Contraindicaciones cardiológicas para la práctica deportiva
Cardiology contraindications for the practice of sports
Gonzalo Graziolia, Daniel Brotonsb, Fernando Pifarreb, Maria Sanz de la Garzaa, Silvia Montserrata, Bàrbara Vidala, Carles Miñarroc, Ramón Pid, Georgia Sarquella-Brugadae, Josep Gutierrezb, Josep Brugadaa, Marta Sitgesa
a Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Cataluña, España
b Consell Català de l’Esport, Cataluña, España
c Centre de Alt Rendiment, Sant Cugat del Vallés, Cataluña, España
d Futbol Club Barcelona, Barcelona, Cataluña, España
e Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Cataluña, España
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array:3 [ "nombre" => "Josep" "apellidos" => "Gutierrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 10 => array:3 [ "nombre" => "Josep" "apellidos" => "Brugada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 11 => array:3 [ "nombre" => "Marta" "apellidos" => "Sitges" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Cataluña, España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Consell Català de l’Esport, Cataluña, España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Centre de Alt Rendiment, Sant Cugat del Vallés, Cataluña, España" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Futbol Club Barcelona, Barcelona, Cataluña, España" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] 4 => array:3 [ "entidad" => "Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Cataluña, España" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "affe" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cardiology contraindications for the practice of sports" ] ] "textoCompleto" => "<span class="elsevierStyleSectionTitle"> Introducción</span><p class="elsevierStylePara"> Los beneficios cardiovasculares que aporta el ejercicio moderado están bien establecidos<a href="#bib20" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a>, aunque el ejercicio puede provocar ocasionalmente la muerte súbita cardiaca en deportistas con enfermedad cardiaca de base<a href="#bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a>. En este contexto, la descalificación del deporte de los individuos afectados ha demostrado ser una estrategia útil en el único estudio realizado con este objetivo<a href="#bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a>.</p><p class="elsevierStylePara"> La reciente actualización de la conferencia de Bethesda<a href="#bib23" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> aporta recomendaciones de nivel C (opinión de expertos) para los deportistas competitivos, pero en algunos puntos difiere de las recomendaciones europeas en miocardiopatías y valvulopatías<a href="#bib24" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a>, arritmias y canalopatías<a href="#bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">, </span><a href="#bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a>, y cardiopatías congénitas<a href="#bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>. El grupo de cardiología deportiva de la Sociedad Europea de Cardiología<a href="#bib28" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> incluyó recomendaciones para los deportistas no competitivos, es decir, los que practican deporte recreativo y actividad física en general, que en recomendaciones previas no habían sido incorporados; también en esta publicación se agrega un cambio de utilidad práctica en el momento de dar una recomendación médica para la realización de deportes, cambiando el componente dinámico de la clasificación de Mitchell<a href="#bib29" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> (<a href="#t0005" class="elsevierStyleCrossRefs">Tabla 1</a>) por el porcentaje de frecuencia cardiaca (FC) máxima obtenida en una prueba de esfuerzo con análisis de gases respirados; o bien con el equivalente en la escala de Borg de esfuerzo percibido (<a href="#t0010" class="elsevierStyleCrossRefs">Tabla 2</a>).</p><p class="elsevierStylePara"><img alt="Tabla 1. Clasificación de Mitchell para los deportes" src="277v52n193-90460720fig1.jpg"></img></p><p class="elsevierStylePara"><img alt="Tabla 2. Escala de Borg" src="277v52n193-90460720fig2.jpg"></img></p><span class="elsevierStyleSectionTitle"> Definiciones</span><p class="elsevierStylePara"> El tipo de actividad física es de especial importancia para la recomendación en la intensidad de ejercicio A continuación se definen aquellas en las que existe consenso internacional en su nomenclatura.<a name="sec0015" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Actividad física</span><p class="elsevierStylePara"> Movimiento corporal activo por contracción muscular que aumenta la tasa metabólica por encima del nivel de reposo. La actividad moderada se define como una actividad entre 3-6 MET y vigoroso cuando es > 6 MET<a href="#bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>.