Contraindicacions cardiològiques per a la pràctica esportiva
Cardiological contraindications in sports
Gonzalo Graziolia, Daniel Brotonsb, Fernando Pifarréb, Maria Sanz de la Garzaa, Sílvia Montserrata, Bárbara Vidala, Carles Miñarroc, Ramón Pid, Georgia Sarquella-Brugadae, Josep Antoni Gutiérrezb, Josep Brugadaa, Marta Sitgesa
a Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Espanya
b Consell Català de l’Esport, Catalunya, Espanya
c Centre d’Alt Rendiment, Sant Cugat del Vallès, Catalunya, Espanya
d Futbol Club Barcelona, Barcelona, Catalunya, Espanya
e Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Catalunya, Espanya
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Classificació dels esports de Mitchell" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducció</span></p><p class="elsevierStylePara"> Els beneficis cardiovasculars que aporta l’exercici moderat estan ben establerts<span class="elsevierStyleSup">1</span>, tot i que l’exercici pot provocar ocasionalment la mort sobtada cardíaca en esportistes amb malaltia cardíaca de base<span class="elsevierStyleSup">2</span>. En aquest context, la desqualificació de l’esport en els individus afectats ha demostrat que és una estratègia útil en l’únic estudi realitzat amb aquest objetiu<span class="elsevierStyleSup">3</span>.</p><p class="elsevierStylePara"> L’actualització recent de la conferència de Bethesda<span class="elsevierStyleSup">4</span> aporta recomanacions de nivell C (opinió d’experts) per als esportistes competitius, però en alguns punts difereix de les recomanacions europees en miocardiopaties i valvulopaties<span class="elsevierStyleSup">5</span>, arítmies i canalopaties<span class="elsevierStyleSup">6,7</span>, i cardiopaties congènites<span class="elsevierStyleSup">8</span>. El grup de cardiologia esportiva de la Societat Europea de Cardiologia<span class="elsevierStyleSup">9</span> inclogué recomanacions per als esportistes no competitius, és a dir, els que practiquen esport recreatiu i activitat física en general, que no havien estat incorporades en recomanacions prèvies; també en dita publicació s’afegeix un canvi d’utilitat pràctica en el moment de fer una recomanació mèdica per a la pràctica de l’esport, canviant el component dinàmic de la classificació de Mitchell<span class="elsevierStyleSup">10</span> (taula 1) pel percentatge de freqüència cardíaca (FC) màxima obtinguda en una prova d’esforç amb anàlisi de gasos respirats; o bé amb l’equivalent en l’escala de Borg, d’esforç percebut (taula 2).</p><p class="elsevierStylePara"><img alt="Taula 1. Classificació dels esports de Mitchell" src="278v52n193-90460853fig1.jpg"></img></p><p class="elsevierStylePara"><img alt="Taula 2. Escala de Borg" src="278v52n193-90460853fig2.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Definicions</span></p><p class="elsevierStylePara"> El tipus d’activitat física té una importància especial per recomanar la intensitat de l’exercici. A continuació es defineixen les activitats en la nomenclatura de les quals hi ha consens internacional.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Activitat física</span></p><p class="elsevierStylePara"> Moviment corporal actiu per contracció muscular que augmenta la taxa metabòlica per damunt del nivell de repòs. L’activitat moderada es defineix com una activitat entre 3-6 MET i vigorosa quan és > 6 MET<span class="elsevierStyleSup">8</span>.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Exercici regular</span></p><p class="elsevierStylePara"> És l’activitat física planificada, estructurada i repetitiva que es realitza per sobre dels 30 min almenys 3 dies per setmana durant els últims 3 mesos amb moderada intensitat; té com a objectiu mantenir o millorar la forma física<span class="elsevierStyleSup">11</span>.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Esport recreatiu</span></p><p class="elsevierStylePara"> Activitat física sense necessitat de jugar a una intensitat major que la desitjada pel participant. L’activitat o l’esport poden ser organitzats o informals, i poden ser espontanis o estructurats perquè hi hagi competència entre els participants o equips. Tanmateix, tot participant pot deixar de participar o pot disminuir la intensitat de la participació en qualsevol moment, sense la pressió d’ell mateix o dels altres per continuar<span class="elsevierStyleSup">8</span>.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Esport competitiu</span></p><p class="elsevierStylePara"> Esport organitzat, competitiu, en què les activitats físiques es regeixen per regles per mantenir un joc net. Existeix pressió per entrenar o jugar, i són a una intensitat alta, independentment de si aquesta mateixa intensitat és desitjada o recomanada pel participant. L’origen d’aquesta pressió pot ser del propi esportista, dels companys, dels entrenadors o dels espectadors<span class="elsevierStyleSup">8</span>.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Elit</span></p><p class="elsevierStylePara"> Esportista competitiu que entrena > 6 h a la setmana i que regularment competeix a nivell regional, nacional o internacional<span class="elsevierStyleSup">12</span>.