RECOMMENDATIONS FOR CARDIOVASCULAR SCREENING OF ADULTS PARTICIPATING IN LEISURE-TIME SPORT ACTIVITIES
Abstract
Participation in regular moderate aerobic physical activity and increased physical fitness is associated with a decrease in cardiovascular mortality, which is after the age of 35 most often due to coronary events. On the other hand, moderate and vigorous physical exertion is associated with an increased risk for cardiac events, including sudden cardiac death in individuals harbouring cardiovascular disease. The risk-benefit ratio may differ in relation to the individual's age, fitness level and the presence and type of cardiovascular disease.
The latest position stand of the European association of Cardiovascular Prevention and Rehabilitation on cardiovascular evaluation in middle aged/senior individuals, who are contemplating exercise or who are already engaged in nonprofessional competitive or recreational leisure sporting activity, is presented in the article. The aim of recommendations is to evaluate and encourage as many individuals as possible to participate in regular physical activity while minimizing the risk of cardiovascular adverse events. Recommendations are based on the individual's risk profile and the intended level of physical activity. Because of the large size of the population, an initial self assessment through health questionaire is proposed, relating to symptoms, risk factors for coronary artery disease and habitual exercise level. For those with positive self-assessed risk profile and those willing to perform high-intensity activities, a further risk stratification/evaluation should be performed by a qualified physician. In individuals with an increased risk for coronary events, maximal exerise is advocated and then further (cardiological) evaluation when needed.
Downloads
References
Talbot LA, Morrell CH, Fleg JL, Metter EJ. Changes in leisure-time physical activity and risk of all-cause mortality in men and women: the Baltimore longitudinal study of aging. Prev Med 2007;45:169–76.
Sofi F, Capalbo A, Cesari F, Abbate R, Gensini GF. Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil 2008;15:247–57.
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WM, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 2012;33:1635–701.
Nocon M, Hiemann T, Müller-Riemenschneider F, Thalau F, Roll S, Willich SN. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2008;15:239–46.
Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women. A meta-analysis. JAMA 2009;301:2024–35.
Maron BJ, Doerer JJ, Haas TS, Tierney, Mueller FO. Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980-2006. Circulation. 2009;119:1085-92.
Hull Jr SS, Vanoli E, Adamson PB, Verrier RL, Foreman RD, Schwartz PJ. Exercise training confers anticipatory protection from sudden death during acute myocardial ischemia. Circulation 1994;89:548–52.
Panagiotakos DB, Kokkinos P, Manios Y, Pitsavos C. Physical activity and markers of inflammation and thrombosis related to coronary artery disease. Prev Cardiol 2004;7:190–4.
Hambrecht R, Wolf A, Gielen S, Linke A, Hofer J, Erbs S, et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J Med 2000;342:454–60.
Siskovick DS, Weiss NS, Fletcher RH, Schoenbach VJ, Wagner EH. Habitual vigorous exercise and primary cardiac arrest: effect of other risk factors on the relationship. J Chronic Dis 1984;37:625-31.
Curfman GD. Is exercise beneficial-or hazardous-to your heart? N Engl J Med 1993;239:1730–1.
Maron BJ. The paradox of exercise. N Engl J Med 2000;343:1409–11.
Burke AP, Farb A, Malcolm GT, Liang Y, Smialek JE, Virmani R. Plaque rupture and sudden death related to exertion in men without coronary artery disease. JAMA 1999;281:921–26.
Rosengren A and Wilhelmsen L. Physical activity protects against coronary death and deaths from all
causes in middle aged men. Evidence from a 20 year follow up of primary prevention study in Goteburg.
Am J Epidemiol 1997;7:69–77.
Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and metaanalysis of randomised controlled trials. Am J Med 2004;116:682–92.
Borjesson M, Urhausen A, Kouidi E, Dugmore D, Sharma S, Halle M, et al. Evaluation of middle-aged/senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2011;18:446-58.
Balady GJ, Chaitman B, Driscoll D, Foster C, Froelicher E, Gordon N, et al. AHA/ACSM scientific statement: Recommendations for cardiovascular screening, staffing, and Emergency policies at health/fitness facilities. Circulation 1998; 97: 2283–93.
Conroy RM, Pyörölä K, Fitzgerald AP, Sans S, Menotti A, deBacker G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987–1003.
Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32(9 Suppl):S498–S504.
Borjesson M, Assanelli D, Carré F, Dugmore D, Panhuyzen-Goedkoop NM, Seiler C, et al. ESC Study Group of Sports Cardiology: recommendations for participation in leisure-time physical activity and competitive sports for patients with ischaemic heart disease Eur J Cardiovasc Prev Rehab 2006;13:137-49.
Fagard RH, Björnstad HH, Børjesson M, Carré F, Deligiannis A, Vanhees L. ESC Study Group of Sports Cardiology Recommendations for participation in leisure-time physical activities and competitive sports for patients with hypertension. Eur J Cardiovasc Prev Rehab 2005;12:326-31.
Pelliccia A, Corrado D, Bjørnstad HH, Panhuyzen-Goedkoop N, Urhausene A, Carre F. Recommendations for participation in competitive sport and leisure-time physical activity in individuals with cardiomyopathies, myocarditis and pericarditis. Eur J Cardiovasc Prev Rehabil 13:876-85.
Maron BJ, Chaitman BR, Ackerman MJ, Bayés de Luna A, Corrado D, Crosson JE et al. Recommendations for Physical Activity and Recreational Sports Participation for Young Patients With Genetic Cardiovascular Diseases. Circulation 2004;109:2807-16.
Hirth A, Reybrouck T, Bjarnason-Wehrens B, Lawrenz W, Hoffmann H. Recommendations for participation in competitive and leisure sports in patients with congenital heart disease: a consensus document. Eur J Cardiovasc Prev Rehabil 2006;13:293.
Heidbüchel H, Panhuyzen-Goedkoop N, Corrado D, Hoffmann E, Biffi A, Delise P, et al. Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions Part I: Supraventricular arrhythmias and pacemakers. Eur J Cardiovasc Prev Rehabil 2006;13:475-84.
Heidbüchel H, Corrado D, Biffi A, Hoffmann E, Panhuyzen-Goedkoop N, Hoogsteen J, et al. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions Part II: Ventricular arrhythmias, channelopathies and implantable defibrillators. Eur J Cardiovasc Prev Rehabil 2006;13:676-86.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
