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    "textoCompleto" => "<span class="elsevierStyleSectionTitle"> Introducci&#243;n</span><p class="elsevierStylePara"> Los beneficios cardiovasculares que aporta el ejercicio moderado est&#225;n bien establecidos<a href="&#35;bib20" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a>&#44; aunque el ejercicio puede provocar ocasionalmente la muerte s&#250;bita cardiaca en deportistas con enfermedad cardiaca de base<a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a>&#46; En este contexto&#44; la descalificaci&#243;n del deporte de los individuos afectados ha demostrado ser una estrategia &#250;til en el &#250;nico estudio realizado con este objetivo<a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a>&#46;</p><p class="elsevierStylePara"> La reciente actualizaci&#243;n de la conferencia de Bethesda<a href="&#35;bib23" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> aporta recomendaciones de nivel C &#40;opini&#243;n de expertos&#41; para los deportistas competitivos&#44; pero en algunos puntos difiere de las recomendaciones europeas en miocardiopat&#237;as y valvulopat&#237;as<a href="&#35;bib24" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a>&#44; arritmias y canalopat&#237;as<a href="&#35;bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a>&#44; y cardiopat&#237;as cong&#233;nitas<a href="&#35;bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>&#46; El grupo de cardiolog&#237;a deportiva de la Sociedad Europea de Cardiolog&#237;a<a href="&#35;bib28" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> incluy&#243; recomendaciones para los deportistas no competitivos&#44; es decir&#44; los que practican deporte recreativo y actividad f&#237;sica en general&#44; que en recomendaciones previas no hab&#237;an sido incorporados&#59; tambi&#233;n en esta publicaci&#243;n se agrega un cambio de utilidad pr&#225;ctica en el momento de dar una recomendaci&#243;n m&#233;dica para la realizaci&#243;n de deportes&#44; cambiando el componente din&#225;mico de la clasificaci&#243;n de Mitchell<a href="&#35;bib29" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> &#40;<a href="&#35;t0005" class="elsevierStyleCrossRefs">Tabla 1</a>&#41; por el porcentaje de frecuencia cardiaca &#40;FC&#41; m&#225;xima obtenida en una prueba de esfuerzo con an&#225;lisis de gases respirados&#59; o bien con el equivalente en la escala de Borg de esfuerzo percibido &#40;<a href="&#35;t0010" class="elsevierStyleCrossRefs">Tabla 2</a>&#41;&#46;</p><p class="elsevierStylePara"><img alt="Tabla 1&#46; Clasificaci&#243;n de Mitchell para los deportes" src="277v52n193-90460720fig1.jpg"></img></p><p class="elsevierStylePara"><img alt="Tabla 2&#46; Escala de Borg" src="277v52n193-90460720fig2.jpg"></img></p><span class="elsevierStyleSectionTitle"> Definiciones</span><p class="elsevierStylePara"> El tipo de actividad f&#237;sica es de especial importancia para la recomendaci&#243;n en la intensidad de ejercicio A continuaci&#243;n se definen aquellas en las que existe consenso internacional en su nomenclatura&#46;<a name="sec0015" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Actividad f&#237;sica</span><p class="elsevierStylePara"> Movimiento corporal activo por contracci&#243;n muscular que aumenta la tasa metab&#243;lica por encima del nivel de reposo&#46; La actividad moderada se define como una actividad entre 3-6&#160;MET y vigoroso cuando es &#62;&#160;6&#160;MET<a href="&#35;bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>&#46;<a name="sec0020" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Ejercicio regular</span><p class="elsevierStylePara"> Es la actividad f&#237;sica planeada&#44; estructurada y repetitiva que se realiza por m&#225;s de 30&#160;min al menos 3&#160;d&#237;as por semana durante los &#250;ltimos 3&#160;meses con moderada intensidad&#59; tiene como objetivo mantener o mejorar la forma f&#237;sica<a href="&#35;bib30" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a>&#46;<a name="sec0025" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Deporte recreativo</span><p class="elsevierStylePara"> Actividades f&#237;sicas sin la necesidad de jugar o con una intensidad mayor que la deseada por el participante&#46; La actividad o el deporte pueden ser organizados o informales&#44; y pueden ser espont&#225;neos o estructurados para la competencia entre los participantes o equipos&#46; Sin embargo&#44; cualquier participante puede dejar de participar o puede disminuir la intensidad de su participaci&#243;n en cualquier momento&#44; sin presi&#243;n de s&#237; mismo o de otros para continuar<a href="&#35;bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>&#46;<a name="sec0030" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Deporte competitivo</span><p class="elsevierStylePara"> Deporte organizado&#44; competitivo y en el que las actividades f&#237;sicas se rigen por reglas para mantener un juego limpio&#46; Existe presi&#243;n para entrenar o jugar&#44; y son a una intensidad alta&#44; independientemente de si esa intensidad es deseada o recomendada para el participante&#46; El origen de esa presi&#243;n puede ser del propio deportista&#44; de compa&#241;eros&#44; de entrenadores o de espectadores<a