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Recomanacions</span></p><p class="elsevierStylePara"> L’objectiu d’aquesta revisió és resumir les principals anomalies i cardiopaties que es poden trobar en esportistes i pretén donar una recomanació i una pauta general de l’actitud a seguir en el cas de la recomanació de l’aptitud cardiològica per a la pràctica esportiva prenent els principals grups de malalties cardíaques, és a dir: miocardiopaties (taula 3), valvulopaties i aorta (taula 4), arítmies i canalopaties (taula 5), i cardiopaties congènites (taula 6). Per a cada una de les alteracions s’atorga una pauta de la intensitat d’exercici recomanat segons el tipus d’esport recreatiu o competitiu. Amb l’objectiu de simplificar aquestes indicacions s’atorga el color vermell si l’esport competitiu està contraindicat i l’esport recreatiu està permès si és de component estàtic baix (Mitchell I) i es practica a una intensitat menor al 0% FC màxima o menor al 5 de l’escala de Borg, i un color groc quan és permès l’esport competitiu només en els esports de la classificació de Mitchell IA (p. ex., golf, bowling) i l’esport recreatiu està permès si és d’un component estàtic baix-moderat (Mitchell I i II) i es realitza a una intensitat menor al 75% FC màxima o menor al 6 de l’escala de Borg. Tanmateix, cal destacar que la decisió ha de ser sempre individualitzada i personalitzada, segons la severitat de la cardiopatia, les comorbiditats del subjecte, la modalitat i disciplina esportiva que es practiqui i, de forma important, també l’entorn personal del subjecte.</p><p class="elsevierStylePara"><img alt="Taula 3. Recomanacions en miocardiopaties9,13" src="278v52n193-90460853fig3.jpg"></img></p><p class="elsevierStylePara"><img alt="Taula 4. Recomanacions en valvulopaties i aorta9,14-16" src="278v52n193-90460853fig4.jpg"></img></p><p class="elsevierStylePara"><img alt="Taula 5. Recomanacions en arítmies i canalopaties6,7,17,18" src="278v52n193-90460853fig5.jpg"></img></p><p class="elsevierStylePara"><img alt="Taula 6. Recomanacions en cardiopaties congènites9,19" src="278v52n193-90460853fig6.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Tornar a jugar</span></p><p class="elsevierStylePara"> La taula 7 mostra les recomanacions sobre quan és possible la tornada a l’esport competitiu («tornar a jugar») després de les diferents intervencions terapèutiques cardiològiques que s’hagin dut a terme. Es recomana, si el procediment no ha presentat complicacions, l’inici de l’entrenament progressiu i pautat en els dies previs a la competició.</p><p class="elsevierStylePara"><img alt="Taula 7. «Tornar a jugar» en esport competitiu posterior a un tractament intervencionista" src="278v52n193-90460853fig7.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicte d’interessos</span></p><p class="elsevierStylePara"> Els autors declaren que no tenen cap conflicte d’interessos.</p><hr></hr><p class="elsevierStylePara"> Rebut el 18 de setembre de 2016;<br></br> acceptat el 27 de setembre de 2016</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">* </span>Autor per a correspondència. <br></br><span class="elsevierStyleItalic">Correu electrònic:</span><a href="mailto:grazioli@clinic.ub.es" class="elsevierStyleCrossRefs">grazioli@clinic.ub.es</a> (G. Grazioli)</p>" "pdfFichero" => "278v52n193a90460853pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec937383" "palabras" => array:1 [ 0 => "Cribratge preparticipatiu; Recomanacions; Mort sobtada cardíaca" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec937384" "palabras" => array:1 [ 0 => "Pre-participation screening; Recommendations; Sudden cardiac death" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"> La mort sobtada a l’esport la majoria de vegades és causada per malalties cardíaques. L’objectiu del cribratge preparticipatiu és poder identificar els individus que requereixen un tractament específic per continuar fent esport o cessar la pràctica esportiva. L’evidència científica actual es basa en recomanacions d’experts que, en alguns casos, són controvertides i, en ocasions, poc pràctiques. Aquesta revisió té per objectiu donar un enfocament actualitzat i pragmàtic de les recomanacions als esportistes amb cardiopatia.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"> Sudden death in sports is caused in most cases by heart disease. The aim of pre-participation screening is to identify individuals who require specific treatment to continue the sport or who should cease the practice of sport. Current scientific evidence is based on expert recommendations that in some cases are controversial and impractical. This review aims to give an updated approach and pragmatic recommendations in athletes with heart disease.</p>" ] ] "multimedia" => array:14 [ 0 => array:7 [ "identificador" => "fig1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "278v52n193-90460853fig1.jpg" "Alto" => 496 "Ancho" => 700 "Tamanyo" => 71192 ] ] "descripcion" => array:1 [ "ct" => "Taula 1. Classificació dels esports de Mitchell" ] ] 1 => array:7 [ "identificador" => "fig2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "278v52n193-90460853fig2.jpg" "Alto" => 154 "Ancho" => 700 "Tamanyo" => 19312 ] ] "descripcion" => array:1 [ "ct" => "Taula 2. 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Article information
ISSN: X8866581Original language: Català
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