p.14 抽出テキスト

................................................................................................................. component. For example, resistance activities can be performed in a predominantly dynamic manner or a predominantly static manner. Some sports require a high motor control component and level of skill, whereas other sports are performed at a low, moderate, high, or very high intensity. These intensities can vary depending upon the type of sport or the professional, amateur, or recreational level of performing the sports.

When providing advice regarding an exercise programme or sports participation, the physician should indicate: (i) the type of sport; (ii) frequency and duration of the exercise programme; and (iii) the intensity that appears most appropriate to the individual.

(1) Regarding the choice of the most convenient sport, the physician may indicate the type of sport as illustrated in Figure 2 (skill, power, mixed, or endurance), with specification of the frequency, duration, and intensity of muscular work to be preferentially maintained during the exercise programme. (2) In order to adequately prescribe the individual intensity of an endurance or mixed type of exercise or sports, the individual should perform a maximal exercise test with 12-lead ECG recording or preferentially, if possible, with simultaneous measurement of respiratory gas exchange (CPET).

Knowing a person’s maximal exercise capacity allows the health professional to determine a personally tailored exercise programme that is safe and most likely to be effective. The exercise test permits the formulation of the appropriate exercise prescription based on well-recognized indices including heart rate reserve (HRR = HRmax - HRrest), VO2 reserve, the ventilatory threshold, or percentage of work rate for a given individual. The exercise test also permits an assessment of any abnormal CV responses that might not otherwise be apparent during usual daily activities (including symptoms, ECG abnormalities, arrhythmias, or abnormal BP response). Based on the exercise testing results, the physician may indicate the intensity, mode, and duration of exercise that appears most suitable to the individual patient (see Table 4). For power sports or resistance training, additionally maximal muscular testing is warranted in order to determine 1 RM or 5 RM. Percentage of these values, number of repetitions, and number of series will enable determination of the CV and muscular demand. Additionally, field tests will facilitate appropriate prescriptions, mainly for team sports.

When prescribing power sports for individuals with CVD, one should also consider the type of muscular work: isometric (static) or isotonic (dynamic) strength exercises. Additionally, the type and amount of exercise training, when preparing for a sport, is very important. The amount of exercise work should be adapted gradually according to the subject’s actual exercise tolerance and to the anticipated level of performance.

4.2 Exercise recommendations in

individuals with cardiovascular risk factors 4.2.1 General introduction Exercise has a positive effect on several risk factors for atherosclerosis.6 Regular exercise reduces the risk of many adverse health outcomes irrespective of age, sex, ethnicity, or the presence of comorbidities. Indeed, there is a doseeffect relationship between exercise and CV and all-cause mortality, with a 2030% reduction in adverse events compared with sedentary individuals.107,108 Consequently, European Guidelines recommend that healthy adults of all ages should perform a minimum of 150 min of moderateintensity endurance exercise training over 5 days or 75 min of vigorous exercise per week over 3 days, with additional benefit derived by doubling the amount to 300 min of moderate-intensity or 150 min of vigorous-intensity aerobic PA per week.6 While exercise is also beneficial in patients with established CVD, the risk associated with vigorous exercise and sports in these individuals is increased. Importantly, CVD may be subclinical and unrecognized; therefore, consideration should be given to pre-participation assessment of risk in individuals with a higher likelihood of CVD. Individuals with multiple risk factors are more likely to develop CVD. Assessment of the individual likelihood of subclinical CVD may be performed by calculating the accumulated risk through established risk scores such as the SCORE risk charts (Figure 3) and considering

Table 4 Indices of exercise intensity for endurance sports from maximal exercise testing and training zones

©ESC 2020

HRmax = maximum heart rate; HRR = heart rate reserve; RPE = rate of perceived exertion; VO2max = maximum oxygen consumption. aAdapted from refs 84,85 using training zones related to aerobic and anaerobic thresholds. Low-intensity exercise is below the aerobic threshold; moderate is above the aerobic threshold but not reaching the anaerobic zone; high intensity is close to the anaerobic zone; and very intense exercise is above the anaerobic threshold. The duration of exercise will also largely influence this division in intensity. Downloaded from academic.oup.com/eurheartj/article/42/1/17/5898937 by guest on 07 October 2026