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............................................. or therapeutic medical strategies. However, the ESC Guidelines do not override in any way whatsoever the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient or the patient’s caregiver where appropriate and/or necessary. It is also the health professional’s responsibility to verify the rules and regulations applicable in each country to drugs and devices at the time of prescription.

2 Introduction

Exercise recommendations and eligibility criteria for sports participation in competitive athletes with cardiovascular disease (CVD) were originally published by the Sports Cardiology Section of the European Society of Cardiology (ESC) in 20051 and some aspects were subsequently updated in 2018 and 2019.2,3 The overarching aim of these recommendations was to minimize the risk of adverse events in highly trained athletes. It is important to recognize, however, that most of the exercising population engages in leisure sport and solo recreational exercise and, unlike elite athletes, these individuals have a higher prevalence of risk factors for atherosclerosis and established CVD.

Regular physical activity (PA), including systematic exercise, is an important component of therapy for most CVDs and is associated with reduced cardiovascular (CV) and all-cause mortality. In an era where there is an increasing trend towards a sedentary lifestyle and a rising prevalence of obesity and associated CVDs, the promotion of PA and regular exercise is more crucial than ever and at the forefront of priorities for all scientific CV societies. Even during routine

©ESC 2020

Figure Central illustration Moderate physical activity should be promoted in all individuals with cardiovascular disease. Appropriate risk stratification and optimal therapy are essential for providing exercise prescription for more vigorous activity. Individuals should be involved in the decision making process and a record of the discussion and exercise plan should be documented in the medical records. Downloaded from academic.oup.com/eurheartj/article/42/1/17/5898937 by guest on 07 October 2026