Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC).

Myocardial diseases are associated with an increased risk of potentially fatal cardiac arrhythmias and sudden cardiac death/cardiac arrest during exercise, including hypertrophic cardiomyopathy, dilated cardiomyopathy, left ventricular non-compaction, arrhythmogenic cardiomyopathy, and myo-pericarditis. Practicing cardiologists and sport physicians are required to identify high-risk individuals harbouring these cardiac diseases in a timely fashion in the setting of preparticipation screening or medical consultation and provide appropriate advice regarding the participation in competitive sport activities and/or regular exercise programmes. Many asymptomatic (or mildly symptomatic) patients with cardiomyopathies aspire to participate in leisure-time and amateur sport activities to take advantage of the multiple benefits of a physically active lifestyle. In 2005, The European Society of Cardiology (ESC) published recommendations for participation in competitive sport in athletes with cardiomyopathies and myo-pericarditis. One decade on, these recommendations are partly obsolete given the evolving knowledge of the diagnosis, management and treatment of cardiomyopathies and myo-pericarditis. The present document, therefore, aims to offer a comprehensive overview of the most updated recommendations for practicing cardiologists and sport physicians managing athletes with cardiomyopathies and myo-pericarditis and provides pragmatic advice for safe participation in competitive sport at professional and amateur level, as well as in a variety of recreational physical activities.

Recommendations for participation in competitive sports of athletes with arterial hypertension: a position statement from the sports cardiology section of the European Association of Preventive Cardiology (EAPC).

Current guidelines of the European Society of Cardiology advocate regular physical activity as a Class IA recommendation for the prevention and treatment of cardiovascular disease. Despite its undisputed multitude of beneficial effects, competitive athletes with arterial hypertension may be exposed to an increased risk of cardiovascular events. This document is an update of the 2005 recommendations and will give guidance to physicians who have to decide on the risk of an athlete during sport participation.

Consensus document regarding cardiovascular safety at sports arenas: position stand from the European Association of Cardiovascular Prevention and Rehabilitation (EACPR), section of Sports Cardiology.

Mass gathering events in sports arenas create challenges regarding the cardiovascular safety of both athletes and spectators. A comprehensive medical action plan, to ensure properly applied cardiopulmonary resuscitation, and wide availability and use of automated external defibrillators (AEDs), is essential to improving survival from sudden cardiac arrest at sporting events. This paper outlines minimum standards for cardiovascular care to assist in the planning of mass gathering sports events across Europe with the intention of local adaptation at individual sports arenas, to ensure the full implementation of the chain of survival.

Athletes with valvular heart disease and competitive sports: a position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology.

This article provides an overview of the recommendations from the Sports Cardiology section of the European Association of Preventive Cardiology on sports participation in individuals with valvular heart disease (VHD). The aim of these recommendations is to encourage regular physical activity including sports participation, with reasonable precaution to ensure a high level of safety for all affected individuals. Valvular heart disease is usually an age-related degenerative process, predominantly affecting individuals in their fifth decade and onwards. However, there is an increasing group of younger individuals with valvular defects. The diagnosis of cardiac disorders during routine cardiac examination often raises questions about on-going participation in competitive sport with a high dynamic or static component and the level of permissible physical effort during recreational exercise. Although the natural history of several valvular diseases has been reported in the general population, little is known about the potential influence of chronic intensive physical activity on valve function, left ventricular remodelling pulmonary artery pressure, and risk of arrhythmia. Due to the sparsity of data on the effects of exercise on VHD, the present document is largely based on clinical experience and expert opinion.

Skeletal age in youth soccer players: implication for age verification.

