ESC 2020 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease
European Society of Cardiology｜循環器 / スポーツ｜80 ページ｜チャンク 793｜推奨 160 件｜current
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| 頁 | クラス | レベル | 推奨文 | 表 |
|---|---|---|---|---|
| p.17 | I | A | At least 150 min/week of moderate-intensity, or 75 min/week of vigorous-intensity aerobic exercise, or an equivalent combination thereof is recommended in all healthy adults.113118 | |
| p.17 | I | A | A gradual increase in aerobic exercise to 300 min/week of moderate-intensity, or 150 min/ week of vigorous-intensity aerobic exercise, or an equivalent combination is recommended for additional benefits in healthy adults.114,116 | |
| p.17 | I | B | Regular assessment and counselling to promote adherence and, if necessary, to support an increase in exercise volume over time are recommended.119 | |
| p.17 | I | B | Multiple sessions of exercise spread throughout the week, i.e. on 45 days a week and preferably every day of the week, are recommended.113,114 aClass of recommendation. bLevel of evidence. ©ESC 2020 | |
| p.18 | IIa | C | Among individuals with low to moderate CVD risk, the participation in all recreational sports should be considered without further CV evaluation. | |
| p.18 | IIa | C | Cardiac screening with family history, symptoms, physical examination, and 12-lead resting ECG should be considered for competitive athletes. Clinical evaluation, including maximal exercise | |
| p.18 | IIa | C | testing, should be considered for prognostic purposes in sedentary people and individuals with high or very high CV risk who intend to engage in intensive exercise programmes or competitive sports. | |
| p.18 | IIb | B | In selected individuals without known CAD who have very high CVD risk (e.g. SCORE>10%, strong family history, or familial hypercholesterolaemia) and want to engage in high- or very high-intensity exercise, risk assessment with a functional imaging test, coronary CCTA, or carotid or femoral artery ultrasound imaging may be considered. | |
| p.21 | I | A | In obese individuals (BMI>_30 kg/m2 or a waist cir- cumference >80 cm for females or >94 cm for males) resistance training >_3 times per week, in addition to moderate or vigorous aerobic exercise (at least 30 min, 57 days per week) is recommended to reduce CVD risk.121 | |
| p.21 | I | A | In individuals with well-controlled hypertension, resistance training >_3 times per week in addition to moderate or vigorous aerobic exercise (at least 30 min, 57 days per week) is recommended to reduce blood pressure and CVD risk. 132 | |
| p.21 | I | A | Among individuals with diabetes mellitus, resistance training >_3 times per week in addition to moderate or vigorous aerobic exercise (at least 30 min, 57 days per week) is recommended to improve insulin sensitivity and achieve a better CVD risk | |
| p.21 | III | C | profile.176,178 Among adults with well-controlled hypertension but high risk and/or target organ damage, high-inten- sity resistance exercise is not recommended. | |
| p.21 | III | C | In individuals with uncontrolled hypertension (SBP>160 mmHg) high-intensity exercise is not recommended until blood pressure has been controlled. CVD = cardiovascular disease; SBP = systolic blood pressure. aClass of recommendation. bLevel of evidence. | |
| p.22 | I | A | Among adults aged 65 years or older who are fit and have no health conditions that limit their mobility, moderate-intensity aerobic exercise for at least 150 min/week is recommended.212,214,215 | |
| p.22 | I | B | In older adults at risk of falls, strength training exercises to improve balance and coordination on at least 2 days a week are recommended.201,212,214,215 | |
| p.22 | IIa | C | A full clinical assessment including a maximal exercise test should be considered in sedentary adults aged 65 years or older who wish to participate in high-intensity activity. | |
| p.22 | IIb | C | Continuation of high- and very high-intensity activity, including competitive sports, may be considered in asymptomatic elderly athletes (master athletes) at low or moderate CV risk. CV = cardiovascular. aClass of recommendation. bLevel of evidence. | |
| p.24 | IIa | C | Among individuals with asymptomatic CCS, defined as CAD without inducible myocardial ischaemia on a functional imaging or conventional exercise stress test, 233 participation in all types of exercise, including competitive sports, should be considered based on individual assessment. | |
