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............................................................ 5. Exercise in clinical settings

5.1 Exercise programmes for

leisure-time and competitive sport participation in chronic coronary syndrome Atherosclerotic CAD is the predominant cause of exercise-related (Ex-R) cardiac events including ACS, AMI, and SCA in individuals with established chronic coronary syndrome (CCS), or SCD as a primary presentation in individuals >35 years of age.218 In addition to atherosclerotic CAD, other entities, including an anomalous origin of a coronary artery (AOCA),219 myocardial bridge (MB),220 and spontaneous coronary artery dissection (SCAD),221 are also associated with myocardial ischaemia, and potentially with Ex-R SCD. Physical inactivity is a risk factor for CAD, but somewhat paradoxically, vigorous physical exertion transiently increases the risk for AMI66 and SCD.216 Overall, the benefits of regular exercise greatly outweigh the Ex-R risk, even in individuals with CCS. Moderate- to vigorous-intensity exercise is strongly associated with a reduced

Table 6 Potential risks for older people during exercise

©ESC 2020

Table 7 Exercise prescription in the elderly

©ESC 2020

Recommendations for exercise in ageing individuals

Recommendations Classa Levelb

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 I A 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 I B 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. IIa 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. IIb C

CV = cardiovascular. aClass of recommendation. bLevel of evidence. Table 8 Exercise activities for older people according to exercise type and intensity

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