.		Eight untrained men were
studied before and after 6
days of ET, which involved
cycling 2 hours/day at 65%
peak aerobic power.		According to the study, brief exercise
training raises exercise stroke volumes by
improving heart rate, plasma volume, and
Vo2max but not resting left ventricular
function.
2The impact
of endurance
exercise training
on left ventricular
systolic
mechanics [26].		The study sought to
evaluate LV systolic
performance in
competitive athletes
before and after 90
days of EET, with an
emphasis on tissue
velocity, strain, and
strain rate.		The study looked at the
impact of competitive
athletics among Harvard
University undergraduates
on their heart health. Data
was collected over a 90-day
period, including endurance
and strength workouts. The
statistical analysis comprised
paired t-tests, Wilcoxon
matched pair tests, and
correlation analysis.		Exercise training (EET) lowers
circumferential strain in left ventricular
septal segments, probably due to
ventricular interdependence. LV strain
and tissue velocity are more sensitive
measures of systolic adaptation. The study
focuses on understanding EET-induced
myocardial adaptation in healthy persons.
3Adaptation of
heart to training:
A comparative
study using
echocardiography
& impedance
cardiography in
male & female
athletes Yılmaz, et
al. [16].		The purpose of the
study is to assess
how endurance
training affects
the hemodynamic
parameters, left
ventricular function,
and heart shape of
athletes, both male
and female.		Transthoracic
echocardiography and
impedance cardiography
were performed on 79
healthy athletes and 82
healthy adolescents, 49% of
whom were male, at the age
of 20.0 ± 2.6 years.		In comparison to inactive controls,
endurance-trained male and female
athletes had increased LV mass, LV cavity
dimensions, and stroke volume. Male
athletes’ resting heart rates were lower
and their mean arterial blood pressure
was greater.
4Regular
endurance
training in
adolescents
impacts atrial and
ventricular size
and function [27].		The purpose of the
study was to look
at the relationship
between maximum
oxygen consumption
and the effects of
long-term endurance
exercise on
adolescent atrial and
ventricular growth
and function.		A study measuring
echocardiograms, Doppler
investigations, and treadmill
exercise VO2max was carried
out with 27 endurance-
trained teenagers between
the ages of 13 and 19 and 27
controls.		Adolescents who engaged in physical
activity displayed greater heart
dimensions and better systolic function
in comparison to controls. This shows
increased atrial and ventricular
dimensions, as well as functional
remodelling, in the heart as a result of
prolonged endurance exercise.
5Left ventricular
remodeling and
the athlete’s
heart, irrespective
of quality load
training [28].		The study’s objective
was to monitor, for
a minimum of five
years, the effects of
physical training on
the morphology and
function of the heart
in a group of elite
rugby and soccer
players.		A total of 250 elite rugby
and soccer players and 114
soccer players were studied
between 1993 and 2015. Of
them, 60 rugby and 78 soccer
players were followed for
five years and paired with a
control group.		After a five-year follow-up, athletes’ LV
dimensions and LVMi were considerably
higher than those of inactive subjects’,
but no significant changes in cardiac
dimensions were noted. Frequent physical
activity causes mild left ventricular
hypertrophy, which is an adaptive
response to stress-exercise.
6The role of
echocardiography
in the evaluation
of cardiac re-
modelling and
differentiation
between
physiological
and pathological
hypertrophy
in teenagers
engaged in
competitive
amateur sports
[29].		This study aimed
to identify cardiac
re-modelling
forms, differentiate
between pathological
and normal
hypertrophy, and
show left ventricular
hypertrophy
prevalence in sports-
playing teens.		Echocardiographic measures
of athletes and control
subjects were acquired using
M-mode, two-dimensional,
and Doppler methods.		According to the study, cardiac re-
modelling and left ventricular mass were
considerably greater in healthy teens
who played both dynamic and static
sports. The prevalence of both forms
of re-modelling was also higher. These
results point to heart remodeling and
physiological hypertrophy in sports.
7Assessment
of myocardial
function in elite
athlete’s heart
at rest - 2D
speckle tracking
echocardiography
in Korean elite
soccer players
[30].		This study looked
at the myocardial
function of elite
Korean soccer
players by
comparing the
results with normal
controls using both
conventional and
advanced speckle
tracking imaging.		The study used
tissue Doppler, STI,
and conventional
echocardiography together
with 2D echocardiography
speckle tracking
echocardiography to evaluate
LV regional strain in 29 elite
soccer players compared to
29 healthy controls.		Soccer players exhibit distinct ventricular
adaptation, including greater basal
circumferential, apical radial, and apical
circumferential strain, as well as higher
rotation at the base and apex, which may
help in cardiovascular adjustment to
activity without major energy expenditure
loss.
8Left ventricular
remodeling in
elite and sub-elite
road cyclists [31].		The purpose of this
study was to use
conventional and
speckle tracking 2D
echocardiography
to characterize
the mechanical,
functional, and
structural properties
of left ventricular
(LV) components in
endurance athletes.		Male elite road cyclists,
sub-elite cyclists, and
healthy non-athlete
university students and staff
participated in this cross-
sectional study.		Septal and lateral E’ velocities,
larger global circumferential strain,
lower ejection percentage, dilated
eccentric hypertrophy, higher chamber
concentricity, and stronger LV structural
adaptability were all seen in elite cyclists
(34.7%). While lower E and E’ velocities
could suggest functional reserve in
EC(Elite Cyclists), higher GCε might be a
compensatory strategy to maintain stroke
volume.
9Ten-year follow-
up of cardiac
function and
neural regulation
in a group of
amateur half-
marathon
runners.		Assessing the
medium- to long-
term impacts of
moderate-to-intense
physical exercise
on cardiovascular
neuronal regulation,
cardiac function,
and the incidence
of cardiovascular
illnesses was the goal
of this follow-up.		To evaluate cardiovascular
disease, neural control, and
heart function, subjects
received transthoracic
echocardiography, physical
exams, interviews, and
standing tests.		Middle-aged sportsmen who engaged
in regular physical training during a
10-year follow-up revealed normal
echocardiographic measurements, a low
incidence of cardiovascular disease, and
decreased sympathetic and enhanced
vagal modulation.
10Training intensity
influences left
ventricular
dimensions in
young competitive
athletes [32].		The purpose of
the study was to
assess how young
competitive athletes’
heart muscles have
changed structurally
and functionally in
response to training
duration, intensity,
and output.		In the Munich Cardiovascular
Adaptations in Young
Athletes Study, which
included 404 kids and
teenagers, several tests
were used to evaluate left
ventricular anatomy, training
intensity, aerobic capacity,
and strength.		The study demonstrates that, in spite of
anatomical alterations and a reduction
in diastolic function, cardiac adaptations
to exercise happen early in life and
are impacted by exercise intensity and
maximal aerobic capacity.

