Current Perspectives
Developments in sports cardiology: The way to a brighter future
Evoluindo na cardiologia desportiva: direções para um futuro melhor
José Miguel Viegasa,
, Hélder Doresb,c,d, António Freitase,f, Luna Caviglig, Flavio D’Ascenzig
Autor para correspondência
a Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
b Department of Cardiology, Hospital da Luz, Lisbon, Portugal
c Human Performance Department, Sport Lisboa e Benfica, Lisbon, Portugal
d Department of Pathophysiology, NOVA Medical School, Lisbon, Portugal
e Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal
f Centro de Medicina Desportiva de Lisboa, Lisbon, Portugal
g Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Accordingly, ensuring safety during sports participation and minimizing the risk of adverse events has become a major concern for medical and sports organizations. Pre-participation screening protocols have been established to reduce the risk of SCD in competitive athletes and are recommended by most medical societies.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Optimal cardiovascular screening should maximize yield without excessive cost; however, the best screening strategy remains the subject of considerable debate and there are calls for further evidenced-based research.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Likewise, with the growing population of amateur athletes, physicians are inevitably being confronted with an increasing number of queries regarding sports participation from individuals at risk or with established CVD. Reflecting the relative lack of large prospective trials supporting eligibility criteria and the fear of potential cardiovascular events, some physicians recommend overly conservative exercise restrictions. This attitude may then be conveyed to patients, who may become fearful of exercising at any level. Severe restrictions hence bear the unintended consequence of contributing to the growing epidemic of sedentary behavior and obesity.</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is imperative to balance the numerous benefits of exercise and the low risk of life-threatening events. Systematic research has demonstrated the cardiovascular and non-cardiovascular benefits of regular exercise, which range from improving quality of life to reducing overall mortality, and play a critical role in primary and secondary prevention of most CVD.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In the current era, sports cardiology is a key pillar of preventive cardiology and should spearhead the promotion of safe engagement in structured physical activity in order to encourage athletes’ ambition to continue performing routine exercise and to improve their functional status following a diagnosis of CVD.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Transitioning out of an athletic career can put the athlete's identity in jeopardy and have a profound impact on their psychosocial functioning.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In view of this danger, it is of paramount importance to recognize mental distress and address psychological needs. Psychological support should be considered when an athlete has been diagnosed with cardiac disease and/or is disqualified from competitive sports. It is also advised when an implantable cardioverter-defibrillator is recommended or if the athlete experiences SCD of a young relative, which may engender symptoms of depression, anxiety and post-traumatic stress.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">There is a need to shift from a historically binary approach to a personalized management plan, which is (and will continue to be) part of sports cardiology as a subspecialty. Respecting the autonomy of the individual and prioritizing the shared decision-making (SDM) process enables the physician to deliver more liberal and tailored advice. This functions as a collaborative process that requires the physician to provide detailed information regarding the potential impact of sports, allowing the athlete and other stakeholders to engage in detailed conversations regarding risk perception and responsibility. Nonetheless, considering the limited evidence available, assessing the athlete's absolute risk of events can be challenging and should take into account the type and severity of disease and the individual's demographic and clinical characteristics, as well as the volume, intensity and type of sport.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> To facilitate the assessment and guidance of both amateur and professional athletes with CVD and to ensure that both physician and athlete are supported, it is crucial to establish multidisciplinary networks and enable close liaison with experienced sports cardiology centers.</p><p id="par0030" class="elsevierStylePara elsevierViewall">An individualized approach, based on a detailed clinical assessment, risk stratification and exercise prescription, is key to ensure safety and minimize risks. In this setting, cardiopulmonary exercise testing (CPET) plays a pivotal role. This is increasingly used in a wide spectrum of clinical applications, from assessing overall cardiovascular performance to screening for undiagnosed exercise intolerance. Furthermore, it is a powerful means to individualize recommendations regarding sports<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> and can be used to monitor the progression of exercise training.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Current European guidelines focus on the formulation of exercise prescriptions and intensity levels based on well-recognized indices and cut-offs, including maximum heart rate, heart rate reserve and VO<span class="elsevierStyleInf">2</span> reserve. However, risk prediction equations are often derived from cross-sectional or longitudinal observations in populations of healthy subjects and cannot necessarily be applied in patients with CVD. In addition, the standard deviation around the regression line is often ignored, disregarding considerable individual variability.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> In patients with disease- and/or drug (e.g. beta-blocker)-related chronotropic incompetence, derived percentages are particularly unreliable for assessing the relative intensity of aerobic effort.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Exercise prescription based on these indices could result in under- or overestimation of individual exercise intensities, causing the patient to train at a different level from that shown to have a proven clinical benefit.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> By contrast, an integrated interpretation of gas exchange parameters that reflect different submaximal ventilatory thresholds (VT) enables the creation of individually determined exercise zones. Therefore, defining exercise intensity through accurate and tailored quantification in individuals with CVD, i.e. using VT, should be the preferred method to prescribe exercise on an individual level.