| p.25 | I | C | Risk stratification for exercise-induced adverse events is recommended in individuals with established (long-standing) chronic coronary syndrome (CCS) prior to engaging in exercise.233 | |
| p.25 | I | B | Regular follow-up and risk stratification of patients with CCS is recommended.233 | |
| p.25 | IIa | C | should be considered in individuals at low risk of exercise-induced adverse events (Table 11).233 | |
| p.25 | IIb | C | induced adverse events (Table 11), including those with persisting ischaemia.233 | |
| p.25 | III | C | ischaemia, with the exception of individually recommended skill sports.233 | |
| p.26 | I | A | Exercise-based cardiac rehabilitation is recom- mended in all individuals with CAD to reduce cardiac mortality and rehospitalization.234 | |
| p.26 | IIa | B | During the initial period, motivational and psy- chological support, and individualized recommendations on how to progress the amount and intensity of sports activities, should be consid- ered in patients with CAD. | |
| p.26 | IIa | C | All sports activities should be considered, at an individually adapted intensity level in low-risk individuals with CCS. | |
| p.27 | III | C | Participation in most competitive sports with a moderate and high cardiovascular demand among individuals with AOCA with an acutely angled take-off or an anomalous course between the large vessels is not recommended.c | |
| p.28 | IIa | C | Participation in competitive and leisure-time sports should be considered in asymptomatic individuals with myocardial bridging and without inducible ischaemia or ventricular arrhythmia during maximal exercise testing. | |
| p.28 | III | C | Competitive sports are not recommended in individuals with myocardial bridging and persis- tent ischaemia or complex cardiac arrhythmias during maximal exercise stress testing. aClass of recommendation. bLevel of evidence. | |
| p.30 | I | A | Regular discussion about exercise participation and provision of an individualized exercise prescription is recommended in all individuals with heart failure.260,261,285 | |
| p.30 | I | A | Exercise-based cardiac rehabilitation is recommended in all stable individuals to improve exer- cise capacity, quality of life, and to reduce the frequency of hospital readmission.260,261,285 | |
| p.30 | IIa | C | Beyond annual cardiac assessment, clinical reassessment should be considered when the inten- sity of exercise is increased. | |
| p.30 | IIa | C | Motivational and psychological support and individualized recommendations on how to progress the amount and intensity of sports activities should be considered. | |
| p.30 | IIb | C | Low- to moderate-intensity recreational sporting activities and participation in structured exer- cise programmes may be considered in stable individuals. | |
| p.30 | IIb | C | High-intensity interval training programmes may be considered in low-risk patients who want to return to high-intensity aerobic and mixed endurance sports. aClass of recommendation. bLevel of evidence. | |
| p.30 | I | C | Before considering a sport activity, a preliminary optimization of heart failure risk factor control and therapy, including device implantation (if appropriate), is recommended. | |
| p.30 | IIa | C | Participation in sports activities should be considered in individuals with heart failure who are at low risk, based on a complete assessment and exclusion of all contraindications, in stable condition for at least 4 weeks, optimal treatment, and NYHA functional class I status. | |
| p.30 | IIb | C | Non-competitive (low- to moderate-intensity rec- reational) skill, power, mixed, or endurance sports may be considered in stable, asymptomatic, and optimally treated individuals with HFmrEF. | |
| p.30 | IIb | C | High-intensity recreational sports, adapted to the capabilities of the individual patient, may be considered in selected stable, asymptomatic, and optimally treated individuals with HFmrEF with an age-matched exercise capacity beyond average. | |
| p.31 | IIb | C | Non-competitive (low-intensity recreational skill-related sports) may be considered (when tolerated) in stable, optimally treated individuals with HFrEF. | |
| p.31 | III | C | High-intensity power and endurance sports are not recommended in patients with HFrEF irrespective of symptoms. | |
| p.31 | I | C | Moderate endurance and dynamic resistance exercise, together with lifestyle intervention and optimal treatment of cardiovascular risk factors (i.e. arterial hypertension and type 2 diabetes) are recommended.287,289292,299 | |
