Exercise in Specific Diseases: Coronary Artery Disease

Abstract

Coronary artery disease (CAD) is a progressive disease, typically starting early in life. CAD is strongly associated with cardiovascular morbidity and mortality. Regular physical activity (PA) has positive effects on multiple risk factors for CAD, while high-intensity PA may act as a trigger for sudden cardiac death, especially in susceptible individuals with an underlying cardiovascular abnormality. Therefore, recommendations for cardiovascular evaluation of older individuals aiming to participate in leisure-time or competitive sports, as well as for those with risk factors for or with established CAD, has been established. If athletes with an increased risk profile for CAD show a normal, truly maximal exercise test, they are not restricted from any competitive sport. Patient-athletes with clinically proven CAD and considered to be at low-risk for cardiac events may be selectively advised to participate in competitive sports but restrictions may apply on an individual basis for certain sports with the highest CV demand (such as extreme power and endurance disciplines) and in older athletes, having a higher risk. Patient-athletes with clinically proven CAD, defined as high risk, should receive appropriate management and be restricted from competitive sport. In patient-athletes with CAD and significant ischemia during exercise, as in all patients, anti-ischemic therapy needs to be optimized. In case of inducible ischemia, revascularization is strongly suggested. Athletes considered as “low-risk” for cardiac events post-MI and/or post-PCI are recommended a minimum of 3 months structured and progressive rehabilitation before assuming/resuming participation in competitive sports. Periodical, at least annual follow-ups of athletes with CAD are recommended, including risk factor management by lifestyle and medications, according to guidelines. Any symptoms should be evaluated, and repeated exercise-testing could be used, for risk stratification and/or modified exercise prescription.