Sudden cardiac arrest in sports - need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation.

There are large variations in the incidence, registration methods and reported causes of sudden cardiac arrest/sudden cardiac death (SCA/SCD) in competitive and recreational athletes. A crucial question is to which degree these variations are genuine or partly due to methodological incongruities. This paper discusses the uncertainties about available data and provides comprehensive suggestions for standard definitions and a guide for uniform registration parameters of SCA/SCD. The parameters include a definition of what constitutes an 'athlete', incidence calculations, enrolment of cases, the importance of gender, ethnicity and age of the athlete, as well as the type and level of sporting activity. A precise instruction for autopsy practice in the case of a SCD of athletes is given, including the role of molecular samples and evaluation of possible doping. Rational decisions about cardiac preparticipation screening and cardiac safety at sport facilities requires increased data quality concerning incidence, aetiology and management of SCA/SCD in sports. Uniform standard registration of SCA/SCD in athletes and leisure sportsmen would be a first step towards this goal.

Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular disease (Part III).

The beneficial effect of exercise training and exercise-based cardiac rehabilitation on symptom-free exercise capacity,cardiovascular and skeletal muscle function, quality of life, general healthy lifestyle, and reduction of depressive symptoms and psychosocial stress is nowadays well recognized. However, it remains largely obscure, which characteristics of physical activity (PA) and exercise training--frequency, intensity, time (duration), type (mode), and volume (dose: intensity x duration) of exercise--are the most effective. The present paper, therefore, will deal with these exercise characteristics in the management of individuals with cardiovascular disease, i.e. coronary artery disease and chronic heart failure patients, but also in patients with congenital or valvular heart disease. Based on the current literature, and if sufficient evidence is available, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding frequency, intensity, time and type of PA, and safety aspects during exercise inpatients with cardiovascular disease. This paper is the third in a series of three papers, all devoted to the same theme: the importance of the exercise characteristics in the management of cardiovascular health. Part I is directed to the general population and Part II to individuals with cardiovascular risk factors. In general, PA recommendations and exercise training programmes for patients with coronary artery disease or chronic heart failure need to be tailored to the individual's exercise capacity and risk profile, with the aim to reach and maintain the individually highest fitness level possible and to perform endurance exercise training 30­60 min daily (3­5 days per week) in combination with resistance training 2­3 times a week. Because of the frequently reported dose­response relationship between training effect and exercise intensity, one should seek sufficiently high training intensities, although more scientific evidence on effect sizes and safety is warranted. At present, there is insufficient data to give more specific recommendations on type, dosage, and intensity of exercise in some other cardiovascular diseases, such as congenital heart disease, valve disease, cardiomyopathies, channelopathies, and patients with implanted devices.

Importance of characteristics and modalities of physical activity and exercise in defining the benefits to cardiovascular health within the general population: recommendations from the EACPR (Part I).

Over the last decades, more and more evidence is accumulated that physical activity (PA) and exercise interventions are essential components in primary and secondary prevention for cardiovascular disease. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit in achieving cardiovascular health. The present paper, as the first of a series of three, will make specific recommendations on the importance of these characteristics for cardiovascular health in the population at large. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and the individual member of the public. Based on previous and the current literature, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and exercise.

Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR. Part II.

In a previous paper, as the first of a series of three on the importance of characteristics and modalities of physical activity (PA) and exercise in the management of cardiovascular health within the general population, we concluded that, in the population at large, PA and aerobic exercise capacity clearly are inversely associated with increased cardiovascular disease risk and all-cause and cardiovascular mortality and that a dose­response curve on cardiovascular outcome has been demonstrated in most studies. More and more evidence is accumulated that engaging in regular PA and exercise interventions are essential components for reducing the severity of cardiovascular risk factors, such as obesity and abdominal fat, high BP, metabolic risk factors, and systemic inflammation. However, it is less clear whether and which type of PA and exercise intervention (aerobic exercise, dynamic resistive exercise, or both) or characteristic of exercise (frequency, intensity, time or duration, and volume) would yield more benefit for each separate risk factor. The present paper, therefore, will review and make recommendations for PA and exercise training in the management of cardiovascular health in individuals with cardiovascular risk factors. The guidance offered in this series of papers is aimed at medical doctors, health practitioners, kinesiologists, physiotherapists and exercise physiologists, politicians, public health policy makers, and individual members of the public. Based on previous and the current literature overviews, recommendations from the European Association on Cardiovascular Prevention and Rehabilitation are formulated regarding type, volume, and intensity of PA and regarding appropriate risk evaluation during exercise in individuals with cardiovascular risk factors.

Nutritional, immunologic and psychological responses to a 7250 km run.

OBJECTIVE: Health, nutritional status, aerobic power, mood state and immune function were studied over 112 days of aerobic activity (a 7250 km cross-Canada run). CASE REPORT: a healthy nulliparous 43 yr old woman ran 65 km/day for 112 days at a 7.9 km/h pace. MEASURES: Food intake, Profile of Mood State and Beck Depression Inventory were monitored weekly. Resting lymphocyte subsets and cytokines were determined before the run, at 3324, 5700 and 7250 km, and after recovery. Clinical data, ventilatory threshold, maximal oxygen intake and immune responses to maximal exercise were obtained before and after the run. OBJECTIVE: Health, nutritional status, aerobic power, mood state and immune function were studied over 112 days of aerobic activity (a 7250 km cross-Canada run). CASE REPORT: a healthy nulliparous 43 yr old woman ran 65 km/day for 112 days at a 7.9 km/h pace. MEASURES: Food intake, Profile of Mood State and Beck Depression Inventory were monitored weekly. Resting lymphocyte subsets and cytokines were determined before the run, at 3324, 5700 and 7250 km, and after recovery. Clinical data, ventilatory threshold, maximal oxygen intake and immune responses to maximal exercise were obtained before and after the run. RESULTS: Early muscle pain was treated with Ibuprofen. A mild paronychia responded to saline soaks, and exercise-induced asthma necessitated inhalation of fenoterol hydrobromide, beclomethasone diproprionate and ipatropium bromide. Food intake, (16.7 MJ/day), was 4.3 MJ/day less than expenditure, covered by metabolizing 16.7 kg of tissue (81.4% fat, 18.6% lean tissue). Ventilatory threshold and aerobic power showed little change. Initial psychological data showed tension and lack of confidence. Depression increased when crossing the Rockies, and there was anger and lack of vigor after the event. The CD8 count was low throughout; the CD25 count increased, but the CD16/56 count, IL-6 and TNF-alpha decreased over the run. Three weeks later, IL-6 had increased, but TNF-alpha remained low. CONCLUSIONS: Given substantial fat reserves, an exercise-induced energy deficit of 4.3 MJ/day can be sustained for 112 days without significant adverse consequences for immune function.