| p.31 | IIb | C | Competitive sports may be considered in selected stable patients without abnormalities on maximal exercise testing. aClass of recommendation. bLevel of evidence. Refer also to the recommendation in section 5.2.5. | |
| p.32 | I | B | Regular exercise through cardiac rehabilitation, combining moderate-intensity aerobic and resistance exercise, is recommended to revert patho- physiology to pre-transplantation time, reduce cardiovascular risk induced by post-transplantation medical treatment, and improve clinical | |
| p.32 | IIa | C | outcome.305312 Recreational (low-intensity recreational) sports participation should be considered and encour- aged in stable, asymptomatic individuals after therapy optimization. | |
| p.32 | IIb | C | Eligibility for competitive sports involving lowand moderate-intensity exercise may be consid- ered in selected, asymptomatic individuals with an uncomplicated follow-up.304,309,310 aClass of recommendation. bLevel of evidence. | |
| p.33 | I | C | Aortic stenosisc Mild Participation in all recreational sports, if desired, is recommended. | |
| p.33 | IIa | C | Moderate Participation in all recreational sports involving low to moderate intensity, if desired, should be con- sidered in individuals with LVEF>_50%, good functional capacity, and normal exercise test. | |
| p.33 | IIb | C | Severe Participation in all recreational sports/exercise involving low intensity, if desired, may be considered in individuals with LVEF>_50% and nor- mal BP response during exercise. | |
| p.33 | III | C | Participation in competitive or rec- reational sports/exercise of moder- ate and high intensity is not recommended. | |
| p.33 | I | C | Aortic stenosisc Mild Participation in all competitive sports, if desired, is recommended. Moderate Participation in all competitive | |
| p.33 | IIb | C | sports involving low to moderate effort, if desired, may be considered in individuals with LVEF>_50%, good functional capacity, and normal BP | |
| p.33 | IIb | C | response during exercise. Severe Participation in low-intensity skill sports may be considered in a select group of individuals with LVEF>_50%. | |
| p.33 | III | C | Participation in sports or exercise of moderate or high intensity is not recommended. | |
| p.34 | I | C | Mild Participation in all recreational sports, if desired, is recommended. | |
| p.34 | I | C | Mild Participation in all competitive sports, if desired, is recommended. | |
| p.34 | IIa | C | Aortic regurgitationc | |
| p.35 | I | C | Mild Participation in all sports, if desired, is recommended. | |
| p.35 | I | C | Mild Participation in all competitive sports, if desired, is recommended. | |
| p.35 | III | C | Participation in competitive sports is not recommended in individuals with a LVEF<60% | |
| p.35 | IIa | C | Mitral regurgitationc,d | |
| p.37 | III | C | Severe (MVA<1 cm2) Participation in leisure sports of moderate or high intensity is not recommended. | |
| p.37 | III | C | Severe (MVA<1.0 cm2) Participation in competitive sports is not recommended. | |
| p.37 | I | C | Mitral stenosisc,d sPAP<40 mmHg and normal exercise test. | |
| p.37 | IIb | C | considered in individuals with resting sPAP<40 mmHg and a normal exercise test. | |
| p.37 | I | C | Mitral stenosisc,d sPAP<40 mmHg and a normal exercise test. | |
| p.37 | IIb | C | with a resting sPAP<40 mmHg and normal exercise test. | |
| p.39 | I | C | Prior to engaging in exercise, risk stratification, with careful assessment including advanced imag- ing of the aorta (CT/CMR) and exercise testing with blood pressure assessment is | |
| p.39 | I | C | recommended. Regular follow-up including risk assessment is recommended. | |
| p.39 | IIa | C | Dynamic exercise should be considered more suitable than static exercise. | |
| p.39 | IIa | C | Participation in competitive or leisure-time sports activities (except power sports) should be considered in low-risk individuals (Table 14). | |
| p.39 | IIb | C | Participation in individualized leisure exercise programmes may be considered in high-risk individuals (Table 14). | |
| p.39 | III | C | Competitive sports are not recommended in individuals who are at high risk (Table 14). | |
| p.41 | IIb | C | Exercise recommendations Participation in high-intensity exercise/competitive sports, if desired (with the exception of those where occurrence of syncope may be associated with harm or death), may be considered for individuals who do not have any markers of increased riskc following expert assessment. | |
