The 'Ten Commandments' for the 2020 ESC Guidelines on Sports Cardiology and Exercise in Patients With Cardiovascular Disease

Sanjay Sharma, MD, FESC; Antonio Pelliccia, MD, FESC; Sabiha Gati


Eur Heart J. 2021;42(1):6-7. 

  • All able individuals with cardiovascular disease should engage in at least 150 min of exercise per week divided over 5 days, or 75 minutes of vigorous exercise divided over 3 days.

  • Among individuals who are obese and have hypertension or type 2 diabetes mellitus, an additional three sessions of 20 minutes of resistance training per week is recommended to reduce cardiovascular risk.

  • A pragmatic preliminary approach is required for identifying individuals at high risk of atherosclerotic coronary artery disease, which includes assessment of symptoms, established risk factors, and systematic coronary risk evaluation (SCORE).

  • Individuals deemed at high risk of an adverse cardiac event from atherosclerotic coronary artery disease who aspire to engage in high-intensity exercise should have risk stratification with an exercise stress test or a functional imaging equivalent.

  • Optimization of medical therapy, assessment of functional capacity, and risk stratification is essential before prescribing an exercise programme in individuals with heart failure.

  • Regular physical activity is the cornerstone for preventing atrial fibrillation in the general population; however, lifelong endurance exercise may increase the risk of atrial fibrillation in some middle-aged and older men.

  • Some asymptomatic individuals with morphologically mild hypertrophic cardiomyopathy and a low European Society of Cardiology (ESC) 5-year risk score may participate in all competitive sport, except those where syncope could result in potentially fatal traumatic injury.

  • Individuals found with severe valvular heart disease, poor left ventricular function, arrhythmogenic cardiomyopathy, and active myocarditis should not engage in intensive exercise.

  • Individuals receiving anticoagulation and those with an implantable cardioverter defibrillator in situ should avoid collision sport and activity associated with potential trauma to the body.

  • Among individuals with potentially serious cardiovascular diseases who desire to participate in high-intensity exercise or competitive sport a shared decision-making process is recommended that informs the individual about the impact of sport and the potential risks of complications and/or adverse events to the individual. Such discussion should be documented in the medical report.

ESC 'Ten Commandments' for Sports Cardiology 2020