As with healthy individuals, the 2020 guidelines indicate that moderate intensity aerobic exercise for at least 150 minutes per week (or 75 minutes per week of vigorous intensity exercise), on most days, should be promoted in all individuals with CVD. Special considerations are detailed for individuals with obesity, well-controlled hypertension, dyslipidaemia or diabetes, which include adding resistance training ≥3 times per week to the moderate or vigorous aerobic exercise.
In addition, exercise recommendations are provided across a wide range of conditions, including coronary artery disease (acute or chronic coronary syndromes), heart failure, valvular heart disease, aortopathy, cardiomyopathies, myocarditis and pericarditis, adult congenital heart disease, arrhythmias, channelopathies, peripheral arterial disease and in individuals with implantable cardiac electronic devices or ventricular assist devices. For some of these conditions, exercise of a specified intensity is actively promoted, but for others, comprehensive evaluation, regular assessments and shared decision making is advocated. There are some incidences where participation in any competitive sport or leisure sports/exercise of moderate or high intensity is not recommended, such as those with severe valvular heart disease or arrhythmogenic cardiomyopathy, or active myo-pericarditis, and these conditions are listed in the recommendations.
The authors noted that many recommendations are built from the vast experience of the consensus group, rather than large prospective studies, since the evidence base is relatively sparse. It is hoped that the new recommendations document will not only serve as a useful clinical guide, but will also provide an incentive for future research to challenge established wisdom.
Want to know more about the types of exercise that your patients can do? The new 2020 ESC Guidelines on sports cardiology and exercise in patients with CVD are now published in the European Heart Journal!