| p.41 | IIb | C | Participation in low- or moderate-intensity recrea- tional exercise, if desired, may be considered for individuals who have any markers of increased riskc following expert assessment . | |
| p.41 | IIb | C | Participation in all competitive sports, if desired, may be considered for individuals who are gene positive for HCM but phenotype negative. | |
| p.41 | III | C | Participation in high-intensity exercise (including recreational and competitive sports) is not recommended for individuals who have ANY markers of increased riskc. | |
| p.41 | I | C | Annual follow-up is recommended for individuals who exercise on a regular basis. | |
| p.41 | IIa | C | Six-monthly follow-up should be considered in adolescent individuals and young adults who are more vulnerable to exercise-related SCD. | |
| p.41 | IIa | C | Annual assessment should be considered for gen- otype-positive/phenotype-negative individuals for phenotypic features and risk stratification purposes. | |
| p.42 | IIa | C | Exercise recommendations Participation in 150 min of low-intensity exercise per week should be considered for all individuals. Participation in low- to moderate-intensity recrea- | |
| p.42 | IIb | C | tional exercise/sports, if desired, may be considered for individuals with no history of cardiac arrest/VA, unexplained syncope, minimal struc- tural cardiac abnormalities, <500 PVCs/24 h and no evidence of exercise-induced complex VAs. | |
| p.42 | III | B | Participation in high-intensity recreational exercise/ sports or any competitive sports is not recommended in individuals with ACM, including those who are gene positive but phenotype negative.384,386 | |
| p.42 | I | C | Annual follow-up is recommended for individuals who exercise on a regular basis. | |
| p.42 | IIa | C | Six-monthly follow-up should be considered in adolescent individuals and young adults who are more vulnerable to exercise-related SCD. | |
| p.42 | IIa | C | Annual assessment should be considered for geno- type-positive/phenotype-negative individuals for phenotypic features and risk stratification purposes. | |
| p.42 | IIa | C | Six-monthly follow-up should also be considered in individuals with high arrhythmic risk genotypes such as DSP, TMEM43, and carriers of multiple pathogenic variants. | |
| p.43 | IIa | B | A diagnosis of LVNC in athletic individuals should be considered if they fulfil imaging criteria, in association with cardiac symptoms, family history of LVNC or cardiomyopathy, LV systolic (EF<50%) or diastolic (E’<9 cm/s) dysfunction, a thin compacted epicardial layer (<5 mm in end-diastole on CMR, or <8 mm in systole on echocardiography), or abnormal 12-lead ECG.404,405,410,411 | |
| p.43 | IIb | C | Exercise recommendations Participation in high-intensity exercise and all competitive sports, if desired, with the exception where syncope may cause serious harm or death, may be considered in asymptomatic individuals with LVNC and LVEF>_50% and absence of fre- quent and/or complex VAs. | |
| p.43 | IIb | C | Participation in recreational exercise programmes of low to moderate intensity, if desired, may be consid- ered in individuals with LVEF 4049% in the absence of syncope and frequent or complex VAs on ambula- tory Holter monitoring or exercise testing. | |
| p.43 | IIb | C | Participation in high- or very high-intensity exer- cise including competitive sports, if desired, may be considered for individuals who are gene posi- tive for LVNC but phenotype negative (with the exception of lamin A/C or filamin C carriers). | |
| p.43 | III | C | Participation in high-intensity exercise or competitive sports is not recommended in individuals with any of the following: symptoms, LVEF<40% and/or frequent and/or complex VAs on ambulatory Holter monitoring or exercise testing. | |
| p.43 | I | C | Follow-up and further considerations Annual assessment for risk stratification is recom- mended for individuals with LVNC and genotypepositive/phenotype-negative individuals who exer- cise on a regular basis. | |
| p.44 | IIa | C | Participation in low- to moderate-intensity recrea- tional exercise should be considered in all individuals with DCM, regardless of the EF, in the absence of limiting symptoms, and exercise-induced VAs. Participation in high- or very high-intensity exercise including competitive sports (with the excep- | |
