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The Present and Future of Sports Cardiology and Exercise
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The Present and Future of Sports Cardiology and Exercise

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Epidemiology, Lifestyle, and Cardiovascular Health".

Deadline for manuscript submissions: closed (31 January 2025) | Viewed by 11749

Special Issue Editor

Dr. Elena Cavarretta

E-Mail Website
Guest Editor
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 40100 Latina, Italy
Interests: sports cardiology; exercise; athlete’s heart; echocardiography; oxidative stress; exercise prescription; electrocardiogram
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The multifaceted sub-specialty of sports cardiology and exercise has gained momentum in the recent years not only for the importance of pre-participation screening in the prevention of sudden cardiac death, but also in the personalized exercise prescription as part of the clinical management of cardiovascular diseases. In addition, different populations in sports cardiology are emerging as master athletes, paediatric athletes and e-athletes, holding specific characteristics that merit attention.

This Special Issue aims at all aspects of the different sub-fields of sports cardiology and exercise. Original articles, case series and high-quality narrative reviews, systematic reviews and meta-analyses are welcome. We particularly appreciate contributions on the following topics:

  • Multimodality imaging assessment in the differential diagnosis between athlete’s heart and cardiovascular diseases;
  • Pre-participation screening of athletes’ heart;
  • Female athletes’ heart;
  • Paediatric athletes;
  • Master athletes;
  • The novelties in the evaluation and management of athletes with cardiovascular diseases;
  • Risk assessment and management for the prevention of sudden cardiac death in athletes;
  • The role of cardiovascular imaging in sports cardiology and exercise;
  • Risk stratification with cardiovascular imaging in young athletes with cardiovascular diseases;
  • Exercise prescription in patients with cardiovascular disease, diabetes and obesity;
  • The emerging field of e-sports and e-athletes;
  • Cardiac rehabilitation and pre-habilitation.

Dr. Elena Cavarretta
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • sports cardiology
  • exercise
  • exercise prescription
  • electrocardiogram
  • echocardiography
  • oxidative stress
  • cardiomyopathy
  • heart valve disease
  • preventive cardiology
  • cardiac rehabilitation

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Published Papers (8 papers)

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Research

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12 pages, 401 KiB  
Article
Differences in Arrhythmia Detection Between Harvard Step Test and Maximal Exercise Testing in a Paediatric Sports Population
by Massimiliano Bianco, Fabrizio Sollazzo, Riccardo Pella, Saverio Vicentini, Samuele Ciaffoni, Gloria Modica, Riccardo Monti, Michela Cammarano, Paolo Zeppilli and Vincenzo Palmieri
J. Cardiovasc. Dev. Dis. 2025, 12(1), 22; https://doi.org/10.3390/jcdd12010022 - 11 Jan 2025
Viewed by 466
Abstract
BACKGROUND: Sport practice may elevate the risk of cardiovascular events, including sudden cardiac death, in athletes with undiagnosed heart conditions. In Italy, pre-participation screening includes a resting ECG and either the Harvard Step Test (HST) or maximal exercise testing (MET), but the relative [...] Read more.
BACKGROUND: Sport practice may elevate the risk of cardiovascular events, including sudden cardiac death, in athletes with undiagnosed heart conditions. In Italy, pre-participation screening includes a resting ECG and either the Harvard Step Test (HST) or maximal exercise testing (MET), but the relative efficacy of the latter two tests for detecting arrhythmias and heart conditions remains unclear. METHODS: This study examined 511 paediatric athletes (8–18 years, 76.3% male) without known cardiovascular, renal, or endocrine diseases. All athletes underwent both HST and MET within 30 days. Absolute data and data relative to theoretical peak heart rates, arrhythmias (supraventricular and ventricular) and cardiovascular diagnoses were collected. RESULTS: HST resulted in a lower peak heart rate than MET (181.1 ± 9.8 vs. 187.5 ± 8.1 bpm, p < 0.001), but led to the detection of more supraventricular (18.6% vs. 13.1%, p < 0.001) and ventricular (30.5% vs. 22.7%, p < 0.001) arrhythmias, clustering during recovery (p = 0.014). This pattern was significant in males but not females. Among athletes diagnosed with cardiovascular diseases (22.3%), HST identified more ventricular arrhythmias (26.3% vs. 18.4%, p = 0.05), recovery-phase arrhythmias (20.2% vs. 14.0%, p = 0.035), and polymorphic arrhythmias (6.1% vs. 1.8%, p = 0.025). CONCLUSIONS: HST detects arrhythmias more effectively than MET in young male athletes, especially during recovery. More ventricular arrhythmias were highlighted even in athletes with cardiovascular conditions. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
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11 pages, 4338 KiB  
Article
The Effect of Upright Posture on Left Atrial Strain in Competitive Athletes
by Joscha Kandels, Stephan Stöbe, Robert Percy Marshall, Andreas Hagendorff and Michael Metze
J. Cardiovasc. Dev. Dis. 2024, 11(9), 284; https://doi.org/10.3390/jcdd11090284 - 9 Sep 2024
Viewed by 944
Abstract
Background: Left atrial strain (LAS) assessment by speckle tracking echocardiography (STE) has been shown to be a remarkable means of quantifying LA function as an early marker of LV pathology. As exercise testing is also performed on a treadmill, the aim of this [...] Read more.
Background: Left atrial strain (LAS) assessment by speckle tracking echocardiography (STE) has been shown to be a remarkable means of quantifying LA function as an early marker of LV pathology. As exercise testing is also performed on a treadmill, the aim of this study was to investigate the effect of upright posture on LAS in healthy athletes. Methods: Fifty male athletes (mean age 25.7 ± 7.3 years) underwent transthoracic echocardiography (TTE) in the upright and left lateral positions. In addition to the conventional echocardiographic parameters, in all athletes, LA conduction strain (LAScd), contraction strain (LASct), reservoir strain (LASr), and maximum LA volume (LAVmax) were assessed by STE in both positions. Results: Comparing upright posture and the left lateral position, LAScd (−14.0 ± 5.9% vs. −27.4 ± 7.1%; p < 0.001), LASct (−4.6 ± 3.5% vs. −11.3 ± 4.1%; p < 0.001), LASr (18.7 ± 7.6% vs. 38.7 ± 8.0%; p < 0.001), and LAVmax (24.4 ± 8.8% vs. 50.0 ± 14.2%) differed significantly. Conclusions: Upright posture has a significant effect on LA deformation, with decreased LAScd, LASct, and LASr. The results of this study contribute to the understanding of athletes’ hearts and must be considered when performing echocardiography in healthy athletes on a treadmill. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
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Review

