*For medical professionals only
The latest consensus express, these four points must be known!
I’m sure you’ve heard the phrase “sitting for long periods of time is equivalent to chronic suicide”. Several previous studies have shown that spending more time exercising (less sedentary time) is associated with health benefits Relatedly, exercise can not only improve cardiorespiratory endurance, but also improve cardiovascular disease-related risk factors [1-3].
So stop “Ge You paralyzed”, hurry up and move!
But inappropriate exercise can lead to severe cardiovascular events such as sudden cardiac death (SCD) and myocardial infarction. So how to prevent exercise-related sudden death or cardiovascular accident?
Recently, the “Chinese Expert Consensus on the Assessment and Monitoring of Risk of Exercise-related Cardiovascular Events”[4] led by Professor Wang Fang of Beijing Hospital gave the answer, mastering this consensus can avoid exercise The sudden death caused, come and understand~
Cardiovascular risk stratification and assessment recommended prior to exercise
1
Exercise-related cardiovascular health risk stratification
Consensus points out that the use of traditional risk factors for coronary heart disease to assess exercise risk is not very accurate. Therefore, the consensus is based on relevant research evidence at home and abroad, and the exercise-related cardiovascular risk is divided into two levels: low-risk state and high-risk state.
Low-Risk Status: A status in which an exerciser has the same risk of cardiovascular events associated with exercise as a healthy population of the same age and sex.
High-Risk Status: is defined as a person who is at risk of developing a high risk due to multiple risk factors such as advanced age, established cardiovascular disease, type 2 diabetes, or kidney disease. Risky and challenging sports (such as extreme mountaineering, alpine skiing, triathlon, etc.) lead to a significantly higher absolute risk of sports-related cardiovascular events in athletes than in healthy people of the same age and gender.
The main variables for exercise-related risk stratification are shown in Table 1. The low-risk state refers to the state in which the individual does not have core variables and has at least one non-core variable; Status of at least one core variable or two or more non-core variables.
Table 1
2
Cardiovascular Risk Assessment in the Exercise Population
Exercise-related cardiovascular risk assessment refers to screening for pre-existing cardiovascular disease or cardiovascular Exercise-related cardiovascular events, performed mainly for the assessment of cardiovascular disease risk.
Cardiovascular risk assessment of exercise population mainly includes four aspects: cardiac structure, myocardial blood supply, arrhythmia and cardiac function. The diagnostic efficacy of each examination method for cardiovascular disease is shown in Table 2.
Table 2
Structural Cardiac Assessment:
Consensus states that evaluating cardiac structure is important to screen for hypertrophic cardiomyopathy, as common causes of SCD in young adults include hypertrophic cardiomyopathy and high-risk congenital coronary anomalies.
Main modality includes echocardiography, electrocardiogram, coronary CT angiography and cardiac magnetic resonance imaging (CMR), as well as invasive coronary angiography.
Assessment of myocardial blood supply:
People over the age of 40 are prone to cardiac arrest or SCD during or after vigorous exercise, the most common cause being atherosclerotic heart disease. For this population, risk assessment before and during exercise is particularly important.
Main examination methods include exercise treadmill test, cardiopulmonary exercise test (CPET), stress echocardiography, stress myocardial perfusion imaging (rMPI), coronary CT angiography Angiography and coronary angiography.
Consensus points out thatCompared with other examinations, CPET can not only be used to screen cardiovascular disease risk, but also provide individualized exercise guidance, making exercise safer and scientific< strong>.
Arrhythmia evaluation:
Structural cardiac abnormalities have previously been identified as a major cause of exercise-related sudden death in young adultsHowever, Recent studies have suggested that the main cause of SCD in young people is sudden arrhythmia syndrome, so the screening of arrhythmia is particularly important.
Main examination methods include resting ECG, Holter, exercise ECG, and CPET. In rare cases, electrophysiological testing and genetic screening are required.
Functional Cardiac Assessment:
Cardiac functional assessment mainly includes assessment under resting state and stress state, including cardiac systolic function, diastolic function and cardiac reserve capacity. It is more important for high-risk groups.
Main examinations include echocardiography, CPET, CMR, rMPI, and left ventricular angiography.
