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Historically, patients with certain cardiac conditions, including cardiomyopathy and long QT syndrome (LQTS), have been advised not to participate in sports due to a presumption that vigorous exercise will increase their risk of life-threatening cardiac events.

Over the past decade, research has shown that with appropriate risk assessment and treatment, many athletes with cardiac conditions can return to playing sports without high risk.

A new study led by Rachel Lampert, MD, Robert W. Berliner Professor of Medicine (cardiovascular medicine) and director of the Yale Sports Cardiology Program, found that patients with LQTS who receive proper risk assessment and treatment in experienced centers have low cardiac event rates whether or not they exercise vigorously.

The paper, entitled “Vigorous Exercise in Patients with Congenital Long QT Syndrome (LQTS): Results of the Prospective, Observational, Multi-National, ‘Lifestyle and Exercise in LQTS’ (LIVE-LQTS),” was recently published in Circulation.

In the following Q&A, Lampert discusses the new paper, current guidelines for college athletes, and additional research necessary to guide clinicians and patients on returning to play.

1. Tell me about the findings of your research.

"In 2015," Lampert explained, "we launched LIVE-QTS, the first prospective study to investigate if vigorous exercise raises the risk of cardiac events in people with LQTS. Patients with LQTS have a rare abnormality in their heart’s electrical system."

"We prospectively enrolled individuals with LQTS and/or the gene for LQTS between the ages of 8-60 from 37 enrolling sites in five countries. Participants or their parents answered surveys about their physical activity and clinical events every six months for three years."

"Our study found that among these individuals with LQTS," she continued, "both those who exercise vigorously and those less active had a low—and very similar—rate of arrhythmic events. Some individuals did experience some cardiac events during vigorous exercise but those events were infrequent. While those exercising vigorously had rare events during exercise, sedentary and moderate exercisers had more events doing low-intensity activities like walking the dog."

"These findings are significant because they show that with appropriate risk assessments and treatment," she added, "many athletes with LQTS can return to play rather than stay on the sidelines."

2. What do guidelines tell us now about returning to play with a cardiac condition?

"The guidelines have changed dramatically in the past decade or so," Lampert stated.

"When I started my career in the 1990s," she said, "guidelines said that if a person had LQTS or many other cardiac conditions they should not play sports. Those guidelines were based on a conservative approach in absence of evidence."

"Evidence continues to emerge that vigorous exercise is not increasing overall rate of cardiac events," she noted. "We are not seeing an overall increase even though occasionally an event happens during exercise."

"In 2015," she mentioned further guidance from AHA began describing participation as something considered rather than restricted absolutely.

"This year Heart Rhythm Society issued an expert consensus statement which I led guiding decisions on sports participation for athletes with arrhythmic conditions," she elaborated. "The statement describes participation as reasonable for many although not all conditions stressing importance expert assessments shared decision-making appropriate treatment plans emergency action plans."

"Our now-published study supports updated guidance for sports participation for athletes Long QT," Lampert concluded.

3. Sudden cardiac arrest is one leading cause death young athletes students parents preparing fall sports screening recommended college athletes?

"AHA recommends competitive athletes under 35 get physical personal family history taken before playing sports especially important if people family died suddenly under age 40 any risk factors experiencing symptoms like passing out during exercise shortness breath racing heart at rest,” Lampert explained.

"Many schools further evaluate their athletes prior sports participation EKG known identify more abnormalities than history physical alone NCAA does not mandate EKG screening roughly half NCAA colleges universities including Yale use them screen more effectively,” she added.

"I partner foundation In Heartbeat work other Connecticut colleges universities provide EKG screening follow-up management needed,” Lampert noted further adding importance right infrastructure trained people knowing what looking next steps evidence-based information specific treatment address problem.”

4. How does vigorous exercise change heart?

"Vigorous endurance sports running anaerobic static weightlifting cause heart thicken chambers larger good changes allow generate output athlete needs perform sport Olympics NCAA championship normal part adaptation mimic problems,” Lampert explained adding experts specially trained differentiate normal adaptation pathology essential diagnose avoid mis-diagnosing disease.”

5. What led interest returning play?

"Early career two different patients diagnosed genetic problems got defibrillators time guidelines said defibrillator can’t play anymore,” Lampert recalled adding patient astutely asked data back guidelines replied didn’t any data conversation sent path help make decisions based evidence rather fear.”

6. What research questions remain help make decisions returning sports?

"Ongoing questions large prospective studies looked two conditions hypertrophic cardiomyopathy need information best treat minimize risk when defibrillators choice medication ablation effective make screening most effective ongoing research keep safe possible back field whenever possible.”

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