A four-part focus seminar series published in the Journal of the American College of Cardiology explores the impact of physical activity, cardiorespiratory fitness and exercise training on the general U.S. population and professional athletes’ cardiovascular health.

In the first part of the series focused on primary and secondary prevention of cardiovascular disease, Wesley J. Tucker, PhD, RDN, et al., highlight the need for regular exercise to meet or exceed the current physical activity guidelines for reducing cardiovascular risk in the general U.S. population. The most recent World Health Organization guidelines recommend that adults perform at least 150 to 300 minutes of moderate-intensity aerobic exercise per week, 75 to 150 minutes of vigorous-intensity aerobic exercise per week and two days of muscle strengthening exercises. Only 53% of U.S. adults currently meet the recommendations for aerobic exercise, and only 22% meet recommendations for combined aerobic and muscle strengthening exercises.

The authors write that long-term aerobic exercise training is associated with changes in cardiac morphology; exercise training can also increase blood circulation and improve cardiovascular disease risk factors such as insulin resistance, blood pressure, dyslipidemia and obesity.

In the second part of the series focused on heart failure with preserved ejection fraction (HFpEF), Andre La Gerche, MBBS, PHD, et al., write that previous research has found that exercise has long been recognized to contribute to a reduced risk of HF and mortality. The authors hypothesize that cardiovascular fitness and HFpEF are inversely related; the impacts of a sedentary lifestyle, combined with aging and other comorbidities, may contribute to the onset of HFpEF. Exercise and cardiorespiratory fitness training can contribute to a better quality of life and can be used as a preventive measure to avoid developing HFpEF.

In the third part of the series focused on hypertrophic cardiomyopathy (HCM), Christopher Semsarian, MBBS, PHD, MPH, et al., write that, based on previous studies, individuals with HCM or other inherited cardiovascular diseases should develop a personalized approach to exercise and competitive sports with their clinician. Historically, individuals with inherited cardiovascular diseases, such as HCM, have been restricted from competitive sports due to risk of sudden cardiac death. The current 2020 AHA/ACC Guideline for Hypertrophic Cardiomyopathy found that clinician-patient shared decision-making can be used to determine whether an athlete with HCM can safely participate in sports.

In the final part of the series focused on the athlete’s heart, Gerche, et al., discuss whether the effects of exercise are always beneficial and protective in professional athletes, how exercise-induced cardiac remodeling can contribute to the development of arrhythmias and address the knowledge gap between male and female athletes’ cardiovascular health. Regular exercise can promote remodeling of the heart, and significant remodeling is rarely associated with adverse clinical affects, such as atrial fibrillation or other arrhythmias. The authors highlight how extreme cases of athlete’s heart could potentially evolve into cardiovascular disease.

“Far from being limited to athletes and competitive sports, this series has been conceived and written to encompass the full spectrum of exercise participation, making it of important relevance to all cardiologists and to all of our patients,” write Jason C. Kovacic, MBBS, PhD, FACC, and Valentin Fuster, MD, PhD, MACC, co-authors of the accompanying introduction article to the focus seminar series.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Sports and Exercise Cardiology, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Exercise

Keywords: Aging, Dyslipidemias, Heart Disease Risk Factors, Obesity, Cardiomyopathy, Hypertrophic, Exercise, Death, Sudden, Cardiac, Risk Factors, Ventricular Remodeling, Stroke Volume, Insulin Resistance, Heart Failure, Cardiorespiratory Fitness, Blood Pressure, Atrial Fibrillation, Sedentary Behavior

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