OBJECTIVE: To evaluate variation in skeletal age (SA) within single-year chronological age (CA) groups of soccer players aged 11 to 17 years in the context of using SA for age verification in age-group competitions. DESIGN: Cross sectional. SETTING: Regional and elite youth soccer programs. PARTICIPANTS: Five hundred ninety-two male players from Portugal and Spain. INDEPENDENT VARIABLES: Skeletal age assessed with the Fels method. MAIN OUTCOME MEASURES: Skeletal age and maturity status (late, average, early, or mature). RESULTS: Chronological age and SA overlapped in players aged 11 to 12 years, but SA was advanced relative to CA in players aged 14 to 16 years. The majority of players between 11 and 12 years of age were on time in skeletal maturity and percentages of late and early maturers did not differ. The majority of players between 13 and 14 years of age were also on time, but early maturers were 4 times more frequent than late maturers. Percentages of late maturers were low among players aged 14 to 16 years. Among 200 players aged 15 to 16 years, 80 (40%) were advanced in SA by > 1 year and 27 (14%) were skeletally mature, whereas among 23 players aged 17 years, 9 (39%) were skeletally mature. CONCLUSIONS: Among adolescent soccer player, boys advanced in SA for CA are overrepresented and those later in SA for CA are underrepresented with increasing CA. If Fels SA was used to verify CA in this sample of youth for under-17 competition, 36 skeletally mature players aged 15 to 17 years (16%) would be disqualified. The results for this sample of male soccer players question the utility of SA or magnetic resonance imaging as a valid estimate of CA in youth sport competitions.

Exercise in the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) era: A Question and Answer session with the experts Endorsed by the section of Sports Cardiology & Exercise of the European Association of Preventive Cardiology (EAPC).

Regular exercise has multiple benefits for physical and mental health, including the body's ability to combat infections. The current COVID-19 pandemic and the social distancing measures employed to curtail the impact of the infection are likely to reduce the amount of usual physical activity being performed by most individuals, including habitual exercisers. The uncertainties relating to the impact of the SARS-CoV-2 virus on the heart may cause increased anxiety, particularly in athletes who need to sustain a vigorous exercise regime in order to maintain their skills and fitness in preparation for return to competition after a short re-training period. The aim of this document is to provide practical answers to pertinent questions being posed by the sporting community, in an attempt to offer reassurance, promote safe participation in exercise during as well as after the COVID-19 pandemic and provide a framework of management for physicians caring for athletes.

Brief recommendations for participation in leisure time or competitive sports in athletes-patients with coronary artery disease: Summary of a Position Statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC).

This paper presents a brief summary of the recommendations from the Sports Cardiology section of the European Association of Preventive Cardiology (EAPC) on sports-participation in patients with coronary artery disease, coronary artery anomalies or spontaneous dissection of the coronary arteries, all entities being associated with myocardial ischaemia.1 Given the wealth of evidence supporting the benefits of exercise for primary and secondary prevention of coronary artery disease, individuals should be restricted from competitive sport only when a substantial risk of adverse event or disease progression is present. These recommendations aim to encourage regular physical activity including participation in sports and, with reasonable precaution, ensure a high level of safety for all individuals with coronary artery disease. The present document is based on available current evidence, but in most instances because of lack of evidence, also on clinical experience and expert opinion.

Exercise training to reduce cardiovascular risk in patients with metabolic syndrome and type 2 diabetes mellitus: How does it work?

Metabolic syndrome (MetS) - a clustering of pathological conditions, including abdominal obesity, hypertension, dyslipidemia and hyperglycaemia - is closely associated with the development of type 2 diabetes mellitus (T2DM) and a high risk of cardiovascular disease. A combination of multigenetic predisposition and lifestyle choices accounts for the varying inter-individual risk to develop MetS and T2DM, as well as for the individual amount of the increase in cardiovascular risk in those patients. A physically active lifestyle can offset about half of the genetically mediated cardiovascular risk. Yet, the extent to which standardized exercise programmes can reduce cardiovascular risk differs between patients. Exercise parameters, such as frequency, intensity, type and duration or number of repetitions, differentially target metabolic function, vascular health and physical fitness. In addition, exercise-induced molecular mechanisms are modulated by other patient-specific variables, such as age, diet and medication. This review discusses the molecular and cellular mechanisms underlying the effects of exercise training on cardiovascular risk specifically in patients with MetS and T2DM.

Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC).

