Sports cardiology: A glorious past, a well-defined present, a bright future

Abstract

The attention towards sports cardiology has dramatically grown after the introduction of preparticipation screening and the need for specific education on electrocardiogram interpretation in athletes, given the differences between athletes and the general population. The present article stresses the need for specific skills, knowledge, and clinical expertise in sports cardiology, which are essential for appropriately screening competitive athletes to prevent sudden cardiac death and avoid overdiagnosis. However, disqualification from sports competitions may lead to sports inactivity, and athletes may enter a gray zone where little or no information is provided about what they can or cannot do to stay active. However, modern sports cardiology cannot neglect the patient's needs and the importance of the safe practice of regular exercise. In this context, the personalized exercise prescription plays a crucial role in the core curriculum and the clinical activity of professionals involved in sports cardiology programs. Given its specificities, sports cardiology requires a formal education plan for medical school students and all residents. Additional education and practice are required for young colleagues who want to focus their professional lives on sports cardiology. The future directions of emerging modern sports cardiology should not neglect the importance of a scientific community that works together, designing multicenter international outcomes-based research to address the many remaining areas of uncertainty.

Keywords: personalized exercise prescription; preparticipation screening; sports cardiology; sudden cardiac death.

Central Illustration 1

Competitive athletes should undergo comprehensive preparticipation screening, including a 12‐lead resting electrocardiogram. In case of a permanent disqualification, it is of paramount importance to evaluate the subject for a tailored exercise prescription. The prescription should include a comprehensive clinical evaluation, culminating in a personalized prescription with a specific target heart rate for aerobic exercise and detailed information about the intensity, type, volume, and frequency of exercise per week, including resistance conditioning (with a personalized intensity). In case of a clinical risk deemed to be excessively high and the impossibility to temporarily practice exercise, the patient should be reevaluated for an exercise program after the implementation of the medical therapy (e.g., after reducing a significant left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy). The exercise program should start gradually, and a routine revaluation after the first months of exercise is essential to evaluate the adaptation to the exercise program, reevaluate the aerobic and anaerobic thresholds, and objectively and subjectively assess the program results. Exercise prescription should also be considered in sedentary individuals who do not want to practice competitive sports but are interested in a personalized training program for primary or secondary prevention. ^e.g., reduction of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy.