The statement is being published in today's print issue of Circulation: Journal of the American Heart Association.
The statement, by the Working Groups of the American Heart Association Committee on Exercise, Cardiac Rehabilitation and Prevention, and the councils on Clinical Cardiology and Cardiovascular Disease in the Young, aims to help clinicians determine how to advise these patients who are at increased risk for sudden death during physical activity.
The panel recommends that clinicians use a graded scale to assess potential eligibility for certain recreational sports.
These recommendations concern "recreational" not "competitive" sports, according to association Committee Chair Barry J. Maron, M.D., director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation, Minneapolis, Minn.
"This document does not address organized competitive sports, including community sports teams, school and professional sports. Rather, it covers what these patients can do in a wide range of recreational sporting and physical activities outside the competitive arena," Maron said.
The panel addresses a group of genetic cardiovascular diseases known to increase risk for sudden death associated with physical activity early in life. They include hypertrophic cardiomyopathy; arrhythmogenic right ventricular cardiomyopathy; Marfan syndrome; and ion-channel diseases, including long QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia.
Individually, the diseases are considered "relatively uncommon," Maron said. However, collectively they cause a substantial proportion of unexpected and sudden deaths in adolescents and young adults. The most common disease in the group, hypertrophic cardiomyopathy, occurs in about one in 500 people in the general population, and it is the most common cause of sudden death in young people.
Hypertrophic cardiomyopathy is a condition in which the muscle mass of the left ventricle enlarges. This can lead to electrical instability and arrhythmias.
A key point of the recommendations is that people with these diseases can and should exercise. "The impetus of the document is to emphasize that the mere presence of a genetic cardiovascular disease should not be regarded as a reason to be sedentary," Maron said. "Instead, this document tries to discern which exercises are preferable and which should be avoided, as well as help clinicians make decisions about how they advise their patients when it comes to recreational exercise."
The document offers advice and a table depicting many different types of exercises and how they might affect patients in each of the disease categories. All the information in the report is geared toward people who have already been diagnosed with a genetic heart disease, Maron said.
There are some generalizations. For example, activities requiring "bursts" of exertion, like sprinting, should be avoided. Rapid acceleration over short distances appears to put these patients at greater risk of a sudden cardiac event or disease progression.
Other types of activities that should be avoided include exercise programs that require "systematic and progressive levels of exertion," including weight lifting, downhill skiing, diving and rock-climbing.
"Extreme sports such as hang-gliding and bungee jumping are activities best avoided," Maron said.
"There is no simple formula that tells you what to avoid and what not to avoid; but the guidelines offer some prudent recommendations governing recreational exercise for patients with known cardiovascular diseases," he said.
Co-authors are: Bernard R. Chaitman, M.D.; Michael J. Ackerman, M.D., Ph.D.; Antonio Bayés de Luna, M.D.; Domenico Corrado, M.D., Ph.D.; Jane E. Crosson, M.D.; Barbara J. Deal, M.D.; David J. Driscoll, M.D.; Mark Estes III, M.D.; Claudio Gil Araújo, M.D.; David H. Liang, M.D., Ph.D.; Matthew J. Mitten, J.D.; Robert J. Myerberg, M.D.; Antonio Pelliccia, M.D.; Paul D. Thompson, M.D.; Jeffrey A. Towbin, M.D.; and Steven P. Van Camp, M.D.
NR04-1267 (Circ/Maron)
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