COMPETITIVE FITNESS FOR ATHLETES WITH CARDIOVASCULAR ALTERATIONS AND PATHOLOGIES - TRAINING-PHYSIOLOGY

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Competitive fitness for athletes with cardiovascular alterations and pathologies

[Article sources: Barry J. Maron and Jere H. Mitchell]

An important aspect of competitive activity consists in verifying whether the athlete is able to exercise his own judgment, his own free and independent evaluation to stop sporting activity if necessary. For example, symptoms such as dizziness, lipothymias , dyspnoea or precordial pain or any other threatening symptom linked to heart disease, observed as a consequence of or during competitive sports, are difficult to reliably distinguish, by the athlete himself, from the normal disturbances of intense physical activity. It is also important to note that due to the particular circumstances and pressures of competitive sport in general, the athlete is often unable to stop physical activity, even when there is an objective medical need to stop.
An athlete can be considered competitive regardless of age and level of sporting activity, this includes youth age, competitions at lower school, college, professional and sports level in the masters or veteran category. The guidelines are not formulated to be applied to non-competitive recreational sports activities, and should not be a limitation for participating in cardiac rehabilitation programs. However, it is recognized that some doctors are very likely to use these guidelines even for athletes participating in non-competitive sports and for non-athletic individuals whose work involves particularly vigorous and intense activities such as firefighters or busy nurses. in emergencies. This process will require the definition of certain criteria and correct extrapolations to evaluate the differences in training intensity between competitive athletes and people who carry out very physically demanding activities.
However, we must point out that the prevalence of cardiovascular disease in a population of young people who play sports is very low. Furthermore, although the precise risk of sudden death in athletes with associated heart disease is not known, it is undoubtedly low. Indeed, it is documented that the number of competitive athletes who die prematurely every year is reduced, particularly when we consider the large number of athletes, of all ages, who participate in the many possible sporting activities. At least 5 million young people are actively involved in competitive sports in the United States at high school, college (high school), and professional levels, and this without including those participating in sports programs in early youth, elementary school or Masters level in the " adulthood.
If sudden death in athletes is a rare event, why should we consider it a relevant medical topic of discussion? This is probably due to the fact that we think competitive athletes are the healthiest and most active part of our society, for whom dramatic heart events seem completely unlikely. As a result, these dramatic events become symbolic, raise important issues, challenge the physician's knowledge, and always draw immediate attention. Furthermore, the resonance of these dramatic events is usually increased, as it is amplified by the mass media; but the interest is usually very high as sport has become a very profitable job from an economic point of view, and often allows athletes to achieve fame and stardom. For these reasons the sudden death of an athlete can have a very obvious impact. on the sensitivity of the public and at the same time on the attitudes of the medical profession.
Only a few reliable data are available which demonstrate that very intense physical exercise predisposes the athlete, with cardiovascular alterations, to a death that otherwise would not have occurred. On the other hand, it is not proven that the interruption of sporting activity necessarily prolongs life.Therefore it is possible that medical judgment may sometimes force some athletes to interrupt sporting activity, in an unjustified and unnecessary way. This of course is not justified, since the athlete derives considerable self-confidence from sporting activity, confidence in one's own means, physical well-being as well as an economic return. It should also be emphasized that the guidelines, which allow the athlete to practice defined loads of physical activity, proposed in this document, are generally quite rigid.
However, they are presented in the context of the guidelines, so they should not be considered unchangeable or absolutely limiting. A doctor, with his knowledge on the severity of the heart disease of the individual athlete, on the psychological response of the same to the competitive race and the knowledge of other clinical factors, relevant from a medical point of view, can in fact choose to make these lines less limiting. guide in some selected cases.

Curated by: Lorenzo Boscariol