April 21, 2026Journal of the American College of Cardiology
Exercise-Induced Cardiovascular Adaptations and Approach to Exercise and Cardiovascular Disease
Key result
Exercise-induced cardiac remodeling requires distinguishing physiological changes from pathology and shared decision-making for athletes.
Key Points
- To explore the cardiovascular adaptations resulting from exercise and the role of sports cardiologists in athlete care.
- Review of diagnostic modalities and their evolution
- Assessment of exercise effects on heart health
- Analysis of approaches to common clinical scenarios in sports cardiology.
- Exercise improves health outcomes by reducing cardiovascular risk.
- Adaptations in cardiovascular structure and function are noted in athletes participating in regular exercise.
- Sports cardiologists provide tailored care based on physiological versus pathological changes in athletes.
PICO
P
Population
Cardiovascular disease in athletes
I
Intervention / Comparator
Exercise
This review highlights the evolving role of sports cardiologists in distinguishing physiological adaptations from pathological changes and managing cardiovascular conditions in athletes.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
AJACC Journal Scan
“The concept of the exercise paradox was revisited, in which habitual exercise lowers long-term CV risk yet vigorous exertion transiently increases the likelihood of acute CV events in those with underlying disease. Thus, clinicians were encouraged to move beyond assumptions of protection and to i...”
“[Shared decision-making] should not be a 'rubber-stamp' allowance to continue with sports participation for all athletes. Risk stratification of the athlete with consultation by experts in sports cardiology and other disciplines is mandatory. Along with the risk of sudden cardiac death, the focus of [shared decision-making] must include the potential negative psychological, social, and overall health impacts of sports restriction.”
“The field of sports cardiology is a well-established but still rapidly evolving subspecialty. Given the mounting interest in sports cardiology, its key relevance to all cardiovascular practitioners, and the knowledge explosion in this field, we felt it was particularly timely to pay special attention to this broad topic with a JACC Focus Seminar series.”
Implication
Requires nuanced risk-benefit assessment plus shared decision-making for athletes with remodeling; leaves open evidence-based return-to-play guidelines.
Abstract
The role of the sports cardiologist has evolved into an essential component of the medical care of athletes. In addition to the improvement in health outcomes caused by reductions in cardiovascular risk, exercise results in adaptations in cardiovascular structure and function, termed exercise-induced cardiac remodeling. As diagnostic modalities have evolved over the last century, we have learned much about the healthy athletic adaptation that occurs with exercise. Sports cardiologists care for those with known or previously unknown cardiovascular conditions, distinguish findings on testing as physiological adaptation or pathological changes, and provide evidence-based and "best judgment" assessment of the risks of sports participation. We review the effects of exercise on the heart, the approach to common clinical scenarios in sports cardiology, and the importance of a patient/athlete-centered, shared decision-making approach in the care provided to athletes.
Discussion
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Cite This Study
Martinez et al. (2021) conducted a review in Cardiovascular disease in athletes. Exercise was evaluated. Exercise induces cardiovascular adaptations and cardiac remodeling, requiring sports cardiologists to distinguish physiological changes from pathology and use shared decision-making for athletes.