p.4 抽出テキスト

............................................................................................................................................................................. 5.7 Exercise recommendations in individuals with adult congenital heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

5.7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 5.7.2 The increasing numbers of athletes with congenital heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 5.7.3 Non-cardiac abnormalities in congenital heart disease and Paralympic sport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 5.7.4 General considerations in the congenital heart disease athlete . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 5.7.5 Sudden death during sport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 5.7.6 Exercise in athletes with congenital heart disease: current guidelines and recommendations . . . . . . . . . . . . . . . . . . . . . . 70 5.7.7 Assessment of the athlete with congenital heart disease . . . 70 6 Key messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 7 Gaps in evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 8 Sex differences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 9 ‘What to do’ and ‘what not to do’ messages from the Guidelines . . . 75 10 Supplementary data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 11 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 12 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

List of tables

Table 1 Classes of recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 2 Levels of evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 3 Characteristics of exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 4 Indices of exercise intensity for endurance sports from maximal exercise testing and training zones . . . . . . . . . . . . . . . . . . . . . . . . . 30 Table 5 Cardiovascular risk categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 6 Potential risks for older people during exercise . . . . . . . . . . . . . 38 Table 7 Exercise prescription in the elderly . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 8 Exercise activities for older people according to exercise type and intensity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 9 Borderline or uninterpretable ECG findings . . . . . . . . . . . . . . . . . 39 Table 10 Factors determining risk of adverse events during intensive exercise and competitive sports in asymptomatic individuals with long-standing coronary artery disease . . . . . . . . . . . . . . . 40 Table 11 High-risk features for exercise-induced adverse cardiac events in patients with atherosclerotic coronary artery disease . . . . . . 40 Table 12 Optimal exercise training dose for patients with chronic heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 13 Factors influencing decreased exercise capacity (peak VO2) and reduced cardiac output in individuals with heart transplants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 14 Classification of risk to perform sports in patients with aortic pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Table 15 Findings during an invasive electrophysiological study (with the use of isoprenaline) indicating an accessory pathway with increased risk of sudden death . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 16 Baseline parameters for assessment in congenital heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

List of figures

Figure Central illustration Moderate physical activity should be promoted in all individuals with cardiovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . 24 Figure 1 Components for expression of physical fitness . . . . . . . . . . . . . 27 Figure 2 Sporting discipline in relation to the predominant component (skill, power, mixed and endurance) and intensity of exercise. Intensity of exercise must be individualized after maximal exercise testing, field testing and/or after muscular strength testing . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Figure 3a and 3b SCORE charts for European populations of countries at HIGH and LOW cardiovascular disease risk . . . . . . . . . . . . 31 Figure 4 Proposed algorithm for cardiovascular assessment in asymptomatic individuals with risk factors for and possible subclinical chronic coronary syndrome before engaging in sports for individuals aged >35 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Figure 5 Clinical evaluation and recommendations for sports participation in individuals with established coronary artery disease . . . . 41 Figure 6 Schematic representation of the most frequent anomalous origin of coronary arteries and associated risk of sudden cardiac death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Figure 7 Schematic representation of a myocardial bridge . . . . . . . . . . . 44 Figure 8 Specific markers of increased risk of sudden cardiac death with mitral valve prolapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Figure 9 Pre-participation assessment of individuals with congenital heart disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Tables of recommendations

General recommendations for exercise and sports in healthy individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Recommendations for cardiovascular evaluation and regular exercise in healthy individuals aged >35 years . . . . . . . . . . . . . . . . . . . . . . . 34 Special considerations for individuals with obesity, hypertension, dyslipidaemia, or diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Recommendations for exercise in ageing individuals . . . . . . . . . . . . . . . . . 38 Recommendations for exercise in individuals at risk of atherosclerotic coronary artery disease and asymptomatic individuals in whom coronary artery disease is detected at screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Recommendations for exercise in individuals with long-standing chronic coronary syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Recommendations for return to exercise after acute coronary syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Recommendations for exercise in young individuals/athletes with anomalous origins of coronary arteries . . . . . . . . . . . . . . . . . . . . . . . . 43 Recommendations for exercise/sports in individuals with myocardial bridging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Recommendations for exercise prescription in heart failure with reduced or mid-range ejection fraction . . . . . . . . . . . . . . . . . . . . . . . . 46 Recommendations for participation in sports in heart failure . . . . . . . . . 46 Recommendations for exercise and participation in sport in individuals with heart failure with preserved ejection fraction . . . . . . . . 47 Recommendations for exercise and participation in sport in heart transplant recipients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Recommendations for exercise and participation in recreational/ leisure-time sports in asymptomatic individuals with aortic stenosis . . . . 49 Recommendations for participation in competitive sports in asymptomatic individuals with aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . 49 Recommendations for participation in recreational/leisure-time sports in asymptomatic individuals with aortic regurgitation . . . . . . . . . 50 Recommendations for participation in competitive sports in asymptomatic individuals with aortic regurgitation . . . . . . . . . . . . . . . . . . 50 Downloaded from academic.oup.com/eurheartj/article/42/1/17/5898937 by guest on 07 October 2026