href="&#35;bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>&#46;<a name="sec0035" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Elite</span><p class="elsevierStylePara"> Deportista competitivo que entrena &#62;&#160;6&#160;h a la semana y que regularmente compite a nivel regional&#44; nacional o internacional<a href="&#35;bib31" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a>&#46;<a name="sec0040" class="elsevierStyleCrossRefs"></a></p><span class="elsevierStyleSectionTitle"> Recomendaciones</span><p class="elsevierStylePara"> El objetivo de esta revisi&#243;n es resumir las principales anomal&#237;as y cardiopat&#237;as que se pueden encontrar en deportistas y pretende dar una recomendaci&#243;n y pauta general de la actitud a seguir en el caso de la recomendaci&#243;n de la aptitud cardiol&#243;gica para la pr&#225;ctica deportiva tomando los principales grupos de enfermedades cardiacas&#44; es decir&#58; miocardiopat&#237;as &#40;<a href="&#35;t0015" class="elsevierStyleCrossRefs">Tabla 3</a>&#41;&#44; valvulopat&#237;as y aorta &#40;<a href="&#35;t0020" class="elsevierStyleCrossRefs">Tabla 4</a>&#41;&#44; arritmias y canalopat&#237;as &#40;<a href="&#35;t0025" class="elsevierStyleCrossRefs">Tabla 5</a>&#41;&#44; y cardiopat&#237;as cong&#233;nitas &#40;<a href="&#35;t0030" class="elsevierStyleCrossRefs">Tabla 6</a>&#41;&#46; Para cada una de las alteraciones se otorga una recomendaci&#243;n de la intensidad de ejercicio recomendado seg&#250;n el tipo de deporte recreativo o competitivo&#46; Con el objetivo de simplificar esta indicaciones se otorg&#243; un color rojo cuando el deporte competitivo est&#225; contraindicado y el deporte recreativo est&#225; permitido si es de un bajo componente est&#225;tico &#40;Mitchell&#160;I&#41; y se realiza a una intensidad menor al 60&#37; FC m&#225;xima o menor al 5 de la escala de Borg&#44; y un color amarillo cuando el deporte competitivo est&#225; permitido solo en los deportes de la clasificaci&#243;n de Mitchell&#160;IA &#40;p&#46;&#160;ej&#46;&#44; golf&#44; bowling&#41; y el deporte recreativo est&#225; permitido si es de un bajo-moderado componente est&#225;tico &#40;Mitchell&#160;I y&#160;II&#41; y se realiza a una intensidad menor al 75&#37; FC m&#225;xima o menor al 6 de la escala de Borg&#46; Sin embargo&#44; hay que destacar que la decisi&#243;n siempre debe ser individualizada y personalizada seg&#250;n la severidad de la cardiopat&#237;a&#44; las comorbilidades del sujeto&#44; la modalidad y disciplina deportiva que se practique y&#44; de forma importante&#44; tambi&#233;n el entorno personal del sujeto&#46;</p><p class="elsevierStylePara"><img alt="Tabla 3&#46; Recomendaciones en miocardiopat&#237;as9&#44;13" src="277v52n193-90460720fig3.jpg"></img></p><p class="elsevierStylePara"><img alt="Tabla 4&#46; Recomendaciones en valvulopat&#237;as y aorta9&#44;14-16" src="277v52n193-90460720fig4.jpg"></img></p><p class="elsevierStylePara"><img alt="Tabla 5&#46; Recomendaciones en arritmias y canalopat&#237;as6&#44;7&#44;17&#44;18" src="277v52n193-90460720fig5.jpg"></img></p><p class="elsevierStylePara"><img alt="Tabla 6&#46; Recomendaciones en cardiopat&#237;as cong&#233;nitas9&#44;19" src="277v52n193-90460720fig6.jpg"></img></p><span class="elsevierStyleSectionTitle"> Volver a jugar</span><p class="elsevierStylePara"> La <a href="&#35;t0035" class="elsevierStyleCrossRefs"> Tabla 7</a> muestra las recomendaciones sobre cu&#225;ndo es posible la vuelta al deporte competitivo &#40;&#171;volver a jugar&#187;&#41; luego de las diferentes intervenciones terap&#233;uticas cardiol&#243;gicas que se hayan realizado&#46; Es recomendado&#44; si el procedimiento no present&#243; complicaciones&#44; el inicio del entrenamiento progresivo y pautado en los d&#237;as previos a la competencia&#46;</p><p class="elsevierStylePara"><img alt="Tabla 7&#46; &#171;Volver a jugar&#187; 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 ning&#250;n conflicto de intereses&#46;</p><hr></hr><p class="elsevierStylePara"> Recibido el 18 de septiembre de 2016&#59;<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">&#42; </span> Autor para correspondencia&#46;<br></br><span class="elsevierStyleItalic">Correo electr&#243;nico&#58; </span><a href="mailto&#58;grazioli&#64;clinic&#46;ub&#46;es" class="elsevierStyleCrossRefs">grazioli&#64;clinic&#46;ub&#46;es</a> &#40;G&#46; Grazioli&#41;&#46;</p>"
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Journal Information
Vol. 52. Issue 193.
Pages 11-16 (January - March 2017)
Full text access
Contraindicaciones cardiológicas para la práctica deportiva
Cardiology contraindications for the practice of sports
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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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Tables (7)
Tabla 1. Clasificación de Mitchell para los deportes
Tabla 2. Escala de Borg
Tabla 3. Recomendaciones en miocardiopatías9,13
Tabla 4. Recomendaciones en valvulopatías y aorta9,14-16
Tabla 5. Recomendaciones en arritmias y canalopatías6,7,17,18
Tabla 6. Recomendaciones en cardiopatías congénitas9,19
Tabla 7. «Volver a jugar» en deporte competitivo posterior a un tratamiento intervencionista
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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.