3
Cardiovascular Risk Screening Process in the Exercise Population
Low-risk populations: No special evaluation required, primary evaluation if desired.
High-risk groups: Go directly to primary assessment. For those with positive results in the primary assessment and all high-risk groups, it is recommended to enter the intermediate assessment, and perform CPET examination to determine the performance status and further assessment.
Positive result of intermediate assessment: exercise warning is given, and it is necessary to enter a professional medical institution for further medical diagnosis and treatment and exercise guidance.
Negative intermediate assessment results: If there are no relevant risk factors, exercise can be started directly. It is recommended to start from low-to-moderate intensity, gradually increase the amount, and perform CPET assessment regularly according to the amount and frequency of exercise, and guide appropriate amount and frequency of exercise. Advanced evaluation was performed if there was a history of relevant cardiac disease.
Negative results of advanced assessment: For people with no previous exercise habits, start with low-moderate intensity and gradually increase the amount of exercise, the elderly need to be more slowly. For people who have exercise habits in the past, they can continue the exercise at the current intensity.
Positive result of advanced assessment: exercise warning is given, and it is necessary to enter a professional medical institution for further medical diagnosis and treatment and exercise guidance.
Table 3
Different individuals have different heart states, and it is necessary to formulate and guide individualized exercise training according to the athlete’s health status, physical fitness, training response and exercise purpose.
In the first 4 to 6 weeks of the exercise program, the duration of each training session is extended by 5 to 10 minutes every 1 to 2 weeks. After regular exercise for at least 1 month, the frequency, intensity, and time can be gradually increased in the next 4 to 8 months to achieve the recommended individualized exercise training quality.
Figure 2
How to monitor cardiovascular health risk while exercising
For people exercising at home (low-intermediate risk of cardiovascular disease): The doctor can recommend suitable wearable devices to monitor cardiovascular health risk; Without monitoring equipment, exercisers rely on symptoms, autonomic fatigue scores, and speaking tests for monitoring.
For example: moderate-intensity physical activity is controlled at 12-14 points for the voluntary fatigue score, and the speaking test reaches the level of breaking sentences immediately. If the individual develops symptoms such as chest pain and suffocation before reaching moderate intensity, they should stop exercising and undergo a medical screening.
For people at high risk of cardiovascular disease, it is still recommended to go to a medical institution to exercise until the risk status is downgraded, and the medical institution will have comprehensive monitoring and professionals.
What if there is an emergency while exercising?
If an individual experiences discomfort during exercise, it is recommended to stop exercising immediately and sit down and rest. If it does not relieve after rest, you need to consult a doctor.
The most dangerous condition in sports is SCD. In order to avoid the occurrence of lowering SCD, it is recommended to perform symptom assessment before each exercise to identify early risks and thus prevent them.
In the unfortunate event of an SCD, a first aid procedure should be initiated immediately. Attempt CPR while calling and asking for help. Multiple studies have confirmed that bystander CPR is the only factor that improves survival in out-of-hospital SCD.
Before the ambulance arrives, if the scene is equipped with an automated external defibrillator (AED), bystanders can use the AED to identify ventricular fibrillation.
Ordinary defibrillators need to be used by qualified personnel, while AEDs can be operated by non-medical personnel. It is recommended to set up AEDs in public places and provide CPR training for relevant personnel. See Figure 2 for the emergency response process for sports venues.
Figure 3
What should healthcare facilities do?
Sports training venues in medical institutions should be equipped with various protective measures, monitoring equipment, ambulances, defibrillators, and respiratory aids, and should be checked by specialized personnel. At the same time, configure first aid teams and multidisciplinary cooperation teams, and ensure smooth flow of first aid procedures and calls. Regularly train personnel to obtain appropriate qualifications.
For the general population who do not perform sports training in medical institutions, medical institutions can try to use the Internet to conduct remote follow-up, so as to facilitate interactive communication with patients and take corresponding measures.
Summary
Consensus emphasizes that exercise is good for physical and mental health, but inappropriate exercise may have health risks for some people.
Consensus hopes to provide a set of technical guidelines for sports enthusiasts to assess and monitor cardiovascular risk for professional institutions such as medical and health institutions in my country, and help doctors and patients to identify and timely prevent and control exercise-related risks factors, and put forward relevant suggestions from a professional point of view.