| p.44 | IIb | C | tion of those where occurrence of syncope may be associated with harm or death) may be considered in asymptomatic individuals who fulfil all of the following: (i) mildly reduced LV systolic func- tion (EF 4550%); (ii) absence of frequent and/or complex VAs on ambulatory Holter monitoring or exercise testing; (iii) absence of LGE on CMR; (iv) ability to increase EF by 1015% during exercise; and (v) no evidence of high-risk genotype (lamin A/C or filamin C). | |
| p.44 | IIb | C | Participation in all competitive sports may be con- sidered in individuals with DCM who are geno- type positive and phenotype negative, with the exception of carriers of high-risk mutations (lamin A/C or filamin C). | |
| p.44 | III | C | Participation in high- or very high-intensity exercise including competitive sports is not recom- mended for individuals with a DCM and any of the following: (i) symptoms or history of cardiac arrest or unexplained syncope; (ii) LVEF<45%; (iii) frequent and/or complex VAs on ambulatory Holter monitoring or exercise testing; (iv) extensive LGE (>20%) on CMR; or (v) high-risk geno- | |
| p.44 | I | C | type (lamin A/C or filamin C). Follow-up recommendations Annual follow-up is recommended for individuals with DCM who exercise on a regular basis. Six-monthly follow-up should be considered in | |
| p.44 | IIa | C | individuals with high-risk mutations and adolescent individuals and young adults whose DCM phenotype may still be evolving and who are more vul- nerable to exercise-related SCD. | |
| p.44 | IIa | C | Annual assessment should be considered for genotype-positive/phenotype-negative individuals for phenotypic features and risk stratification purposes. | |
| p.46 | I | B | Comprehensive evaluation, using imaging studies, exercise stress test and Holter monitoring, is recommended following recovery from acute myo- carditis to assess the risk of exercise-related SCD.455,462,463 Return to all forms of exercise including competi- | |
| p.46 | IIa | C | tive sports should be considered after 36 months in asymptomatic individuals, with normal troponin and biomarkers of inflammation, normal LV systolic function on echocardiography and CMR, no evidence of ongoing inflammation or myocardial fibrosis on CMR, good functional capacity, and absence of frequent and/or complex | |
| p.46 | III | C | VAs on ambulatory Holter monitoring or exercise testing.430,434,453,459,460,464 Among individuals with a probable or definitive diagnosis of recent myocarditis, participation in leisure-time or competitive sports while active inflammation is present is not recommended.459,460 | |
| p.46 | III | B | Participation in moderate- to high-intensity exercise for a period of 36 months after acute myo- carditis is not recommended.459461,467 | |
| p.46 | III | C | Participation in leisure exercise or competitive sports involving high intensity in individuals with residual myocardial scar and persistent LV dys- function is not recommended. | |
| p.46 | I | C | Return to all forms of exercise including competi- tive sports is recommended after 30 days to 3 months for individuals who have recovered com- pletely from acute pericarditis, depending on clini- cal severity.459,460 | |
| p.46 | III | C | Participation in leisure-time or competitive sports is not recommended for individuals with a prob- able or definitive diagnosis of recent pericarditis while active inflammation is present, regardless of age, sex, or extent of LV systolic dysfunction.459,460 | |
| p.46 | III | C | Participation in moderate- to high-intensity exercise, including competitive sports, is not recom- mended for individuals with constrictive pericarditis. LV = left ventricle. aClass of recommendation. bLevel of evidence. | |
| p.47 | I | A | vent AF.297,470473 | |
| p.47 | I | A | Regular physical activity is recommended to pre- Evaluation and management of structural heart disease, thyroid dysfunction, alcohol or drug abuse, or other primary causes of AF is recommended before engaging in sports.485 | |
| p.47 | I | B | Counselling about the effect of long-lasting intense sports participation on (recurrence of) AF is rec- ommended in individuals with AF who exercise vigorously for prolonged periods, especially in middle-aged men.471,475,481,490 | |
| p.47 | I | B | AF ablation is recommended in exercising individuals with recurrent symptomatic AF, and/ or in those who do not want drug therapy, given its impact on athletic performance.488,489 | |
