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........................................ Asymptomatic individuals with mild MS [mitral valve area (MVA) 1.52.0 cm2] and moderate MS (MVA 1.01.5 cm2) who are in sinus rhythm and demonstrate good functional capacity on exercise testing and a normal sPAP may participate in all competitive and leisure sports. Mildly symptomatic individuals with severe MS (MVA < 1.0 cm2) may only participate in leisure exercise involving physical effort of low intensity. Individuals with symptomatic MS should be referred for intervention and advised to abstain from participation in sports and recreational exercise of moderate or high intensity. Individuals with AF should be anticoagulated and avoid contact/collision sport. In cases of balloon mitral valvuloplasty with good results (i.e. MVA > 2.0 cm2) regular exercise and competitive sport may be considered in asymptomatic individuals with good functional capacity.

5.3.7 Tricuspid regurgitation Tricuspid regurgitation (TR) is usually secondary to left heart disease, pulmonary hypertension, or right ventricular (RV) dysfunction. In most patients with secondary TR, exercise limitations relate to the underlying pathology. Mild TR is common in athletes and accompanied by physiological dilatation of the inferior vena cava, which is easily collapsible with inspiration. Severe TR is characterized by increasing tricuspid annular dilatation and RV remodelling that eventually leads to RV dysfunction and a non-reactive inferior vena cava. Individuals with severe TR may also have a reduced exercise capacity due to an impaired cardiac output response with exercise.339 Furthermore, they may experience increased right- and left-sided filling pressures during exercise, the latter being due to diastolic ventricular interaction.340

In general, asymptomatic patients with TR who have good functional capacity, non-dilated right ventricle, preserved ventricular function, sPAP<40 mmHg, and absence of complex arrhythmias may compete in all competitive and recreational sports.

5.4 Exercise recommendations in

individuals with aortopathy 5.4.1 Introduction Thoracic aortic aneurysms are largely asymptomatic until a sudden and catastrophic event, including aortic rupture or dissection, occurs,

Recommendations for participation in recreational/leisure-time sports in individuals with mitral stenosis

Mitral stenosisc,d

Recommendation Classa Levelb

Mild (MVA 1.52.0 cm2) Participation in all recreational sports, if desired, is recommended in individuals with a resting

sPAP<40 mmHg and normal exercise test. I C

Moderate (MVA 1.01.5 cm2) Participation in all recreational sports involving low and moderate intensity, if desired, may be

considered in individuals with resting sPAP<40 mmHg and a normal exercise test. IIb C

Severe (MVA<1 cm2) Participation in leisure sports of moderate or high intensity is not recommended. III C

MVA = mitral valve area; sPAP = systolic pulmonary artery pressure. aClass of recommendation. bLevel of evidence. cFor mixed valvular disease, the recommendation for the predominant valve lesion should be followed. dNo collision or body contact sports if anticoagulated for atrial fibrillation.

Recommendations for participation in competitive sports in asymptomatic individuals with mitral stenosis

Mitral stenosisc,d

Recommendation Classa Levelb

Mild (MVA 1.52.0 cm2) Participation in all competitive sports, if desired, is recommended in individuals with a resting

sPAP<40 mmHg and a normal exercise test. I C

Moderate (MVA 1.01.5 cm2) Participation in all competitive sports involving low intensity may be considered in individuals

with a resting sPAP<40 mmHg and normal exercise test. IIb C

Severe (MVA<1.0 cm2) Participation in competitive sports is not recommended. III C

MVA = mitral valve area; sPAP = systolic pulmonary artery pressure. aClass of recommendation. bLevel of evidence. cFor mixed valvular disease, the recommendation for the predominant valve lesion should be followed. dNo collision or body contact sports if anticoagulated for atrial fibrillation. Downloaded from academic.oup.com/eurheartj/article/42/1/17/5898937 by guest on 07 October 2026