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12 pages, 286 KiB  
Review
Exercise, Sports, and Cardiac Rehabilitation Recommendations in Patients with Aortic Aneurysms and Post-Aortic Repair: A Review of the Literature
by Michael Stiefel, Hadassa Brito da Silva, Christian Marc Schmied and David Niederseer
J. Cardiovasc. Dev. Dis. 2024, 11(12), 379; https://doi.org/10.3390/jcdd11120379 - 27 Nov 2024
Viewed by 1518
Abstract
Introduction: Balancing the well-documented benefits of regular exercise, particularly its positive impact on cardiovascular risk factors like hypertension, with the potential risks for patients with aortic aneurysms presents a significant challenge. This narrative review aims to summarize the current evidence and guidelines to [...] Read more.
Introduction: Balancing the well-documented benefits of regular exercise, particularly its positive impact on cardiovascular risk factors like hypertension, with the potential risks for patients with aortic aneurysms presents a significant challenge. This narrative review aims to summarize the current evidence and guidelines to assist clinicians in making informed exercise and sports recommendations for patients with aortic aneurysms or post-aortic repair. Methods: Nine clinical trials on the effect of exercise on abdominal aortic aneurysms (AAAs) were identified, including one study on cardiopulmonary exercise testing (CPET) in AAA patients. As no clinical trials on exercise in thoracic aortic aneurysms (TAAs) were found, we extrapolated data from other studies on exercise in aortic diseases, including data from patients who have had an aortic dissection, as well as three studies on cardiac rehabilitation (CR) and one study on CPET after proximal aortic repair. Review articles and guidelines were also incorporated to ensure a comprehensive overview of the topic. Results: Currently, no clear correlation exists between intense sports activities and the development of aortic aneurysms or dissections. Conclusions: Light to moderate physical activity appears safe and beneficial for patients with aortic aneurysms and post-aortic repair. Given the lack of evidence linking athletic activity to aortic complications, caution is warranted in restricting such activities for athletes, underscoring the importance of shared decision-making. Regular follow-up and optimal management of cardiovascular risk factors are essential. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
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15 pages, 5473 KiB  
Review
Electrocardiographic Clues for Early Diagnosis of Ventricular Pre-Excitation and Non-Invasive Risk Stratification in Athletes: A Practical Guide for Sports Cardiologists
by Simone Ungaro, Francesca Graziano, Sergei Bondarev, Matteo Pizzolato, Domenico Corrado and Alessandro Zorzi
J. Cardiovasc. Dev. Dis. 2024, 11(10), 324; https://doi.org/10.3390/jcdd11100324 - 14 Oct 2024
Viewed by 1391
Abstract
Ventricular pre-excitation (VP) is a cardiac disorder characterized by the presence of an accessory pathway (AP) that bypasses the atrioventricular node (AVN), which, although often asymptomatic, exposes individuals to an increased risk of re-entrant supraventricular tachycardias and sudden cardiac death (SCD) due to [...] Read more.
Ventricular pre-excitation (VP) is a cardiac disorder characterized by the presence of an accessory pathway (AP) that bypasses the atrioventricular node (AVN), which, although often asymptomatic, exposes individuals to an increased risk of re-entrant supraventricular tachycardias and sudden cardiac death (SCD) due to rapid atrial fibrillation (AF) conduction. This condition is particularly significant in sports cardiology, where preparticipation ECG screening is routinely performed on athletes. Professional athletes, given their elevated risk of developing malignant arrhythmias, require careful assessment. Early identification of VP and proper risk stratification are crucial for determining the most appropriate management strategy and ensuring the safety of these individuals during competitive sports. Non-invasive tools, such as resting electrocardiograms (ECGs), ambulatory ECG monitoring, and exercise stress tests, are commonly employed, although their interpretation can sometimes be challenging. This review aims to provide practical tips and electrocardiographic clues for detecting VP beyond the classical triad (short PR interval, delta wave, and prolonged QRS interval) and offers guidance on non-invasive risk stratification. Although the diagnostic gold standard remains invasive electrophysiological study, appropriate interpretation of the ECG can help limit unnecessary referrals for young, often asymptomatic, athletes. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
