ESC Offers Sports, Exercise Guide for Heart Disease Patients
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The European Society of Cardiology (ESC) released its first guidelines for sports and physical activity in all types of heart disease, mirroring in major respects the U.S. guidelines but also drilling in deeper on specific conditions.

Overall, the guidelines, published online in the European Heart Journal agreed with U.S. recommendations for 150 minutes per week of moderate physical activity or 75 minutes of vigorous intensity activity as the goal for healthy adults.

For example, people with type 2 diabetes got a class Ia recommendation for resistance training at least three times a week along with moderate to vigorous aerobic exercise most days of the week. Those with hypertension that is uncontrolled, high-risk, or that has caused target organ damage got a class IIIc recommendation against high-intensity exercise.

The new European guideline agrees with the U.S. versions that a stress test isn't necessary for everyone with heart disease who starts an exercise program, he noted. Low-risk patients with coronary artery disease -- those with no ongoing ischemia or ST-segment elevation and who show rhythm regularity and a good ejection fraction -- can usually safely participate in competitive and endurance sports without any pre-participation cardiovascular assessment.

Another difference is that the ESC guideline more explicitly defines recommendations for subsets of cardiac patients, he said, pointing out that moderate-to-vigorous activity is usually safe for those with heart failure and in fact may improve their prognosis.

For valvular disease, the take-home-message was that at least some exercise is recommended across the board, with no restrictions on intensity for those with mild disease but no intense exercise with severe stenosis.

People with myocarditis or pericarditis should refrain from vigorous activity and competitive sports while inflammation remains, regardless of age or extent of left ventricular systolic dysfunction, likely for 3 to 6 months.

The guidelines did not address cardiac inflammation due to COVID-19 or the virus more generally. Researchers suggested that, in the absence of any good evidence, it's reasonable to start slowly back into a walking program for those without ongoing symptoms or chest pain.