Table 1: Research findings of Cardiac Functions in response of training by different researchers.

11Concentric
and Eccentric
Remodelling
of the Left
Ventricle and Its
Association to
Function in the
Male Athletes
Heart: An
Exploratory Study
[33].		The study compared
left ventricular
(LV) functional
parameters, peak
strain and strain
rate, and temporal
strain and strain
rate curves in 45
male athletes with
concentric, eccentric,
and normal LV
geometry.		Based on LV geometry, 45
elite male athletes between
the ages of 18 and 35 were
included in the research.
They had a thorough
cardiovascular evaluation
that included 2DSTE, TTE,
and ECG to measure global
myocardial distortion.		The study discovered that whereas
normal left ventricular function is often
linked with these remodeling patterns,
concentric remodeling in athletes’ hearts
raises ejection fraction (EF) and temporal
myocardial strain.
12Biventricular
mechanical
pattern of the
athlete’s heart:
comprehensive
characterization
using three-
dimensional
echocardiography
[34].		This study aimed
to characterize
biventricular
morphology and
function in elite
athletes using three-
dimensional (3D)
echocardiography.		Athletes’ left ventricular
and RV end-diastolic
volumes (EDVi) and ejection
fractions were found to
be considerably greater
than controls’ in a research
including top athletes and
healthy individuals. The
reductions in LV GLS(Global
Longitudinal Strains) and RV
GCS(Global circumferential
strains) brought on by
exercise were greater.		Athletes’ left ventricular and RV end-
diastolic volumes (EDVi) and ejection
fractions were found to be considerably
greater than controls’ in a research
including top athletes and healthy
individuals. The reductions in LV
GLS(Global Longitudinal Strains) and
RV GCS (Global circumferential strains)
brought on by exercise were greater.
13Cardiac cycle
timing intervals in
university varsity
athletes [35].		This study set out
to characterize
the contractility
characteristics and
cardiac cycle timing
intervals in varsity
athletes competing at
the university level.		In a study with 152 male
and 93 female athletes, the
researchers discovered
that although men’s heart
rates were lower, women’s
isovolumic relaxation times,
systolic times, and heart
rates were shorter. Timing
interval variations were
also observed in sports,
with football players having
shorter diastole periods and
basketball players having
longer systolic times.		These findings suggest that male and
female athletes exhibit distinct cardiac
features and contribute reference cardiac
cycle timing data to the literature. Team
differences imply that distinct training
regimens for various sports may produce
distinct alterations in heart function;
yet, they seem to be correlated with the
players’ sex. These cardiac cycle timing
intervals provide a useful comparison tool
to enhance our comprehension of heart
physiology in varsity sports groups.
14Cardiac functional
adaptation to
resistance and
endurance
exercise training:
a randomized
crossover study
[36].		This study examined
the impact of
endurance and
resistance training
on changes in left
ventricular (LV)
systolic and diastolic
function in healthy
participants.		The study involved 64
participants in a 12-week
crossover design trial, with
echocardiograms assessing
systolic function, diastolic
function, and left atrial
volume indexed to body
surface area.		Results showed that LV mass increased
with both RES and END training, but
remained significant after END. The
adaptation in LVM and LA volumes, as well
as diastolic function, was exercise mode
specific. Twelve weeks of intensive END
increased LVM, LA volumes, and increased
diastolic function. However, after RES,
LVM increased, although this was
attenuated after accounting for changes in
lean body mass.