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17 pages, 5779 KiB  
Review
The Role of Nuclear Medicine in the Diagnostic Work-Up of Athletes: An Essential Guide for the Sports Cardiologist
by Alessandro Zorzi, Sergei Bondarev, Francesca Graziano, Annagrazia Cecere, Andrea Giordani, Luka Turk, Domenico Corrado, Pietro Zucchetta and Diego Cecchin
J. Cardiovasc. Dev. Dis. 2024, 11(10), 306; https://doi.org/10.3390/jcdd11100306 - 3 Oct 2024
Viewed by 1290
Abstract
Athletes with heart disease are at increased risk of malignant ventricular arrhythmias and sudden cardiac death compared to their sedentary counterparts. When athletes have symptoms or abnormal findings at preparticipation screenings, a precise diagnosis by differentiating physiological features of the athlete’s heart from [...] Read more.
Athletes with heart disease are at increased risk of malignant ventricular arrhythmias and sudden cardiac death compared to their sedentary counterparts. When athletes have symptoms or abnormal findings at preparticipation screenings, a precise diagnosis by differentiating physiological features of the athlete’s heart from pathological signs of cardiac disease is as important as it is challenging. While traditional imaging methods such as echocardiography, cardiac magnetic resonance, and computed tomography are commonly employed, nuclear medicine offers unique advantages, especially in scenarios requiring stress-based functional evaluation. This article reviews the use of nuclear medicine techniques in the diagnostic work-up of athletes with suspected cardiac diseases by highlighting their ability to investigate myocardial perfusion, metabolism, and innervation. The article discusses the application of single photon emission computed tomography (SPECT) and positron emission tomography (PET) using radiotracers such as [99mTc]MIBI, [99mTc]HDP, [18F]FDG, and [123I]MIBG. Several clinical scenarios are explored, including athletes with coronary atherosclerosis, congenital coronary anomalies, ventricular arrhythmias, and non-ischemic myocardial scars. Radiation concerns are addressed, highlighting that modern SPECT and PET equipment significantly reduces radiation doses, making these techniques safer for young athletes. We conclude that, despite being underutilized, nuclear medicine provides unique opportunities for accurate diagnosis and effective management of cardiac diseases in athletes. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
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22 pages, 8751 KiB  
Review
Athlete’s ECG Made Easy: A Practical Guide to Surviving Everyday Clinical Practice
by Valerio Fanale, Andrea Segreti, Chiara Fossati, Giuseppe Di Gioia, Federica Coletti, Simone Pasquale Crispino, Francesco Picarelli, Raffaele Antonelli Incalzi, Rocco Papalia, Fabio Pigozzi and Francesco Grigioni
J. Cardiovasc. Dev. Dis. 2024, 11(10), 303; https://doi.org/10.3390/jcdd11100303 - 1 Oct 2024
Viewed by 1391
Abstract
Electrocardiogram modifications in athletes are common and usually reflect structural and electrical heart adaptations to regular physical training, known as the athlete’s heart. However, these electrical modifications sometimes overlap with electrocardiogram findings that are characteristic of various heart diseases. A missed or incorrect [...] Read more.
Electrocardiogram modifications in athletes are common and usually reflect structural and electrical heart adaptations to regular physical training, known as the athlete’s heart. However, these electrical modifications sometimes overlap with electrocardiogram findings that are characteristic of various heart diseases. A missed or incorrect diagnosis can significantly impact a young athlete’s life and potentially have fatal consequences during exercise, such as sudden cardiac death, which is the leading cause of death in athletes. Therefore, it is crucial to correctly distinguish between expected exercise-related electrocardiogram changes in an athlete and several electrocardiogram abnormalities that may indicate underlying heart disease. This review aims to serve as a practical guide for cardiologists and sports clinicians, helping to define normal and physiology-induced electrocardiogram findings from those borderlines or pathological, and indicating when further investigations are necessary. Therefore, the possible athlete’s electrocardiogram findings, including rhythm or myocardial adaptation, will be analyzed here, focusing mainly on the differentiation from pathological findings. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
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Other

