Maisch B
Philipps University Marburg, Feldbergstr. 45, 35043, Marburg, Germany,
Herz. 2015 May;40(3):395-401. doi: 10.1007/s00059-015-4221-7.
Physical training has a well-established role in the primary and secondary prevention of coronary artery disease. Moderate exercise has been shown to be beneficial in chronic stable heart failure. Competitive sports, however, is contraindicated in most forms of hypertrophic cardiomyopathy (HCM), in myocarditis, in pericarditis, and in right ventricular cardiomyopathy/dysplasia. In most European countries, the recommendations of medical societies or public bodies state that these diseases have to be ruled out by prescreening before an individual can take up competitive sports. But the intensity and quality of this health check vary considerably from country to country, from the type of sports activity, and from the individuals who want to participate in sports. Prescreening on an individual basis should also be considered for leisure sports, particularly in people who decide to start training in middle age after years of physical inactivity to regain physical fitness. In leisure sports the initiative for a medical check-up lies primarily in the hands of the "healthy" individual. If she or he plans to participate in extreme forms of endurance sports with excessive training periods such as a marathon or ultramarathon and competitive cycling or rowing, they should be aware that high-intensity endurance sports can lead to structural alterations of the heart muscle even in healthy individuals. Physical exercise in patients with heart disease should be accompanied by regular medical check-ups. Most rehabilitation programs in Europe perform physical activity and training schedules according to current guidelines. Little is known about athletes who are physically handicapped and participate in competitive sports or the Paralympics, and even less is known about individuals with intellectual disabilities (ID) who participate in local, regional, international competitions or the Special Olympics or just in leisure sport activities.
体育锻炼在冠状动脉疾病的一级和二级预防中具有公认的作用。适度运动已被证明对慢性稳定型心力衰竭有益。然而，竞技运动在大多数肥厚型心肌病（HCM）、心肌炎、心包炎和右心室心肌病/发育异常中是禁忌的。在大多数欧洲国家，医学协会或公共机构的建议指出，在个人参加竞技运动之前，必须通过预筛查排除这些疾病。但这种健康检查的强度和质量因国家、体育活动类型以及想要参加运动的个人而异。对于休闲运动，也应考虑进行个体预筛查，特别是对于那些决定在多年缺乏体育活动后中年开始训练以恢复身体健康的人。在休闲运动中，进行医学检查的主动权主要掌握在“健康”个体手中。如果她或他计划参加极端形式的耐力运动，如马拉松或超级马拉松以及竞技自行车或赛艇等训练期过长的运动，他们应该意识到高强度耐力运动即使在健康个体中也可能导致心肌结构改变。心脏病患者的体育锻炼应伴有定期医学检查。欧洲的大多数康复项目都根据当前指南执行体育活动和训练计划。对于身体有残疾并参加竞技运动或残奥会的运动员了解甚少，对于参加地方、区域、国际比赛或特奥会或仅仅参加休闲体育活动的智力残疾（ID）个体了解更少。