Table 2: Research findings of Cardiac Functions in response of training by different researchers.

Results and Discussion

Our thorough review research provide insight into the complex connection between athletic training for track and field and left ventricular (LV) functional adaptation. The findings of the different researchers demonstrate the profound physiological alterations in the heart that result from consistent physical training, particularly for track and field competitors.

The finding of the other researchers indicated that the training routine of track and field athletes, especially endurance athletes, causes significant left ventricular adaptations. Enhanced LV performance, larger cavity size, thicker walls, and greater LV mass are some of these modifications. These modifications are sometimes referred to as the “athlete’s heart,” which symbolizes the heart’s capacity to adjust and function at its best in response to demands placed on it by sports.

Athletes’ left ventricular adaptations and cardiac function were examined in depth in the research summarized in Table - 1. Studies such as those conducted by Goodman, et al. [25], for example, have shown that short-term endurance training can raise exercise stroke volumes without appreciably compromising resting left ventricular function. Other research, like Baggish, et al. [26], demonstrated how endurance exercise training may affect LV strain and tissue velocity and emphasized the significance of LV systolic mechanics in competitive athletes. Maximizing cardiac performance during exercise depends on these adaptations, which are regulated by age, genetics, training style, intensity, and duration. Improved cardiac efficiency, higher left ventricular compliance, concentric and eccentric hypertrophy, and increased left ventricular mass (LVM) are among the main alterations seen in the left ventricles of athletes. More force production and stroke volume are possible with increased left ventricular mass brought on by exercise. When it comes to hypertrophy, athletes that train for endurance are more likely to experience eccentric hypertrophy than strength training athletes. Higher cardiac output and stroke volume are the results of continuous exercise’s improvement in left ventricular compliance. More output is produced at lower heart rates is the indication of more efficient hearts of athletes than non-athletes [2, 37].

The subject of left ventricular functional adaptation in sprinters and distance runners of track & field has been studied extensively. The findings imply that both sprinters and distance runners undergo physiological adjustments in their left ventricles as a result of training. These adaptations include increased left ventricular internal dimensions, mass, and ejection fractions [38].

Track and field throwers and master resistance-trained athletes may have distinct somatotypes. They are bigger people with more absolute power, somatotypes like those from “Strongmen” competitions. Younger competitors in the Strongmen competition, who have trained for ten years and are between the ages of twenty and forty-five, had smaller diastolic function but larger absolute heart dimensions than controls [39].

Sports-related exercise training has an impact on left ventricular function; isotonic training improves diastolic function, but isometric exercise usually results in normal or slightly diminished function. Training of any kind has little effect on left ventricular systolic performance at rest [26].