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17 pages, 2884 KiB  
Systematic Review
A Systematic Review and Meta-Analysis of Randomized Trials to Evaluate the Impact of Exercise on Heart Rate Variability Post-Bariatric Surgery
by Tulio H. B. Bitencourt, Camila Marcondes de Oliveira, Andrey A. Porto, Davi C. de Andrade, David M. Garner, Rodrigo D. Raimundo and Vitor E. Valenti
J. Cardiovasc. Dev. Dis. 2024, 11(8), 248; https://doi.org/10.3390/jcdd11080248 - 13 Aug 2024
Viewed by 1829
Abstract
Bariatric surgery is an approach used to treat patients with obesity in a small minority of eligible patients. Non-pharmacological therapies are important to maintain decent health status post-bariatric surgery. We performed a systematic review with meta-analysis to evaluate the effects of exercise on [...] Read more.
Bariatric surgery is an approach used to treat patients with obesity in a small minority of eligible patients. Non-pharmacological therapies are important to maintain decent health status post-bariatric surgery. We performed a systematic review with meta-analysis to evaluate the effects of exercise on heart rate variability (HRV) in patients submitted to bariatric surgery. The searches were made via MEDLINE/PubMed (via the National Library of Medicine), EMBASE, Web of Science, and Scopus databases. We included non-blind, single-, or double-blind randomized control trials in patients older than 18 years of age submitted to bariatric surgery. The intervention group should be submitted to an exercise training protocol, including aerobic, strength, and other exercise modality after bariatric surgery. We documented 245 studies, and after screening and eligibility phases, only 4 were included. We observed no significant change for the SDNN: subtotal = 19.74 (CI: −4.98, 44.45), p = 0.12, I2 = 85% (very low quality of evidence); pNN50: subtotal = 13.09 (CI: −9.17, 35.35), p = 0.25, I2 = 93% (very low quality of evidence); RMSSD: subtotal = 8.44 (CI: −3.61, 25.50), p = 0.17, I2 = 95% (very low quality of evidence); SD1: subtotal = 9.36 (CI: −4.48, 23.21), p = 0.19, I2 = 96% (very low quality of evidence). We could not detect significant effects of exercise on resting HRV after bariatric surgery. The low certainty of the results via the evidence level analysis suggest further studies might be beneficial. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
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17 pages, 586 KiB  
Systematic Review
The Effects of Exercise Training on Functional Capacity and Quality of Life in Patients with Rheumatoid Arthritis: A Systematic Review
by Amalia Athanasiou, Ourania Papazachou, Nikoletta Rovina, Serafim Nanas, Stavros Dimopoulos and Christos Kourek
J. Cardiovasc. Dev. Dis. 2024, 11(6), 161; https://doi.org/10.3390/jcdd11060161 - 22 May 2024
Cited by 2 | Viewed by 2118
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation. The purpose of this systematic review is to evaluate the effectiveness of exercise training on functional capacity and quality of life (QoL) in patients with RA. We performed a search in four [...] Read more.
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation. The purpose of this systematic review is to evaluate the effectiveness of exercise training on functional capacity and quality of life (QoL) in patients with RA. We performed a search in four databases, selecting clinical trials that included community or outpatient exercise training programs in patients with RA. The primary outcome was functional capacity assessed by peak VO2 or the 6 min walking test, and the secondary outcome was QoL assessed by questionnaires. Seven studies were finally included, identifying a total number of 448 patients. The results of the present systematic review show a statistically significant increase in peak VO2 after exercise training in four out of seven studies. In fact, the improvement was significantly higher in two out of these four studies compared to the controls. Six out of seven studies provided data on the patients’ QoL, with five of them managing to show statistically significant improvement after exercise training, especially in pain, fatigue, vitality, and symptoms of anxiety and depression. This systematic review demonstrates the beneficial effects of exercise training on functional capacity and QoL in patients with RA. Full article
(This article belongs to the Special Issue The Present and Future of Sports Cardiology and Exercise)
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