Sports Cardiologists Call for Patient-Centered Approach to Optimizing Cardiovascular Health through Regular and High-Level Physical Activity

Exercise is generally considered healthy and beneficial, even for individuals living with cardiovascular disease. However, there is a growing demand for personalized heart health advice that considers individual differences. A Theme Issue opens in new tab/window on sports and exercise of the Canadian Journal of Cardiology opens in new tab/window, published by Elsevier, investigates the risks and benefits of physical activity taking socioeconomic, gender, genetic, and demographic factors into account.

Guest Editor of the issue Paul Dorian, MD, MSc, FRCPC, Department of Medicine, University of Toronto, Division of Cardiology, St. Michael’s Hospital, and Sports Cardiology Toronto, Heart & Stroke/Richard Lewar Centre of Excellence in Cardiovascular Research, identifies the following trends and challenges related to cardiovascular health and exercise:

1. An increased demand for access to and expansion of the number of sports cardiologists to make sure that patients who need personalized advice get it.

2. A growing need for research to predict the risks of cardiac events related to sports.

3. A better understanding of the long-term effects of endurance sports on the cardiovascular system.

Dr. Dorian says, "Navigating the complexities of sports cardiology, an emerging specialty, can be challenging. Most people initially consult their family doctor, while sports medicine primarily focuses on musculoskeletal injuries. Sports doctors often lack specialized training in sports cardiology. With limited numbers of qualified specialists available (e.g., fewer than 10 sports cardiologists in Canada), access to this expertise is limited."

This Theme Issue contains 13 invited papers on the following topics:

• Impact of remote work on exercise and cardiovascular health

• Risks and benefits of exercise, particularly for individuals with heart disease

• Methods for assessing physical activity in clinical settings

• Importance of specialized training for sports cardiologists

• Exercise training in pediatric congenital heart disease

• Cardiovascular benefits and risks of exercise across different populations (race, ethnicity, sex)

• Prevention of exercise-related sudden cardiac arrest

• Sex differences in cardiovascular adaptations to exercise

• Exercise and fitness quantification in clinical practice

• Impact of exercise dose and type on cardiovascular function

• Quantification of training load in endurance athletes

• Acquisition of cardiovascular adaptations to exercise

• Role of genetics in fitness and cardiac remodeling.

The issue highlights disparities in sports participation and related health outcomes between males and females as well as socioeconomic disparities. Women appear to have a lower risk of sudden cardiac death during sports compared to men. Individuals from disadvantaged backgrounds face barriers to sports participation due to financial constraints, time limitations, and limited access to resources. These disparities are often rooted in social-cultural factors rather than purely medical ones. Recognizing and addressing these disparities is crucial for ensuring equitable access to sports and exercise for all individuals.

Dr. Dorian concludes, "In general, exercise at any intensity is very safe and beneficial for heart health for 99.9% of the population. However, for individuals with certain risk factors, such as older people and/or those who smoke, are unhealthy, have diabetes or known heart issues, it is recommended to ask the advice of a specialist when planning to engage in regular or higher-level sports activities, particularly high-intensity ones such as training for a marathon or climbing a mountain."

Notes for editors

Sports and Exercise Theme Issue

Volume 41, issue 3 (March 2025) of the Canadian Journal of Cardiology opens in new tab/window, published by Elsevier.

https://onlinecjc.ca/issue/S0828-282X(25)X0003-9 opens in new tab/window

Guest Editors:

Laura Banks, PhD, R. Kin, KITE Research Institute, Toronto Rehabilitation Institute – University Health Network Toronto, ON, Canada; and Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada

Paul Dorian, MD, MSc, FRCPC, Department of Medicine, University of Toronto, Division of Cardiology, St. Michael’s Hospital and Sports Cardiology Toronto, Heart & Stroke/Richard Lewar Centre of Excellence in Cardiovascular Research

Andre La Gerche, MBBS, PhD, R. Kin, Heart, Exercise and Research Trials, St Vincent’s Institute of Medical Research, Fitzroy, Victoria, Australia; and Cardiology Department, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia; and The University of Melbourne, Parkville, Victoria, Australia; and Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia

Benjamin D. Levine, MD, FACC, FAHA, FACSM, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas; and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

Jennifer L. Reed, PhD, R. Kin, Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; and Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia; and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; and School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada

Jane S. Thornton, MD, PhD, CCFP (SEM), Dip Sp Phy (IOC), Dip. Sport Med, OLY, Western Centre for Public Health & Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.

Full text of the articles is available to credentialed journalists upon request. Contact Astrid Engelen at +31 6 14395474or [email protected] opens in new tab/window for a copy of the PDFs or more information. Journalists wishing to interview the Guest Editors or authors should contact Paul Dorian at [email protected] opens in new tab/window.

About the Canadian Journal of Cardiology

The Canadian Journal of Cardiology opens in new tab/window is the official journal of the Canadian Cardiovascular Society opens in new tab/window. It is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as a major venue for the results of Canadian cardiovascular research and Society guidelines. The journal publishes original reports of clinical and basic research relevant to cardiovascular medicine as well as editorials, review articles, case reports, and papers on health outcomes, policy research, ethics, medical history, and political issues affecting practice. www.onlinecjc.ca opens in new tab/window

About the Editor-in-Chief

Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About the Canadian Cardiovascular Society (CCS)

The CCS opens in new tab/window is the national voice for cardiovascular clinicians and scientists, representing more than 2,300 cardiologists, cardiac surgeons and other heart health specialists across Canada. We advance heart health for all by setting standards for excellence in heart health and care, building the knowledge and expertise of the heart team, and influencing policy and advocating for the heart health of all Canadians. For further information on the CCS visit www.ccs.ca/en opens in new tab/window.

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