Although routine physical exercise is an effective way to reduce the risk of cardiovascular disease – especially with the growing population of competitive athletes and highly active people (CAHAP) – it can actually increase the risk of cardiovascular events.

A review published October 2 in the Journal of American College of Cardiology highlights the basic knowledge and corollary skills required for the effective practice of sports cardiology and provides a clinical framework for cardiovascular practitioners who participate in the care of CAHAP.

Aaron L. Baggish, MD, FACC, et al., identify the four fundamental clinical domains of knowledge that are critical to the care of CAHAP. The domains include differentiation of exercise-induced cardiac remodeling (EICR) from cardiovascular pathology, evaluation of the symptomatic CAHAP, management of the CAHAP with cardiovascular disease and collaborative pre-participation cardiovascular screening (PPCS).

The study authors note that moderate- to high-intensity physical activity requires an adaptive and healthy cardiovascular system, and these adaptations are apparent during clinical evaluation, physical examination and interpretation of diagnostic testing. Essential knowledge base and skill sets for the sports cardiologist pertaining to EICR is critical for the understanding of both basic exercise physiology and the numerous adaptive cardiovascular changes that are common in this patient population.

Sports cardiologists also must be able to evaluate CAHAP that have symptoms suggestive of underlying cardiovascular disease, requiring integration of basic principles of general cardiology and exercise physiology, with a comprehensive understanding of issues unique to this population. Common reasons for CAHAP to seek medical attention are chest pain, palpitations and impaired exercise capacity.

One of the most important responsibilities of a sports cardiologist is the management of CAHAP with established cardiovascular disease. It is crucial to have an essential knowledge base pertaining to these patients, especially in cases of heart muscle diseases, electrical heart disease, intracardiac device considerations, atherosclerotic cardiovascular disease, hypertension and atrial fibrillation, as well as an understanding of the competitive sports eligibility criteria.

The review also notes the significance of PPCS, which is recommended by numerous professional organizations for the detection of heart diseases associated with risk for sudden death and to provide an opportunity to reduce adverse events through disease-specific therapy and sport restriction.

"As the number of practicing sports cardiologists continues to rise, it is of paramount importance that high-quality standards of clinical care and targeted research initiatives continue to develop in parallel," the study authors concluded. "Future efforts to ensure the provision of effective sports cardiology care must include educational initiatives geared toward cardiovascular trainees and established cardiovascular practitioners."