Sports and Cardiomyopathy: Myths, Facts and Its Importance

A new year has begun, and with it, a myriad of new initiatives for AICARM. Among those we are most proud of, there are undoubtedly our webinars. These are in fact monthly appointments, in which we discuss fundamental topics for patients with Cardiomyopathies with the best experts in the Italian panorama. Not only that: it is a moment in which the patient is not the main subject, but also the true protagonist. In fact, he will have the opportunity to interact through questions that will be addressed during the webinar.

It is an experiment that we have already started. In fact, in the first webinar of 2025 organized by AICARM, with Professor Flavio D'Ascenzi of the University of Siena we addressed the topic of sport in cardiomyopathies, debunking myths and presenting the most recent scientific evidence.

The most important conceptual shift that emerged during the meeting is that physical activity is no longer seen as an enemy to be avoided, but as a real therapeutic tool for patients with cardiomyopathy. This change in perspective is based on new scientific data that have modified the traditional approach, according to which the heart patient had to limit physical activity as much as possible. We started from the basics, defining physical activity, that is, it must be understood as any movement that increases energy expenditure compared to rest. It is important to underline that we are not only talking about competitive sports, but a very broad spectrum of activities that ranges from simple walking to structured sports activity. The benefits are already evident with moderate levels of activity: for example, contrary to the popular belief of 10.000 steps a day, it has been seen that the benefits begin with 3.500-4.000 steps a day.

We have addressed the age-old problem of competitive sports, for which the Italian (COCIS) and European guidelines provide precise indications. The 2023 version is more permissive than the previous one from 2017, allowing some patients with low-risk cardiomyopathies to practice competitive sports, for some disciplines, in compliance with certain clinical characteristics of the athlete. However, the percentage of eligible patients remains relatively low and derives from careful clinical analysis and informed discussion with the reference expert.

Another key aspect that emerged during the webinar is the concept of “exercise prescription” (PEF). This practice, different from the simple authorization for sports activity, involves a personalized program based on a complete clinical evaluation, cardiopulmonary test, heart rate monitoring and customization of intensity, mode and type of exercise. In fact, most patients can and should do physical activity, but with the right mode and intensity. The crucial aspect is not so much the speed or type of activity, but maintaining the correct reference heart rate, which is established through specific tests. We also addressed particular situations, arising from questions from friends connected, such as patients with an implanted defibrillator, what to do if you suffer from atrial fibrillation, young people with genetic mutations but without clinical manifestations and benefit/risk of specific activities such as yoga, swimming and cycling. Finally, for patients on anticoagulant therapy, particular attention is paid to activities with risk of trauma, for example favoring running over cycling. Finally, the positive role of electric assisted bicycles was highlighted, which allow patients to maintain an active social life by modulating the effort.

In all this, patient associations, such as AICARM, must be an important point of reference to direct patients to specialized centers and expert doctors, facilitating access to appropriate and personalized care. We remind you that all the contents of the webinar are available in the heart library on the AICARM website.

We are not stopping here though, given the huge success, we immediately got back to work to organize the next event, namely the Webinar on Dilated Cardiomyopathy at the end of February, with perhaps the greatest expert in Italy, Professor Gianfranco Sinagra from Trieste. This will be followed by webinars on pregnancy, on the rights and duties of patients with cardiomyopathy, on nutrition and many others that we will surely decide together. So…stay tuned!