Risk Stratification, Exercise Prescription, and Sport Participation in Individuals with Aortic Valve Disease
Key result
Tailoring safe exercise in aortic valve disease requires risk stratification by lesion severity, LVEF, and aortic size.
Why the study?
Balancing cardiovascular benefits of physical activity with hemodynamic risks in individuals with aortic valve disease requires precise risk stratification and clear exercise guidelines.
Key Points
- To review and compare contemporary clinical guidelines for exercise prescription and competitive sports participation in individuals with aortic valve disease.
- Synthesized recommendations from the European Society of Cardiology, Italian sports cardiology guidelines (COCIS 2023, SIC Sport, FMSI), and 2025 AHA/ACC guidelines.
- Evaluated key criteria influencing sports eligibility, focusing on valvular dysfunction severity, left ventricular ejection fraction, and aortic dimensions.
- Sports eligibility depends predominantly on the grade of valvular defect, left ventricular ejection fraction, and specific aortic dimensions across international frameworks.
- Post-intervention athletic clearance varies substantially based on surgical or transcatheter procedure type, hemodynamic recovery, and clinical follow-up.
- Safe athletic participation requires regular clinical surveillance, advanced cardiovascular imaging, maximal exercise stress testing, and shared decision-making.
Structured PICO
P
Population
Individuals with aortic valve disease (AVD), including bicuspid aortic valve (BAV) and aortic regurgitation (AR)
This review synthesizes current international guidelines on exercise prescription and sports participation for patients with aortic valve disease, emphasizing risk stratification based on defect severity, LVEF, and aortic dimensions.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our manuscript provides a comprehensive overview of risk stratification, exercise prescription, and sport participation in individuals with aortic valve disease, emphasizing the need for a balanced and patient-centric approach in managing this complex condition.”
Implication
May aid individualized exercise counseling in AVD; extends ESC/COCIS guidelines but leaves prospective validation open.
Abstract
Aortic valve disease (AVD), including bicuspid aortic valve (BAV) and aortic regurgitation (AR), presents a complex challenge in sports cardiology. Balancing the cardiovascular benefits of physical activity with the hemodynamic risks associated with valvular dysfunction and aortopathy requires precise risk stratification. The present review comprehensively analyses the contemporary criteria for exercise prescription and competitive sports participation in individuals with AVD, highlighting also the distinctions between the European guidelines (European Society of Cardiology—ESC), the Italian Sports Cardiology Guidelines for competitive sport practice (COCIS 2023) and the recommendations for exercise prescription in cardiovascular diseases promoted by the Italian Sports Cardiology Society (SIC Sport) and the Italian Federation for Sports Medicine (FMSI). Relevant differences with the 2025 AHA/ACC recommendations are also highlighted where they may influence sports eligibility. Eligibility hinges primarily on the degree of valvular defect, left ventricular ejection fraction (LVEF), and aortic dimensions. Furthermore, post-operative sports participation is highly contingent on the intervention type, post-operative results and follow-up. Ultimately, safe exercise prescription relies on meticulous clinical surveillance, advanced imaging, maximal stress testing, and a shared decision-making process to maximize cardiovascular health while mitigating the risk of acute adverse events.
Discussion
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Cite This Study
Perone et al. (2026) conducted a review in Aortic valve disease. Exercise prescription and competitive sports participation was evaluated. Safe exercise prescription for individuals with aortic valve disease requires careful risk stratification based on valvular defect severity, left ventricular ejection fraction, and aortic dimensions.