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(Circulation. 2001;103:327.)
© 2001 American Heart Association, Inc.

AHA Science Advisory

Recommendations for Preparticipation Screening and the Assessment of Cardiovascular Disease in Masters Athletes

An Advisory for Healthcare Professionals From the Working Groups of the World Heart Federation, the International Federation of Sports Medicine, and the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention

Barry J. Maron, MD, Chair; Claudio Gil S. Araújo, MD; Paul D. Thompson, MD; Gerald F. Fletcher, MD; Antonio Bayés de Luna, MD; Jerome L. Fleg, MD; Antonio Pelliccia, MD; Gary J. Balady, MD; Francesco Furlanello, MD; Steven P. Van Camp, MD; Roberto Elosua, MD; Bernard R. Chaitman, MD; Terry L. Bazzarre, PhD

Key Words: AHA Science Advisory • exercise • prevention • coronary disease • aging

In recent years, there has been a major international focus on both the risks and benefits of exercise, as well as the relationship between physical activity and cardiovascular health at all ages.^{1 2 3 4 5 6 7 8} Based on more than 40 observational epidemiological studies, physical inactivity and sedentary lifestyle are recognized as major risk factors for the development of coronary heart disease, adverse cardiovascular events, and mortality.^{9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28} Regular aerobic exercise (occupational or leisure time) confers many health benefits, may reduce the risk for fatal and nonfatal myocardial infarction and other coronary events,^{1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28} and has been promoted as a national public health agenda in several countries for both primary and secondary prevention of cardiovascular disease.^{3 4 5 6 7 22 24 29 30}

Conversely, acute vigorous physical exertion may trigger sudden death or myocardial infarction^{31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52} in the presence of underlying heart disease,⁴⁸ particularly in individuals not accustomed to such activity or to regular exercise.^{31 32 33 35 41 51 52 52A 52B} As sedentary individuals begin (or reinitiate) an exercise program, there is a period of increased risk during which exertion can provoke a cardiac event, whereas such risk associated with habitual exercise in active individuals is relatively low.³¹ Also, it is generally assumed that particularly strenuous exertion or sports competition may predispose athletes to greater cardiac risk than nonstrenuous physical activity. Nevertheless, there is widespread agreement that the overall benefits of exercise usually outweigh associated risks.^{1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 35} Mechanisms by which exercise may protect patients from coronary events have also been proposed.^{53 54}

Prior expert consensus documents have addressed the risk for sudden death associated with sports participation in competitive or recreational athletes . . . [Full Text of this Article]

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