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New recommendations on sports participation for athletes-patients with cardiovascular diseases

EuroPrevent Congress News - Lisbon

Rehabilitation and Sports Cardiology


papadakis-michael-2019.jpgIn 2005, the EAPC published a consensus document on competitive sports participation in athletes across a range of cardiovascular (CV) diseases.1 There have been many developments over the past decade and Doctor Michael Papadakis, Sports Cardiology and Exercise Section Chair, described the rationale for updating the 2005 document to align EAPC recommendations with more contemporary evidence and experience. Over the last 10 years, we have developed a better understanding of the clinical features and natural history of several CV diseases. We now also have better tools to assess and manage the risk of death for a number of conditions. In addition, as part of the preventive drive, we advocate screening of individuals and this is identifying more athletes with silent conditions, most of whom are of low risk.”

“We have started a series of six position statements, which each present updated guidance on exercising with specific conditions. Recommendations have recently been published about participation in leisure time and competitive sports for individuals with arterial hypertension,2 patients with coronary artery disease3 and patients with cardiomyopathies, myocarditis or pericarditis.4 We are working on recommendations for patients with arrhythmias, valvular heart disease and congenital heart disease/aortic disease.”

About the new recommendations, Dr. Papadakis states, “We have long known that exercise, in moderation, has many beneficial effects for most individuals with cardiac disease. We are also now developing a better understanding that for many conditions, the risk of more intense exercise is not as harmful as we thought previously. The 2005 recommendations were conservative, but based on recent experience, our updated recommendations are more liberal in places. We try to strike a balance between protecting the athlete-patient from the potential harmful effects of intense exercise versus allowing them to participate in sports that they enjoy and that may bring them benefits in terms of physical and mental wellbeing. The new recommendations take a very practical approach, with algorithms to guide healthcare professionals about what they need to assess, what are the ‘red flags’ they should look out for and what types of sports may be appropriate for their patient. However, it is important to highlight that we still lack robust evidence and the updated recommendations largely reflect expert opinion and therefore cannot be considered as legally binding. Importantly, the new recommendations emphasise the need for a shared decision-making process between healthcare professionals and the athlete-patient, with involvement of their families and even sports clubs in some situations.”

With regards to another advantage of the updated advice, Dr. Papadakis explains, “The conservative nature of the 2005 recommendations may have created obstacles to research, as for example all athletes-patients with hypertrophic cardiomyopathy were excluded from sport, irrespective of disease severity. The new less restrictive recommendations will allow us to examine the effects of exercise on fully informed athletes who choose to participate in sports. We then may be able to increase the evidence level of future updates beyond expert consensus to more evidence-based recommendations.”

  1. Pelliccia A, et al. Eur Heart J. 2005;14:1422–1445.
  2. Niebauer J, et al. Eur Heart J. 2018;39:3664–3671.
  3. Borjesson M, et al. Eur Heart J. 2019;40:13–18.
  4. Pelliccia A, et al. Eur Heart J. 2019;40:19–33.

Don’t miss!

New EAPC exercise recommendations will be discussed in a case-based symposium

Saturday: 11:00 – 12:00; Coimbra