Assess understanding of the physiological mechanisms by which chronic endurance training alters cardiovascular structure and function in adults. Scope includes central adaptations (stroke volume, cardiac output, ventricular remodeling, heart rate), peripheral changes (capillarization, mitochondrial density, oxidative enzyme activity, muscle fiber shifts), vascular and endothelial adaptations (nitric oxide–mediated vasodilation, arterial compliance), autonomic and baroreflex modulation, blood volume and hematological responses, key molecular signals (e.g., PGC‑1α, VEGF), and the effects of training dose, age, sex, and detraining; students should integrate mechanisms with common outcome measures (VO2max, ejection fraction, arterial stiffness) and interpret typical clinical/research data.