LV systolic function is represented by stroke volume (SV), LV ejection fraction (EF), fractional shortening (FS), cardiac output (Q), cardiac index, peak systolic myocardial velocity (S’), LV myocardial performance index (Tei index), concentricity, and sphericity index. Endurance athlete’s EF was significantly increased in the study by Rundqvist, et al. [27]. Divided into dynamic and static types of sport, Sulovic, et al. [40] reported a significantly higher ejection fraction (EF) in dynamic exercising athletes and a significantly reduced EF in static exercising athletes. Contrary to these findings, three studies did not report significant differences [41, 42, 43]. The same is reported for Fractional Shortening (FS) [41, 42].

The underlying stimuli for cardiac adaptation have been identified as being factors like the training history, training volume and intensity, the types of sports [44], genetics [45] and pubertal and hormonal status [46, 47, 48].

Impact of Training Intensity and Duration

The importance of training time and intensity in determining left ventricular adaptations was also highlighted in our review study. Research conducted by Weberruss, et al. [32] showed that the volume and intensity of training, affect the anatomical and functional changes of young competitive athletes’ hearts. High intensity and low volume repetitive exercises such as resistance training elicit morphological increment of the left ventricle of an athlete which is termed as concentric hypertrophy. In case of concentric hypertrophy, left ventricular septum, posterior wall and interventricular septum thickness may chronically increase workload on the heart, most commonly resulting from pressure overload. On the other hand, moderate intensity and high-volume exercises such as marathon run elicit cardiac hypertrophy which is known as eccentric hypertrophy. In case of eccentric hypertrophy, the heart responds by increasing left ventricular internal diameter and left ventricular wall thickness. Ventricular dilation is caused by volume overload. The significance of echocardiography in recognizing cardiac remodelling types and differentiating between normal and pathological hypertrophy in athletes was brought to light by studies such as Šulović, et al. [29].

Gender and Age Variations

We also reviewed age and gender differences in left ventricular adaptations in athletes. Research has shown that the LV shape, functional characteristics, and adaptive responses to training may differ between male and female athletes [33]. Age-related variations in cardiac adaptability and function were also noted, highlighting the necessity of customized training regimens based on personal traits [49, 50, 51].

Clinical Implications and Future Directions

Healthcare practitioners need to know the information regarding sports specific cardiac hypertrophy in order to diagnose, treat, and prevent cardiac problems. Future studies should concentrate on investigating cardiac adaptation mechanisms, creating individualized training strategies, and evaluating the long-term effects of training on heart function. The analysis highlights the intricate connection between cardiac function, long-term health outcomes, and athletic training, underscoring the necessity of customized training regimens and cardiac monitoring in the treatment of athletes.

Conclusion

The study of left ventricular (LV) functional adaptation in track and field athletes is a complex and dynamic field that intersects sports science, cardiology, and exercise physiology [52, 53, 54, 55, 56]. Through our comprehensive review, we have discussed the intricate mechanisms and adaptations that occur within the athlete’s heart, shedding light on the physiological changes that accompany rigorous athletic training.

To conclude, this analysis offers significant understanding into the complex connection between left ventricular functional adaptation and endurance training in track and field athletes [57, 58, 59, 60]. The intricate relationship among cardiac remodelling, athletic demands, and long-term health outcomes, we may improve the performance, well- being, and care of athletes in a variety of sports. In order to focus on further understanding and promote cardiovascular health in the athletic community, it is crucial to engage in more research, education, and cooperation [61, 62, 63, 64].

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@article{sharma2024,
  title   = {Echocardiographic Insights into Left Ventricular Functional Adaptation in Track and Field Athletes: A Comprehensive Review},
  author  = {Sharma B, Gupta S and Mukhopadhyay K},
  journal = {Open Access Journal of Kinesiology and Sports Medicine},
  year    = {2024},
  volume  = {2},
  number  = {1},
  doi     = {10.23880/oajksm-16000113}
}
Sharma B, Gupta S and Mukhopadhyay K (2024). Echocardiographic Insights into Left Ventricular Functional Adaptation in Track and Field Athletes: A Comprehensive Review. Open Access Journal of Kinesiology and Sports Medicine, 2(1). https://doi.org/10.23880/oajksm-16000113
TY  - JOUR
TI  - Echocardiographic Insights into Left Ventricular Functional Adaptation in Track and Field Athletes: A Comprehensive Review
AU  - Sharma B, Gupta S and Mukhopadhyay K
JO  - Open Access Journal of Kinesiology and Sports Medicine
PY  - 2024
VL  - 2
IS  - 1
DO  - 10.23880/oajksm-16000113
ER  -