Patients with type 2 diabetes mellitus suffer from dysregulation of a plethora of cardiovascular and metabolic functions, including dysglycaemia, dyslipidaemia, arterial hypertension, obesity and a reduced cardiorespiratory fitness. Exercise training has the potential to improve many of these functions, such as insulin sensitivity, lipid profile, vascular reactivity and cardiorespiratory fitness, particularly in type 2 diabetes mellitus patients with cardiovascular comorbidities, such as patients that suffered from an acute myocardial infarction, or after a coronary intervention such as percutaneous coronary intervention or coronary artery bypass grafting. The present position paper aims to provide recommendations for prescription of exercise training in patients with both type 2 diabetes mellitus and cardiovascular disease. The first part discusses the relevance and practical applicability of treatment targets that may be pursued, and failure to respond to these targets. The second part provides recommendations on the contents and methods to prescribe exercise training tailored to these treatment targets as well as to an optimal preparation and dealing with barriers and risks specific to type 2 diabetes mellitus and cardiac comorbidity.

Monitoring the health of transitioning professional footballers: protocol of an observational prospective cohort study.

INTRODUCTION: Transitioning out of professional football is a challenging time in most players' lives. During these preretirement and postretirement years, professional footballers may struggle with their mental, musculoskeletal, neurocognitive and cardiovascular health. Currently, longitudinal data about these health conditions are lacking. This article presents the design of a prospective cohort study with the primary aim of gathering epidemiological evidence about the onset and course of mental, musculoskeletal, neurocognitive and cardiovascular health conditions in professional footballers during their preretirement and postretirement years and evaluating the associations between risk indicators and the health conditions under study in these players. METHODS AND ANALYSIS: An observational prospective cohort study with repeated measurements over a follow-up period of 10 years will be conducted among at least 200 professional footballers (male; 27 (±1) years old). Mental health will be explored by assessing symptoms of distress, anxiety, depression, sleep disturbance, alcohol misuse, drug misuse and disordered eating. Musculoskeletal health will be explored by assessing severe joint injury and related surgery, clinical and radiological osteoarthritis, and joint function (hips, knees and ankles). Neurocognitive health will be explored by assessing the concussion, brain structure and functioning, and neurocognitive functioning. Cardiovascular health will be explored by assessing blood pressure, lipid profile and ECG abnormalities. ETHICS AND DISSEMINATION: Ethical approval for the study was provided by the Medical Ethics Review Committee of the Amsterdam University Medical Centers. The results of the study will be submitted to peer-reviewed journals, will be presented at scientific conferences and will be released in the media (postpublication). TRIAL REGISTRATION NUMBER: The Dutch Trial Registry (Drake Football Study NL7999).

Brief recommendations for participation in competitive sports of athletes with arterial hypertension: Summary of a Position Statement from the Sports Cardiology Section of the European Association of Preventive Cardiology (EAPC).

Owing to its undisputed multitude of beneficial effects, European Society of Cardiology guidelines advocate regular physical activity as a class IA recommendation for the prevention and treatment of cardiovascular disease. Nonetheless, competitive athletes with arterial hypertension may be exposed to an increased risk of cardiovascular events. Guidance to physicians will be given in this summary of our recently published recommendations for participation in competitive sports of athletes with arterial hypertension.

Nonischemic Left Ventricular Scar as a Substrate of Life-Threatening Ventricular Arrhythmias and Sudden Cardiac Death in Competitive Athletes.