<a name="sec0020" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Ejercicio regular</span><p class="elsevierStylePara"> Es la actividad física planeada, estructurada y repetitiva que se realiza por más de 30 min al menos 3 días por semana durante los últimos 3 meses con moderada intensidad; tiene como objetivo mantener o mejorar la forma física<a href="#bib30" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a>.<a name="sec0025" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Deporte recreativo</span><p class="elsevierStylePara"> Actividades físicas sin la necesidad de jugar o con una intensidad mayor que la deseada por el participante. La actividad o el deporte pueden ser organizados o informales, y pueden ser espontáneos o estructurados para la competencia entre los participantes o equipos. Sin embargo, cualquier participante puede dejar de participar o puede disminuir la intensidad de su participación en cualquier momento, sin presión de sí mismo o de otros para continuar<a href="#bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>.<a name="sec0030" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Deporte competitivo</span><p class="elsevierStylePara"> Deporte organizado, competitivo y en el que las actividades físicas se rigen por reglas para mantener un juego limpio. Existe presión para entrenar o jugar, y son a una intensidad alta, independientemente de si esa intensidad es deseada o recomendada para el participante. El origen de esa presión puede ser del propio deportista, de compañeros, de entrenadores o de espectadores<a href="#bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>.<a name="sec0035" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Elite</span><p class="elsevierStylePara"> Deportista competitivo que entrena > 6 h a la semana y que regularmente compite a nivel regional, nacional o internacional<a href="#bib31" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a>.<a name="sec0040" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Recomendaciones</span><p class="elsevierStylePara"> El objetivo de esta revisión es resumir las principales anomalías y cardiopatías que se pueden encontrar en deportistas y pretende dar una recomendación y pauta general de la actitud a seguir en el caso de la recomendación de la aptitud cardiológica para la práctica deportiva tomando los principales grupos de enfermedades cardiacas, es decir: miocardiopatías (<a href="#t0015" class="elsevierStyleCrossRefs">Tabla 3</a>), valvulopatías y aorta (<a href="#t0020" class="elsevierStyleCrossRefs">Tabla 4</a>), arritmias y canalopatías (<a href="#t0025" class="elsevierStyleCrossRefs">Tabla 5</a>), y cardiopatías congénitas (<a href="#t0030" class="elsevierStyleCrossRefs">Tabla 6</a>). Para cada una de las alteraciones se otorga una recomendación de la intensidad de ejercicio recomendado según el tipo de deporte recreativo o competitivo. Con el objetivo de simplificar esta indicaciones se otorgó un color rojo cuando el deporte competitivo está contraindicado y el deporte recreativo está permitido si es de un bajo componente estático (Mitchell I) y se realiza a una intensidad menor al 60% FC máxima o menor al 5 de la escala de Borg, y un color amarillo cuando el deporte competitivo está permitido solo en los deportes de la clasificación de Mitchell IA (p. ej., golf, bowling) y el deporte recreativo está permitido si es de un bajo-moderado componente estático (Mitchell I y II) y se realiza a una intensidad menor al 75% FC máxima o menor al 6 de la escala de Borg. Sin embargo, hay que destacar que la decisión siempre debe ser individualizada y personalizada según la severidad de la cardiopatía, las comorbilidades del sujeto, la modalidad y disciplina deportiva que se practique y, de forma importante, también el entorno personal del sujeto.</p><p class="elsevierStylePara"><img alt="Tabla 3. Recomendaciones en miocardiopatías9,13" src="277v52n193-90460720fig3.jpg"></img></p><p class="elsevierStylePara"><img alt="Tabla 4. Recomendaciones en valvulopatías y aorta9,14-16" src="277v52n193-90460720fig4.jpg"></img></p><p class="elsevierStylePara"><img alt="Tabla 5. Recomendaciones en arritmias y canalopatías6,7,17,18" src="277v52n193-90460720fig5.jpg"></img></p><p class="elsevierStylePara"><img alt="Tabla 6. Recomendaciones en cardiopatías congénitas9,19" src="277v52n193-90460720fig6.jpg"></img></p><span class="elsevierStyleSectionTitle"> Volver a jugar</span><p class="elsevierStylePara"> La <a href="#t0035" class="elsevierStyleCrossRefs"> Tabla 7</a> muestra las recomendaciones sobre cuándo es posible la vuelta al deporte competitivo («volver a jugar») luego de las diferentes intervenciones terapéuticas cardiológicas que se hayan realizado. Es recomendado, si el procedimiento no presentó complicaciones, el inicio del entrenamiento progresivo y pautado en los días previos a la competencia.</p><p class="elsevierStylePara"><img alt="Tabla 7. «Volver a jugar» en deporte competitivo posterior a un tratamiento intervencionista" src="277v52n193-90460720fig7.jpg"></img></p><span class="elsevierStyleSectionTitle"> Conflicto de intereses</span><p class="elsevierStylePara"> Los autores declaran no tener ningún conflicto de intereses.