| p.47 | IIa | C | The ventricular rate while exercising with AF should be considered in every exercising indi- vidual (by symptoms and/or by ECG monitor- ing), and titrated rate control should be instituted. | |
| p.47 | IIa | C | Participation in sports without antiarrhythmic therapy should be considered in individuals without structural heart disease, and in whom AF is well tolerated. | |
| p.47 | IIa | C | Cavo-tricuspid isthmus ablation should be consid- ered in those with documented flutter who want to engage in intensive exercise, to prevent atrial flutter 1 : 1 atrioventricular conduction. | |
| p.47 | IIa | C | Prophylactic cavo-tricuspid isthmus ablation to prevent flutter should be considered in individu- als with AF who want to engage in intensive exercise and in whom class I drug therapy is initiated. | |
| p.47 | III | C | The use of class I antiarrhythmic drugs as mono- therapy, without proof of adequate rate control of AF/AFL during vigorous exercise, is not recommended.482,483 | |
| p.47 | III | C | After ingestion of pill-in-the-pocket flecainide or propafenone, participation in intensive sports is not recommended until two half-lives of the anti- arrhythmic drug have elapsed (i.e. up to 2 days).484 | |
| p.47 | III | A | Sports with direct bodily contact or prone to trauma are not recommended in exercising indi- viduals with AF who are anticoagulated.485 | |
| p.49 | I | B | In individuals with palpitations, a comprehensive assessment to exclude (latent) pre-excitation, structural heart disease, and VAs is recommended.500 | |
| p.49 | I | C | Participation in all sports activities is recom- mended in individuals PSVT without preexcitation.500 | |
| p.49 | I | C | Ablation of the accessory pathway is recom- mended in competitive and recreational athletes with pre-excitation and documented arrhythmias.500 | |
| p.49 | I | B | In competitive/professional athletes with asymp- tomatic pre-excitation, an EP study is recommended to evaluate the risk for sudden death.497,500 | |
| p.49 | IIa | C | In competitive athletes with PSVT but without pre-excitation, curative treatment by ablation should be considered. | |
| p.50 | I | C | In exercising individuals with >_2 PVCs on a base- line ECG (or >_1 PVC in the case of high-endur- ance athletes) thorough evaluation (including a detailed family history) to exclude underlying structural or arrhythmogenic conditions is recommended.503,522 | |
| p.50 | I | C | Among individuals with frequent PVCs and nonsustained VT a thorough investigation with Holter monitoring, 12-lead ECG, exercise test, and suitable imaging is recommmended.503 | |
| p.50 | I | C | It is recommended that all competitive and lei- sure-time sports activities are permitted, with periodic re-evaluation in individuals without familial or structural underlying disease.503 | |
| p.51 | I | B | It is recommended that all exercising individuals with LQTS with prior symptoms or prolonged QTc be on therapy with beta-blockers at target dose.529 | |
| p.51 | I | B | It is recommended that exercising individuals with LQTS should avoid QT prolonging drugs (www.crediblemeds.org) and electrolyte imbalance such as hypokalaemia and hypomagnesaemia.529 | |
| p.51 | IIa | C | Shared decision making should be considered regarding sports participation in patients with genotype-positive/phenotype-negative LQTS (i.e. <470/480 ms in men/women). Type and set- ting of sports (individual vs. team), type of mutation, and extent of precautionary measures should be considered in this context. | |
| p.51 | III | B | Participation in high-intensity recreational and competitive sports, even when on beta-blockers, is not recommended in individuals with a QTc>500 ms or a genetically confirmed LQTS with a QTc>_470 ms in men or >_480 ms in women. | |
| p.51 | III | C | Participation in competitive sports (with or with- out ICD) is not recommended in individuals with LQTS and prior cardiac arrest or arrhythmic syncope. | |
| p.51 | I | C | ICD implantation is recommended in patients with BrS with episodes of arrhythmic syncope and/or aborted SCD.247 | |
| p.51 | IIa | C | Following implantation of an ICD, resumption of leisure or competitive sports should be considered after shared decision making in individuals who have not experienced recurrent arrhyth- mias over 3 months after ICD implantation. | |
