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Physical activity and sport in primary and secondary prevention
Management of young competitive athletes with cardiovascular conditions
  1. Andrew D'Silva1,2,
  2. Sanjay Sharma1,2
  1. 1Department of Cardiovascular and Cell Sciences, St George's University of London, London, UK
  2. 2St George's University Hospital Foundation NHS Trust, London, UK
  1. Correspondence to Professor Sanjay Sharma, Department of Cardiovascular and Cell Sciences, St George's University of London, Cranmer Terrace, London SW17 ORE, UK; sasharma{at}sgul.ac.uk

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Learning objectives

  • To recognise contraindications to exercise/sporting competition and the recommendations for professional sports participation.

  • To recognise the risk factors and mechanisms of sudden cardiac death during and after strenuous exercise.

  • To appreciate the benefits of exercise training and safety issues in exercise and sport.

Introduction

Physical activity has numerous substantial health benefits, including reduction in cardiovascular disease,1 lower incidence of certain cancers,2 ,3 improved healthy ageing4 and all-cause mortality.1 In this regard, young competitive athletes epitomise the healthiest segment of society. These individuals regularly push their limits for club and country and are a source of inspiration and aspiration to our youth. Paradoxically, occasionally a young athlete may die suddenly during intensive exercise from a diverse spectrum of relatively rare inherited or congenital diseases5–7 ordinarily associated with a low adverse event rate. Indeed, athletes harbouring cardiovascular disease have an increased risk of clinical deterioration and sudden cardiac death (SCD) in comparison to sedentary individuals with the same disease.8

Although sudden death is rare (approximately 1:50 0009), most victims lose several decades of life from cardiac diseases which are detectable during life and for which several lifestyle and therapeutic interventions can minimise the risk of SCD. It is on this premise that both the American Heart Association (AHA) and European Society of Cardiology (ESC) recommend screening athletes for disease.

In an effort to prevent exercise-related SCD in affected athletes, expert consensus documents were developed to provide guidance on sports activities that could be performed safely.10 ,11 However, absolute risks of exercise are difficult to quantify where the evidence base is limited. Therefore, in most circumstances the consensus recommendations are conservative in nature, aiming to encompass all preventable deaths. A more individualised approach, tailoring exercise advice and counselling regarding event risk is warranted, but currently …

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