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Training is critical to interpreting data appropriately and it is therefore advisable to consign CPET and exercise prescription to be performed by physicians with expertise in the field. Given its cost and limited availability, CPET cannot be applied in all clinical scenarios and may be dispensed with in low-to-moderate risk individuals, in whom alternative tools, such as exercise stress testing, may be preferred to investigate the cardiovascular response to exercise.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Other than promoting a healthy and active lifestyle, the ultimate goal of personalizing exercise prescription is to mitigate the risk of adverse events. Unfortunately, it is impossible to fully eliminate the hazards and reduce the risk to zero. Current recommendations highlight a clear need for policies to increase public awareness, community training in cardiopulmonary resuscitation (CPR), and the availability of automated external defibrillators (AEDs). All sports facilities should develop a first-aid training policy and an emergency action plan incorporating CPR and AED use to safeguard sports participation and further reduce the impact of exercise-related SCD.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In summary, healthcare professionals should be aware of the changing paradigm concerning the safe participation of athletes with CVD in structured and individualized exercise training. A tailored exercise prescription has emerged as a vital component of the cutting-edge management of these individuals and may serve as an integral element in the SDM process, laying the groundwork for modern sports cardiology (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). CPET is a valuable tool for exercise prescription and should be more commonly used in clinical practice to optimize exercise recommendations. Incorporating a personalized exercise training program within the overall management plan is the current state of the art. This approach will ensure individuals with CVD are not deprived of the many benefits (physical and psychological) of exercise and will ultimately enable a safe exercise routine.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-03-21" "fechaAceptado" => "2023-03-23" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1277 "Ancho" => 2341 "Tamanyo" => 152890 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cornerstones of modern sports cardiology.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "AMSSM position statement on cardiovascular preparticipation screening in athletes: current evidence, knowledge gaps, recommendations and future directions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.A. Drezner" 1 => "F.G. O’Connor" 2 => "K.G. Harmon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjsports-2016-096781" "Revista" => array:6 [ "tituloSerie" => "Br J Sports Med" "fecha" => "2017" "volumen" => "51" "paginaInicial" => "153" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27660369" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of cardiac imaging in the evaluation of athletes in the clinical practice: a survey by the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology and University of Siena, in collaboration with the European Association of Cardiovascular Imaging, the European Heart Rhythm Association and the ESC Working Group on Myocardial and Pericardial Diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. D’Ascenzi" 1 => "F. Anselmi" 2 => "S. Mondillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/2047487320932018" "Revista" => array:6 [ "tituloSerie" => "Eur J Prev Cardiol" "fecha" => "2021" "volumen" => "28" "paginaInicial" => "1071" "paginaFinal" => "1077" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34425587" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise for primary and secondary prevention of cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W.J. Tucker" 1 => "I. Fegers-Wustrow" 2 => "M. Halle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2022.07.004" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2022" "volumen" => "80" "paginaInicial" => "1091" "paginaFinal" => "1106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36075680" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stages of psychological impact after diagnosis with serious or potentially lethal cardiac disease in young competitive athletes: a new model" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "I.M. Asif" 1 => "D. Price" 2 => "L.A. Fisher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jelectrocard.2014.12.018" "Revista" => array:6 [ "tituloSerie" => "J Electrocardiol" "fecha" => "2015" "volumen" => "48" "paginaInicial" => "298" "paginaFinal" => "310" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25680944" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychological issues in managing families with inherited cardiovascular diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Ingles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1101/cshperspect.a036558" "Revista" => array:5 [ "tituloSerie" => "Cold Spring Harb Perspect Med" "fecha" => "2020" "volumen" => "10" "paginaInicial" => "a036558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31548222" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise in hypertrophic cardiomyopathy: yes or no?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Dores" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2023.01.019" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2023" "volumen" => "42" "paginaInicial" => "285" "paginaFinal" => "286" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36706914" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of ventilatory thresholds to define aerobic exercise intensity in cardiac patients and healthy subjects" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Anselmi" 1 => "L. Cavigli" 2 => "A. Pagliaro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Scand Med Sci Sports" "fecha" => "2021" "volumen" => "31" "paginaInicial" => "1796" "paginaFinal" => "1808" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinician approach to cardiopulmonary exercise testing for exercise prescription in patients at risk of and with cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. D’Ascenzi" 1 => "L. Cavigli" 2 => "A. Pagliaro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Sports Med" "fecha" => "2022" "volumen" => "56" "paginaInicial" => "1180" "paginaFinal" => "1187" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise intensity: a matter of measuring or of talking?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Vanhees" 1 => "A. Stevens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00008483-200603000-00004" "Revista" => array:6 [ "tituloSerie" => "J Cardiopulm Rehabil" "fecha" => "2006" "volumen" => "26" "paginaInicial" => "78" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16569973" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unreliability of the %VO<span class="elsevierStyleInf">2</span> reserve versus %heart rate reserve relationship for aerobic effort relative intensity assessment in chronic heart failure patients on or off beta-blocking therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Mezzani" 1 => "U. Corrà" 2 => "A. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
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| 2023 Novembro | 67 | 68 | 135 |
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