| p.51 | IIb | C | In asymptomatic individuals with BrS, asymptomatic mutation carriers and asymptomatic ath- letes with only an inducible ECG pattern, participation in sports activities that are not associated with an increase in core temperature >39C (e.g. endurance events under extremely hot and/or humid conditions) may be considered. | |
| p.51 | III | C | Prescription of drugs that may aggravate BrSc, electrolyte abnormalities, and sports practice that increases core temperature >39 C are not recommended in individuals with overt BrS or phenotypically negative mutation carriers. | |
| p.53 | I | B | It is recommended that individuals with implanted devices with/without resynchronization and underlying disease follow the recom- mendations pertaining to the underlying disease.384,425 | |
| p.53 | IIa | C | Participation in sports and exercise (except colli- sion sports) should be considered in individuals with pacemaker therapy who do not have pathological substrates for fatal arrhythmias. | |
| p.53 | IIa | C | Prevention of direct impact to the implanted device by adapting the site of lead and/or device implantation, padding, or restricting direct impact sports should be considered. | |
| p.53 | IIa | C | Holter recordings and device interrogation dur- ing and after resuming sports should be considered to allow appropriate tailoring of rate- responsive pacing parameters, exclusion of myo- potential or electromagnetic inhibition, and detection of VAs. Shared decision making should be considered dur- | |
| p.53 | IIa | C | ing decisions relating to continuation of intensive or competitive sports participation in individuals with an ICD, taking into account the effect of sports on the underlying substrate, the fact that intensive sports will trigger more appropriate and inappropriate shocks, the psychological impact of shocks on the athlete/patient, and the potential | |
| p.53 | III | C | risk for third parties. An ICD is not recommended as a substitute for disease-related recommendations when these mandate sports restrictions. | |
| p.56 | I | B | Participation in regular moderate exercise is rec- ommended in all individuals with CHD.588,591594,619 | |
| p.56 | I | B | A discussion on exercise participation and provi- sion of an individualized exercise prescription is recommended at every CHD patient encounter.574,597,598,617 | |
| p.56 | I | C | Assessment for ventricular function, pulmonary artery pressure, aortic size, and arrhythmia risk is recommended in all athletes with CHD.342,348,573,597 | |
| p.56 | IIa | C | Competitive sports participation should be considered for CHD athletes in NYHA class I or II who are free from potentially serious arrhyth- mias after individual tailored evaluation and shared decision making.573,595,597,598 | |
| p.56 | III | C | Competitive sports are not recommended for individuals with CHD who are in NYHA class IIIIV or with potentially serious arrhythmias.605,608 6 Key messages | |
| p.59 | I | A | Exercise-based cardiac rehabilitation is recommended in all individuals with CAD to reduce cardiac mortality and rehospitalization. | |
| p.60 | III | C | High-intensity power and endurance sports are not recommended in patients with HFrEF irrespective of symptoms. | |
| p.60 | III | C | Participation in competitive sports is not recommended in individuals with severe mitral regurgitation with a LVEF<60%. | |
| p.60 | III | C | Competitive sports are not recommended in individuals who are at high risk (Table 14). | |
| p.60 | I | C | Annual assessment for risk stratification is recommended in all individuals with cardiomyopathy who exercise regularly. | |
| p.60 | III | B | Participation in moderate- to high-intensity exercise for a period of 36 months after acute myocarditis is not recommended. | |
| p.61 | I | A | Regular physical activity is recommended to prevent AF. | |
| p.61 | III | C | Sports with direct bodily contact or prone to trauma are not recommended in exercising individuals with AF who are anticoagulated. | |
| p.61 | I | C | ICD implantation is recommended in patients with BrS with episodes of arrhythmic syncope and/or aborted SCD. | |
| p.61 | III | C | An ICD is not recommended as a substitute for disease-related recommendations when these mandate sports restrictions. | |
| p.61 | I | B | Participation in regular moderate exercise is recommended in all individuals with CHD. | |
| p.62 | III | C | Sports that may potentially affect any of the VAD components (e.g. with body contact) are not recommended. | |
| p.62 | I | C | 11 Appendix |