2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease
We have completed guidelines recommended for an “exercise program in a patient with chronic coronary syndrome for leisure time and competitive sports participation” in the month of November. While moving forward in this 2020 ESC guidelines, we are going to summarize guidelines for “Exercise recommendations in individuals with valvular heart disease” this month.
Antonio Pelliccia and the members of the European Society of Cardiology (2020) have come up with a guidelines entitled, “2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease“, to recommend exercises in different types of cardiac problems.
Objective:
To provide safe and evidence-based exercise programs for a patient with valvular heart disease
Method:
The guideline was developed from the currently available evidence and scientific and medical knowledge. The selected articles were later classified and graded depending on the usefulness/ efficacy of the procedure and methodology of clinical trials.
Recommended guidelines:
Recommendations for exercise and participation in recreational/leisure-time sports in asymptomatic individuals with aortic stenosis (AS):
In mild AS, participation in all recreational sports is recommended as per the patient’s desire.
In moderate AS, if patients have Left ventricular ejection fraction (LVEF) ≥ 50%, normal exercise test, and good functional capacity; they can participate in all recreational sports with low to moderate intensity.
In severe AS, with consideration of LVEF ≥50% and normal BP response during exercise; the patient can Participate in all recreational low-intensity sports/exercise. Sports/ exercise of other intensities is not recommended for these patients.
Recommendations for participation in competitive sports in asymptomatic individuals with aortic stenosis:
In mild AS, participation in all recreational sports is recommended depending on the patient’s desire.
In moderate AS, if patients have LVEF ≥50%, normal BP response during exercise, and good functional capacity; they may participate in all recreational sports with low to moderate intensity.
In severe AS, selected individuals with LVEF ≥50% can participate in low-intensity skills. Sports/ exercise of other intensities is not recommended for these patients.
Recommendations for participation in recreational/leisure-time sports in asymptomatic individuals with aortic regurgitation (AR):
In mild AR, participation in all recreational sports is recommended depending on the patient’s desire.
In moderate AR, as per the patient’s desire; participation should be considered in asymptomatic individuals with a non-dilated LV with LVEF >50% and normal exercise stress test.
In consideration of a mild or moderately dilated LV with LVEF >50% and normal exercise stress test, patients with severe AR can participate in all recreational sports with low and moderate intensity. Any moderate/high-intensity recreational exercise is not advised in patients with h LVEF<_50% and/or exercise-induced arrhythmias.
Recommendations for participation in competitive sports in asymptomatic individuals with aortic regurgitation:
In mild AR, participation in all recreational sports is recommended depending on the patient’s desire.
With consideration to LVEF >50% and normal exercise test, participation in all competitive sport is recommended for individuals with moderate AR.
In severe AR, individuals with normal exercise stress tests and mild to moderate dilated LV with LVEF >50% can participate in most competitive sports with low-moderate intensity activities. Restrictions for any moderate- or high-intensity competitive sports is suggested for patients with exercise-induced arrhythmias or LVEF ≤50%.
Recommendations for participation in recreational/leisure-time sports in asymptomatic individuals with mitral regurgitation (MR):
In mild MR, participation in all sports is recommended depending on the patient’s desire.
In moderate MR, individual fulfilling the following criteria can participate in all recreational sports, if desired: LVEF ≥60%, left ventricular end-diastolic diameter (LVEDD) <60 mm or <35.3 mm/m2 in men and <40 mm/m2 in women, Normal exercise test, Resting systolic pulmonary artery pressure (sPAP) <50 mmHg.
In severe MR, individual fulfilling the following criteria can participate in all low and moderate-intensity recreational sports, if desired: LVEF ≥60%, LVEDD<60 mm or <35.3 mm/m2 in men and <40 mm/m2 in women, Normal exercise test, Resting sPAP<50 mmHg
Recommendations for participation in competitive sports in asymptomatic individuals with mitral regurgitation:
In mild MR, participation in all competitive sports is recommended depending on the patient’s desire.
In moderate MR, individual fulfilling the following criteria can participate in all competitive sports, if desired: LVEF ≥60%, left ventricular end-diastolic diameter (LVEDD)<60 mm or <35.3 mm/m2 in men and <40 mm/m2 in women, Normal exercise test, Resting systolic pulmonary artery pressure (sPAP) <50 mmHg.
In severe MR, individual fulfilling the following criteria can participate in low-intensity competitive sports, if desired: LVEF ≥60%, LVEDD<60 mm or <35.3 mm/m2 in men and <40 mm/m2 in women, Normal exercise test, Resting sPAP<50 mmHg. In individuals with an LVEF<60%, participation in competitive sports is not recommended.
Recommendations for participation in recreational/leisure-time sports in individuals with mitral stenosis (MS):
In Mild MS [Mitral valve prolapse (MVA)1.5-2.0 cm2], patients can participate in all recreational sports, if they have normal exercise test and resting sPAP<40 mmHg.
In Moderate MS (MVA 1.0-1.5 cm2), patients can participate in all recreational sports with low and moderate intensity, if they have normal exercise test and resting sPAP<40 mmHg.
In Severe MS (MVA<1.0 cm2), Patients are not recommended to participate in leisure sports of moderate or high intensity.
Recommendations for participation in competitive sports in asymptomatic individuals with mitral stenosis:
In Mild MS (MVA 1.5-2.0 cm2), patients can participate in all competitive sports, if they have a normal exercise test and resting sPAP<40 mmHg.
In Moderate MS (MVA 1.0-1.5 cm2), patients can participate in all competitive sports with low intensity, if they have normal exercise test and resting sPAP<40 mmHg.
In Severe MS (MVA<1.0 cm2), Patients are not recommended to participate in any competitive sports.
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