2020 ESC guidelines on sports cardiology part1

2020 ESC guidelines on sports cardiology part1

How exercise professionals can use the 2020 ESC guidelines part 1: the exercise paradox, pre-participation screening and exercise assessments; cardiometabolic disease, coronary artery disease.

This is part one of a five part series on the 2020 European Society of cardiology guidelines on sports cardiology and exercising patients with cardiovascular disease in part one which is the subject of this blog, I’m going to talk about how our exercise professionals can use these 2020 European society cardiology guidelines first of all talking about the exercise paradox pre-participation screening and exercise assessments and the ESC guidelines on cardio metabolic disease and coronary artery disease.

In terms of the exercise paradox there is a small increased risk of sudden cardiac arrest or sudden cardiac death during exercise itself for individuals with either overt or covert cardiovascular disease,  but this is well and truly counterbalanced in terms of risk benefit by a reduced risk of these adverse events for the other 23 or 23 1/2 hours and of the day.

We have published an article in SportsMedicine in 2018 on pre-participation screening and I have made another YouTube video on this topic which I have referenced in this particular video.

Now to pre-participation exercise assessments. The European society of cardiology recommends that individuals about to embark on a moderate to vigorous physical activity or exercise programs undergo some form of pre-participation exercise assessment whether it be a submaximal Ergon to test all the way up to the gold standard of cardio pulmonary exercise testing or similar. The latter that is CPAP testing is not mandated or necessary if other forms of exercise testing which would include some vigilance around adverse signs or symptoms is more than adequate at this pre-participation phase.

Exercise assessments are also more useful to broadly detect or record previously and reported adverse signs or symptoms that may be clinically significant with a referral back to the primary care medical practitioner pre-participation exercise ECG should be reserved for symptomatic individuals including some athletes although is deemed to be at high risk of adverse events or adverse signs or symptoms triggered by exercise. I need to note at this point that exercise ECG on its own has relatively poor sensitivity and specificity for coronary artery disease (CAD), but it is a very useful tool for detecting exercise induced arrhythmias and conduction defects.

The use of predictive equations for heart rate peak and the use of heart rate range and percentage of heart rate peak for prescribing exercise is not recommended for many individuals with cardiovascular disease on the basis that many of these individuals are being treated or have medical conditions that affect the heart rate responses to exercise. And I would particularly emphasise those with a read me as such as atrial fibrillation. For these individuals it is better to use percent of VO2 peak or ratings of perceived exertion to prescribe exercise. fit.test estimates  relation %VO2peak simply and reliably, based on The American College of Sports Medicine algorithms that I have embedded in fit.test.

The rest of the video then goes on to talk about various cardio metabolic conditions, and coronary artery disease and provides very nice tables that summarise what to do in the situations as Wellers giving some nice medical background summaries.