Contraindicaciones para la práctica deportiva. Documento de Consenso de la Sociedad Española de Medicina del Deporte (SEMED). Versión 2023 / Contraindications of sports practice. Consensus document of the Spanish Society of Sports Medicine (SEMED). Version 2023

La función principal de la medicina del deporte es el cuidado de la salud del deportista, no solo desde el punto de vista del tratamiento, sino también desde el de la prevención. Los reconocimientos médicos para la aptitud deportiva, una de las atribuciones principales de esta especialidad, están destinados a descubrir patologías, enfermedades o alteraciones que pueden afectar a la salud, y abarcan desde las situaciones que pueden desencadenar incidentes mortales hasta las que, sin poner en riesgo la vida, pueden afectar la salud o el rendimiento del deportista. La realización adecuada de reconocimientos para el deporte implica el diagnóstico de problemas médicos que deben analizarse, entre otros puntos de vista, desde la óptica de la aptitud para la práctica deportiva, y el médico encargado debe disponer de una guía que le oriente sobre la decisión de autorizar o no la práctica de deporte, y en caso de no autorización, la temporalidad de esta y el riesgo asumible de participación en algunos deportes. Las contraindicaciones para la práctica deportiva mejor conocidas son las de origen cardiovascular, tratadas extensamente en la literatura, pero también existen contraindicaciones del resto de aparatos y sistemas del organismo, entendiendo que el deportista es un ser completo y que el ejercicio físico afecta a todo su conjunto. Este documento, además de recoger dichas contraindicaciones, analiza los aspectos legales que afectan a los profesionales en los que recae la responsabilidad de realizar los reconocimientos y los aspectos documentales que les son propios.(AU)

Main purpose of sports medicine is reaching the health care of the athlete, not only from the point of view of treatment, but also from the point of view of prevention. The performance of preparticipation medical sports evaluation, one of the main attributions of this specialty, is aimed at the discovery of pathologies, diseases or alterations that may affect health. They might range from situations that can trigger deadly incidents, to those without putting life at risk, can affect the health or performance of the athlete. Adequate implementation of preparticipation medical sports evaluation implies the diagnosis of medical problems that must be analyzed, from other points of view such as the perspective of fitness for sport practice. In addition, the doctor in charge must have a guide for clearance for sports practice. In case of non-authorization, time for non-sports activities must be recommended in order to decrease injury risks. Cardiovascular pathologies are the best-known contraindications in sport practice, treated extensively in the literature. However, there are also contraindications secondary to problems or issues of the rest of apparatus organs and systems of the organism, knowing that the athlete represents an entity in which physical exercise affects all their sets. This document highlights those contraindications already discussed above and analyzes the legal aspects of sports practice contraindications. Medical professionals are responsible for managing the pre-participation medical sports evaluation as well as the documentary aspects that support it.(AU)

Circulating microRNAs as emerging cardiac biomarkers responsive to acute exercise.

BACKGROUND: Circulating microRNAs (c-miRNAs) are mediators of intercellular communication with great potential as cardiac biomarkers. The analysis of c-miRNAs in response to physiological stress, such as exercise, would provide valuable information for clinical practice and a deeper understanding of the molecular response to physical activity. Here, we analysed for the first time the acute exercise response of c-miRNAs reported as biomarkers of cardiac disease in a well-characterized cohort of healthy active adults. METHODS: Blood samples were collected immediately before and after (0 h, 24 h, 72 h) a 10-km race, a half-marathon (HM) and a marathon (M). Serum RNA from 10-km and M samples was extracted and a panel of 74 miRNAs analysed using RT-qPCR. c-miRNA response was compared with a panel of nine cardiac biomarkers. Functional enrichment analysis was performed. Pre- and post-M echocardiographic analyses were carried out. RESULTS: Serum levels of all cardiac biomarkers were upregulated in a dose-dependent manner in response to exercise, even in the absence of symptoms or signs of cardiac injury. A deregulation in the profiles of 5 and 19 c-miRNAs was observed for 10-km and M, respectively. Each race induced a specific qualitative and quantitative alteration of c-miRNAs implicated in cardiac adaptions. Supporting their discriminative potential, a number of c-miRNAs previously associated with cardiac disease were undetectable or stable in response to exercise. Conversely, "pseudo-disease" signatures were also observed. CONCLUSIONS: c-miRNAs may be useful for the management of cardiac conditions in the context of acute aerobic exercise. TRANSLATIONAL ASPECTS OF THE WORK: Circulating microRNAs could offer incremental diagnostic value to established and emerging cardiac biomarkers, such as hs-cTnT or NT-proBNP, in those patients with cardiac dysfunction symptoms after an acute bout of endurance exercise. Furthermore, circulating miRNAs could also show "pseudo-disease" signatures in response to acute exercise. Clinical practitioners should be aware of the impact caused by exercise in the interpretation of miRNA data.

[Exercise as the cornerstone of cardiovascular prevention]. / Ejercicio, piedra angular de la prevención cardiovascular.