</p><hr></hr><p class="elsevierStylePara"> Recibido el 18 de septiembre de 2016;<br></br> aceptado el 27 de septiembre de 2016<br></br> Disponible en Internet el 13 de diciembre de 2016</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">* </span> Autor para correspondencia.<br></br><span class="elsevierStyleItalic">Correo electrónico: </span><a href="mailto:grazioli@clinic.ub.es" class="elsevierStyleCrossRefs">grazioli@clinic.ub.es</a> (G. Grazioli).</p>" "pdfFichero" => "277v52n193a90460720pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec937342" "palabras" => array:3 [ 0 => "Cribado pre-participativo" 1 => "Recomendaciones" 2 => "Muerte súbita cardíaca" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec937341" "palabras" => array:3 [ 0 => "Pre-participation screening" 1 => "Recommendations" 2 => "Sudden cardiac death" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"> La muerte súbita en el deporte está causada en la mayoría de ocasiones por enfermedades cardiacas. El objetivo del cribado pre-participativo es poder identificar a los individuos que requieran un tratamiento específico para continuar el deporte o el cese de la práctica deportiva. La evidencia científica actual se basa en recomendaciones de expertos que en algunos casos son controvertidas y en ocasiones poco prácticas. Esta revisión tiene como objetivo dar un enfoque actualizado y pragmático de las recomendaciones en los deportistas con cardiopatía.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"> In most cases, sudden death in sports is caused by heart disease. The aim of pre-participation screening is to identify individuals who require specific treatment to continue the sport or stop practicing it. Current scientific evidence is based on expert recommendations that in some cases are controversial and sometimes impractical. This review aims to present an updated and pragmatic approach to the recommendations in athletes with heart disease.</p>" ] ] "multimedia" => array:14 [ 0 => array:8 [ "identificador" => "tbl1" "etiqueta" => "Tabla 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "277v52n193-90460720fig1.jpg" "imagenAlto" => 508 "imagenAncho" => 700 "imagenTamanyo" => 77482 ] ] ] ] ] "descripcion" => array:1 [ "es" => "Clasificación de Mitchell para los deportes" ] ] 1 => array:8 [ "identificador" => "tbl2" "etiqueta" => "Tabla 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "277v52n193-90460720fig2.jpg" "imagenAlto" => 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 6 | 15 |
| 2024 October | 106 | 54 | 160 |
| 2024 September | 118 | 52 | 170 |
| 2024 August | 91 | 65 | 156 |
| 2024 July | 100 | 48 | 148 |
| 2024 June | 116 | 37 | 153 |
| 2024 May | 132 | 54 | 186 |
| 2024 April | 79 | 34 | 113 |
| 2024 March | 100 | 26 | 126 |
| 2024 February | 58 | 30 | 88 |
| 2024 January | 68 | 46 | 114 |
| 2023 December | 82 | 54 | 136 |
| 2023 November | 101 | 42 | 143 |
| 2023 October | 152 | 55 | 207 |
| 2023 September | 125 | 60 | 185 |
| 2023 August | 86 | 25 | 111 |
| 2023 July | 86 | 26 | 112 |
| 2023 June | 72 | 31 | 103 |
| 2023 May | 108 | 33 | 141 |
| 2023 April | 100 | 42 | 142 |
| 2023 March | 168 | 72 | 240 |
| 2023 February | 106 | 51 | 157 |
| 2023 January | 74 | 27 | 101 |
| 2022 December | 96 | 37 | 133 |
| 2022 November | 109 | 29 | 138 |
| 2022 October | 104 | 59 | 163 |
| 2022 September | 92 | 38 | 130 |
| 2022 August | 86 | 33 | 119 |
| 2022 July | 78 | 39 | 117 |
| 2022 June | 76 | 38 | 114 |
| 2022 May | 87 | 40 | 127 |
| 2022 April | 70 | 43 | 113 |
| 2022 March | 73 | 38 | 111 |
| 2022 February | 71 | 43 | 114 |
| 2022 January | 56 | 36 | 92 |
| 2020 December | 69 | 19 | 88 |
| 2020 November | 104 | 18 | 122 |
| 2020 October | 84 | 27 | 111 |
| 2020 September | 78 | 34 | 112 |
| 2020 August | 64 | 21 | 85 |
| 2020 July | 54 | 25 | 79 |
| 2020 June | 75 | 37 | 112 |
| 2020 May | 76 | 32 | 108 |
| 2020 April | 85 | 28 | 113 |
| 2020 March | 88 | 29 | 117 |
| 2020 February | 80 | 20 | 100 |
| 2020 January | 54 | 32 | 86 |
| 2019 December | 66 | 40 | 106 |
| 2019 November | 81 | 55 | 136 |
| 2019 October | 112 | 77 | 189 |
| 2019 September | 72 | 78 | 150 |
| 2019 August | 56 | 40 | 96 |
| 2019 July | 53 | 41 | 94 |
| 2019 June | 66 | 59 | 125 |
| 2019 May | 71 | 61 | 132 |
| 2019 April | 96 | 110 | 206 |
| 2019 March | 44 | 43 | 87 |
| 2019 February | 53 | 65 | 118 |
| 2019 January | 66 | 60 | 126 |
| 2018 December | 80 | 47 | 127 |
| 2018 November | 89 | 36 | 125 |
| 2018 October | 85 | 28 | 113 |
| 2018 September | 30 | 28 | 58 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 6 | 1 | 7 |
| 2018 April | 20 | 10 | 30 |
| 2018 March | 29 | 11 | 40 |
| 2018 February | 60 | 20 | 80 |
| 2018 January | 32 | 29 | 61 |
| 2017 December | 52 | 22 | 74 |
| 2017 November | 39 | 39 | 78 |
| 2017 October | 71 | 56 | 127 |
| 2017 September | 60 | 37 | 97 |
| 2017 August | 120 | 81 | 201 |
| 2017 July | 123 | 61 | 184 |
| 2017 June | 164 | 104 | 268 |
| 2017 May | 179 | 94 | 273 |
| 2017 April | 85 | 46 | 131 |
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