BACKGROUND: The clinical profile and arrhythmic outcome of competitive athletes with isolated nonischemic left ventricular (LV) scar as evidenced by contrast-enhanced cardiac magnetic resonance remain to be elucidated. METHODS AND RESULTS: We compared 35 athletes (80% men, age: 14-48 years) with ventricular arrhythmias and isolated LV subepicardial/midmyocardial late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (group A) with 38 athletes with ventricular arrhythmias and no LGE (group B) and 40 healthy control athletes (group C). A stria LGE pattern with subepicardial/midmyocardial distribution, mostly involving the lateral LV wall, was found in 27 (77%) of group A versus 0 controls (group C; P<0.001), whereas a spotty pattern of LGE localized at the junction of the right ventricle to the septum was respectively observed in 11 (31%) versus 10 (25%; P=0.52). All athletes with stria pattern showed ventricular arrhythmias with a predominant right bundle branch block morphology, 13 of 27 (48%) showed ECG repolarization abnormalities, and 5 of 27 (19%) showed echocardiographic hypokinesis of the lateral LV wall. The majority of athletes with no or spotty LGE pattern had ventricular arrhythmias with a predominant left bundle branch block morphology and no ECG or echocardiographic abnormalities. During a follow-up of 38±25 months, 6 of 27 (22%) athletes with stria pattern experienced malignant arrhythmic events such as appropriate implantable cardiac defibrillator shock (n=4), sustained ventricular tachycardia (n=1), or sudden death (n=1), compared with none of athletes with no or LGE spotty pattern and controls. CONCLUSIONS: Isolated nonischemic LV LGE with a stria pattern may be associated with life-threatening arrhythmias and sudden death in the athlete. Because of its subepicardial/midmyocardial location, LV scar is often not detected by echocardiography.

Cardiopulmonary resuscitation and use of the automatic external defibrillator in sport / Reanimación cardiopulmonar y uso del desfibrilador externo automático en el deporte

Cardiac arrest during sport practice is a low-incidence event, however, as it is commonly seen witnessed to have a high survival rate compared to general non-hospital cardiac arrest. The objective of this review is to analyze the special characteristics, give recommendations for the installation of automatic external defibrillators and the elaboration of an adequate medical action plan for each sports center (AU)

La parada cardiaca durante la práctica de deporte es un evento de baja incidencia, sin embargo, al ser habitualmente presenciado presenta una tasa de supervivencia elevada si se compara con el paro cardiaco extra-hospitalario en general. El objetivo de esta revisión es analizar las características especiales, dar recomendaciones para la instalación de desfibriladores externos automáticos y elaboración de un plan de acción médica adecuado a cada centro deportivo (AU)

The C allele of the AGT Met235Thr polymorphism is associated with power sports performance.

Whether the Met235Thr (rs699) variation in the angiotensinogen (AGT) gene, encoding a threonine instead of a methionine in codon 235 of the mature protein, is associated with athletic performance remains to be elucidated. We compared the genotype and allele frequencies for the AGT Met235Thr variation (rs699) in 119 nonathletic controls, 100 world-class endurance athletes (professional cyclists, Olympic-class runners), and 63 power athletes (top-level jumpers, throwers, sprinters). Participants were all males and from the same descent (Caucasian) for > or =3 generations. The proportion of the CC genotype was significantly higher in the power group (34.9%) than in either the control (16%) or the endurance group (16%) (p = 0.008 and p = 0.005, respectively). The odds ratio (95% CI) of being a power athlete if the subject has a CC genotype was 1.681 (1.176-2.401), compared with the control group. In summary, the C allele of the AGT Met235Thr polymorphism might favour power sports performance. Although more research is needed, this could be attributed to the higher activity of angiotensin II, a skeletal muscle growth factor.

TW3 and Fels skeletal ages in elite youth soccer players.

BACKGROUND: Skeletal age (SA) tends to be advanced for chronological age (CA) in adolescent male soccer players. AIM: The study compared SA assessments with the TW3 and Fels methods in a sample of male, elite youth soccer players. METHODS: SAs were assessed with the Tanner-Whitehouse 3 (TW3) radius-ulna-short bone (RUS) and Fels methods in a sample of 40 elite youth soccer players 12.5-16.1 years of age. Players were classified as late, on time or early on the basis of relative SA, the difference between SA and CA. Players who reached skeletal maturity were labeled mature. RESULTS: SA was in advance of CA. Among 14 players >15.0 years, two are skeletally mature with the Fels method (CA 15.7 and 15.9 years), while 11 are skeletally mature with the TW3 method (CA 15.0-16.1 years). CONCLUSION: The TW3 and Fels methods yield different SAs in elite youth soccer players. Significantly more 15-year-old boys are classified as skeletally mature with the TW3 method than with the Fels method. These observations have implications for international age group competitions as well as for medico-legal circumstances that require CA verification. SA is not a valid measure of CA and should not be used as such.