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............. exercising at high altitude in an unacclimatized state are not recommended.

Finally, females represent the largest population of obese individuals worldwide and females with T2DM have a higher prevalence of cardiovascular complications and death compared with men. In this regard all women should be incentivized to engage in regular PA and exercise programmes irrespective of age, ethnicity, and CV morbidities.

Recommendations: What to do and what not to do for exercise and sports in healthy individuals Classa Levelb

General recommendations for exercise and sports in healthy individuals At least 150 min/week of moderate-intensity, or 75 min/week of vigorous-intensity aerobic exercise or an equivalent combination thereof is recommended in all healthy adults. I A Regular assessment and counselling to promote adherence and, if necessary, to support an increase in exercise volume over time are recommended. I B Multiple sessions of exercise spread throughout the week, i.e. on 45 days a week and preferably every day of the week, are recommended. I B Special considerations for individuals with obesity, hypertension, dyslipidaemia, or diabetes In obese individuals (BMI>_30 kg/m2 or a waist circumference >80 cm for females or >94 cm for males) resistance training >_3 times per week, in addition to moderate or vigorous aerobic exercise (at least 30 min, 57 days per week) is recommended to reduce CVD risk. I A In individuals with well-controlled hypertension, resistance training >_3 times per week in addition to moderate or vigorous aerobic exercise (at least 30 min, 57 days per week) is recommended to reduce blood pressure and CVD risk. I A Among individuals with diabetes mellitus, resistance training >_3 times per week) in addition to moderate or vigorous aerobic exercise (at least 30 min, 57 days per week) is recommended to improve insulin sensitivity and achieve a better CVD risk profile. I A In individuals with uncontrolled hypertension (SBP>160 mmHg) high-intensity exercise is not recommended until BP has been controlled. III C Recommendations for exercise in ageing individuals 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. 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. I B Recommendations for exercise in individuals with coronary artery disease Recommendations for exercise in individuals with long-standing chronic coronary syndrome Risk stratification for exercise-induced adverse events is recommended in individuals with established (long-standing) CCS prior to engaging in exercise. I 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. III C Recommendations for return to exercise after acute coronary syndrome Exercise-based cardiac rehabilitation is recommended in all individuals with CAD to reduce cardiac mortality and rehospitalization. I A Recommendations for exercise in young individuals/athletes with anomalous origins of coronary arteries Participation in most competitive sports with a moderate and high CV demand among individuals with AOCA with an acutely angled take-off or an anomalous course between the large vessels is not recommended. III C Recommendations for exercise/sports in individuals with myocardial bridging Competitive sports are not recommended in individuals with myocardial bridging and persistent ischaemia or complex cardiac arrhythmias during maximal exercise stress testing. III C Recommendations for exercise in chronic heart failure Recommendations for exercise prescription in heart failure with reduced or mid-range ejection fraction Regular discussion about exercise participation and provision of an individualized exercise prescription is recommended in all individuals with HF. I A Exercise-based cardiac rehabilitation is recommended in all stable individuals to improve exercise capacity and quality of life and to reduce the frequency of hospital readmission. I A

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9 ‘What to do’ and ‘what not to do’ messages from the Guidelines

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