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Figure 5 Clinical evaluation and recommendations for sports participation in individuals with established coronary artery disease. CCS = chronic coronary syndrome; LAD = left anterior descending coronary artery; LM = left main coronary artery; LVEF = left ventricular ejection fraction. *With documented ischaemia or a haemodynamically relevant lesion defined by FFR <0.8 or iFR <0.9.

Recommendations for exercise in individuals with long-standing chronic coronary syndrome

Recommendations Classa Levelb

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 I C Regular follow-up and risk stratification of patients with CCS is recommended.233 I B It is recommended that individuals at high risk of an adverse event from CAD are managed according to the current Guidelines on CCS.233 I C Competitive or leisure sports activities (with some exceptions such as older athletes and sports with extreme CV demands) should be considered in individuals at low risk of exercise-induced adverse events (Table 11).233 IIa C Leisure-time exercise, below the angina and ischaemic thresholds, may be considered in individuals at high risk of exerciseinduced adverse events (Table 11), including those with persisting ischaemia.233 IIb C Competitive sports are not recommended in individuals at high risk of exercise-induced adverse events or those with residual ischaemia, with the exception of individually recommended skill sports.233 III C

CAD = coronary artery disease; CCS = chronic coronary syndrome; CV = cardiovascular. aClass of recommendation. bLevel of evidence. Downloaded from academic.oup.com/eurheartj/article/42/1/17/5898937 by guest on 07 October 2026