Palabras clave:
Cribado pre-participativo
Recomendaciones
Muerte súbita cardíaca

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.

Keywords:
Pre-participation screening
Recommendations
Sudden cardiac death
Full Text
Introducción

Los beneficios cardiovasculares que aporta el ejercicio moderado están bien establecidos1, aunque el ejercicio puede provocar ocasionalmente la muerte súbita cardiaca en deportistas con enfermedad cardiaca de base2. En este contexto, la descalificación del deporte de los individuos afectados ha demostrado ser una estrategia útil en el único estudio realizado con este objetivo3.

La reciente actualización de la conferencia de Bethesda4 aporta recomendaciones de nivel C (opinión de expertos) para los deportistas competitivos, pero en algunos puntos difiere de las recomendaciones europeas en miocardiopatías y valvulopatías5, arritmias y canalopatías6, 7, y cardiopatías congénitas8. El grupo de cardiología deportiva de la Sociedad Europea de Cardiología9 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 Mitchell10 (Tabla 1) 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 (Tabla 2).

Definiciones

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.

Actividad física

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 MET8.

Ejercicio regular

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 física11.

Deporte recreativo

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 continuar8.

Deporte competitivo

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 espectadores8.

Elite

Deportista competitivo que entrena > 6 h a la semana y que regularmente compite a nivel regional, nacional o internacional12.

Recomendaciones

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 (Tabla 3), valvulopatías y aorta (Tabla 4), arritmias y canalopatías (Tabla 5), y cardiopatías congénitas (Tabla 6). 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.

Volver a jugar

La Tabla 7 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.

Conflicto de intereses

Los autores declaran no tener ningún conflicto de intereses.


Recibido el 18 de septiembre de 2016;

aceptado el 27 de septiembre de 2016

Disponible en Internet el 13 de diciembre de 2016

* Autor para correspondencia.

Correo electrónico: grazioli@clinic.ub.es (G. Grazioli).

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