Athlete’s Heart: New Guidelines for Competitive Sports Participation

⁢ Updated June 08, 2025

Athletes with cardiovascular abnormalities may be able to ⁣safely participate‍ in⁤ competitive sports, provided they engage in shared decision-making with their doctors regarding potential risks. This is⁣ according to a joint scientific statement published in Circulation and the Journal of the American College of ⁣Cardiology (JACC).

The statement, titled “Clinical Considerations for Competitive Sports ⁣Participation for ‍Athletes with Cardiovascular Abnormalities,” incorporates evidence⁢ gathered over the past ⁣decade. It marks a shift from previous blanket prohibitions, saeid Dr. Jonathan H.Kim, chair of the writing group and director of sports cardiology at Emory University School of⁢ Medicine. The new‍ guidelines offer ⁢best practices for health care professionals guiding athletes with⁣ heart conditions, from children to masters athletes, in assessing risks and rewards.

Recent studies on various cardiac conditions ⁤suggest that the‍ risks of ⁢competitive sports may not be as high as previously believed. This understanding of the athlete’s heart—the structural and functional changes that occur due to intense training—allows for a more evidence-based approach to return-to-play decisions.

The updated statement moves away from rigid sports classifications, acknowledging the dynamic nature of training and the variability among athletes, sports,⁢ and cardiac conditions. It defines competitive athletes as those who ‍prioritize achievement ⁣and train rigorously ⁤for team or⁢ individual sports.

The guidelines⁣ now ⁤include considerations for masters athletes (35 ‍and older) with conditions like coronary disease and valve disease,and also for athletes in extreme sports⁣ and pregnant athletes. The⁤ statement addresses how to better inform a healthy person who wants to play competitive⁢ sports during pregnancy about potential risks, given⁢ the meaningful ⁢shift in physical and metabolic state brought about by pregnancy.

Kim acknowledged that there are ⁣instances where the risks ‍of⁤ competing outweigh the benefits for athletes with cardiovascular abnormalities.

⁣ ⁢ “In⁢ the past, there was no ⁣shared decision-making ‍about ⁢sports eligibility for athletes with heart disease… This new scientific statement reviews best clinical practices for athletes with certain cardiovascular conditions ⁣and how⁤ health⁤ care professionals can guide these athletes… in a shared decision-making discussion about⁤ potential risks and rewards,” said Kim.
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New ⁢Evidence Informs Updates

• The statement emphasizes pre-participation cardiac screening using the ⁢Association’s 14-point evaluation, ⁤including physical exams, blood pressure checks, and family health history. Electrocardiograms‍ (ECGs) are also considered reasonable for asymptomatic athletes, ⁣provided there is expertise in athletic ECG interpretation and equitable access to follow-up evaluations.
• For ⁣athletes on blood thinners, the guidelines offer more specific risk assessments based on the sport. Activities ⁣with higher trauma risk, like⁣ football and cycling, require careful consideration.
• The update clarifies that a blanket⁣ sports restriction is not appropriate for people with cardiomyopathies. ⁢Participation may be reasonable under clinical guidance for ⁣some genetic cardiomyopathies.
• Previous recommendations advised against sports for three to six months after myocarditis. Current research suggests that ⁣many athletes can safely return sooner, though individual assessment remains crucial.
• The statement advises that not all ⁢young athletes with aortopathy should be restricted from sports participation, offering ‍more details on evaluating athletes with an enlarged aorta.
• For catecholaminergic polymorphic ventricular tachycardia, a genetic heart rhythm disorder,⁣ competitive sports ‍might potentially be⁤ considered for athletes⁣ receiving expert care and⁤ risk stratification.

What’s next

Further⁤ research is needed‍ to understand how continued sports participation affects ‍athletes with‍ cardiovascular ⁤disease.‍ The Outcomes Registry for Cardiac conditions in Athletes (ORCCA) study, launched in‍ May 2020, is monitoring clinical outcomes in athletes with perhaps ⁢life-threatening cardiovascular conditions. There is also a need⁣ to address social disparities‍ affecting athletes’ heart health.