Lack of physical activity in the general population is a public health problem and is recognized as an independent risk factor for the development of coronary disease. The relative risk of inactivity is similar to that of hypertension, hypercholesterolemia and smoking. Consequently, a sedentary lifestyle is associated with a concurrent increase in cardiovascular disease. Engaging regularly in mild-to-moderate physical exercise results in a range of physiological adaptations that are beneficial for health. Various studies have demonstrated that there is an inverse relationship between regular exercise and the risk of coronary heart disease, cardiac events and death. Exercise improves the lipid profile and glycemic control, reduces or prevents hypertension, obesity and stress, and promotes fitness and longevity. However, most evidence for the benefits of exercise comes from observational studies and, although maximum oxygen uptake and the duration of exercise on an exercise stress test are powerful predictors of mortality, there is no agreement on the quantity or intensity of the physical activity needed for primary or secondary prevention. On the other hand, although there is a temporarily increased risk of acute myocardial infarction during exhaustive exercise, the balance of risks and benefits is strongly in favor of the benefits because there is a minimum threshold for the weekly energy expenditure required to reduce cardiovascular risk.

Ejercicio, piedra angular de la prevención cardiovascular / Exercise as the cornerstone of cardiovascular prevention

La falta de actividad física es un problema de salud pública que se reconoce como un factor independiente de riesgo de enfermedad coronaria. El riesgo relativo de la inactividad es similar al de la hipertensión arterial, la hipercolesterolemia y el tabaquismo, por lo que el sedentarismo se asocia a un aumento simultáneo de las enfermedades cardiovasculares. La práctica regular de ejercicio físico a una intensidad ligera-moderada induce una serie de adaptaciones que producen los beneficios para la salud. Diferentes estudios han mostrado una relación inversa entre ejercicio habitual y riesgo de enfermedad coronaria, eventos cardiacos y muerte. El ejercicio mejora el perfil lipídico y el control de la glucemia, reduce o previene la hipertensión arterial, la obesidad y el estrés, mejora la forma física y aumenta la longevidad. Sin embargo, la mayoría de las evidencias de sus beneficios se extraen de estudios observacionales, y aunque el consumo máximo de oxígeno y el tiempo de ejercicio durante la prueba de esfuerzo son potentes predictores de mortalidad, no hay acuerdo en la cantidad y la intensidad de la actividad física necesaria en prevención primaria y secundaria. Por otro lado, aunque durante la realización de un ejercicio extenuante aumenta temporalmente el riesgo de infarto agudo de miocardio, el balance entre los riesgos y los beneficios es claramente favorable a éstos, aunque hay un umbral mínimo de gasto energético semanal necesario para disminuir el riesgo cardiovascular (AU)

Lack of physical activity in the general population is a public health problem and is recognized as an independent risk factor for the development of coronary disease. The relative risk of inactivity is similar to that of hypertension, hypercholesterolemia and smoking. Consequently, a sedentary lifestyle is associated with a concurrent increase in cardiovascular disease. Engaging regularly in mild-to-moderate physical exercise results in a range of physiological adaptations that are beneficial for health. Various studies have demonstrated that there is an inverse relationship between regular exercise and the risk of coronary heart disease, cardiac events and death. Exercise improves the lipid profile and glycemic control, reduces or prevents hypertension, obesity and stress, and promotes fitness and longevity. However, most evidence for the benefits of exercise comes from observational studies and, although maximum oxygen uptake and the duration of exercise on an exercise stress test are powerful predictors of mortality, there is no agreement on the quantity or intensity of the physical activity needed for primary or secondary prevention. On the other hand, although there is a temporarily increased risk of acute myocardial infarction during exhaustive exercise, the balance of risks and benefits is strongly in favor of the benefits because there is a minimum threshold for the weekly energy expenditure required to reduce cardiovascular risk (AU)

[Cardiovascular prevention and cardiac rehabilitation]. / Prevención cardiovascular y rehabilitación cardiaca.

This article contains a review of the main developments in cardiovascular disease prevention reported during the last year. In addition, the most recent clinical practice guidelines are also discussed. The aims of cardiovascular prevention are to reduce mortality and morbidity in individuals at a high risk and to help those at a low risk to maintain their status. Lifestyle modification and the reduction of modifiable cardiovascular risk factors are key to cardiovascular disease prevention. The implementation of clinical practice guidelines provides the primary means of achieving these goals.

Utilidad del electrocardiograma de reposo en la prevención de la muerte súbita del deportista documento del consenso de la federación española de medicina del deporte / No disponible

No disponible

Muerte súbita, deporte y anomalías coronarias. Respuesta / Sudden death, spots activities and coronary artery anomalies. Reply

No disponible

¿Morir por el deporte? / Dying for sport?

No disponible

Características morfológicas del corazón del deportista / Morphological characteristics of the athlete's heart

No disponible

Guías de práctica clínica de la Sociedad Española de Cardiología sobre la actividad física en el cardiópata / Guidelines of the Spanish Society of Cardiology for physical activity in patients with cardiac disease

Este artículo contiene las normas generales de actuación para la concesión de la aptitud para la práctica deportiva, tanto a nivel recreativo como de competición. Su elaboración se ha realizado de acuerdo con los conocimientos actuales de la medicina del deporte y de la cardiología deportiva, aunque se ha de tener en cuenta que éstas se encuentran en continua evolución y las directrices que se marcan pueden sufrir modificaciones conforme se avance en el conocimiento del 'corazón del deportista'. El ejercicio físico forma parte del contexto lúdico de la sociedad. Muchos pacientes que presentan una patología cardíaca no quieren renunciar a una actividad física o deportiva que realizaban previamente y, por otra parte, es indudable que muchas cardiopatías pueden beneficiarse de un plan de ejercicio físico. La realización de éste con un mínimo riesgo para el paciente hace necesario un exhaustivo conocimiento de los procesos adaptativos cardíacos al esfuerzo, una valoración personalizada de la patología y una prescripción adecuada del plan de entrenamiento en función de la patología existente (AU)