For a long time, it was believed that exercise provided only health benefits. Recent research shows that long-term high-intensity exercise training can, in some cases, also carry risks. For this reason, European and American cardiology associations have combined their expertise to help physicians better recognize and treat cardiovascular disease in Masters athletes – active athletes of middle and older age. The aim is to provide better and more tailored care for this growing group of athletes.
‘Exercise is healthy, but athletes are not immune to cardiovascular disease’, says exercise physiologist Thijs Eijsvogels from Radboudumc. People who exercise regularly live longer and healthier lives on average. However, athletes can still present known risk factors such as high blood pressure or elevated cholesterol. These risk factors should be taken just as seriously in athletes as in individuals with a less active lifestyle. Being physically active does not automatically eliminate the risk of heart problems.
In fact, some cardiac abnormalities appear to occur more frequently in athletes than in non-athletes. Examples include arrhythmias and coronary artery calcification. Why these conditions are more common in athletes is not yet fully understood. This raises important questions: how can these issues be detected in time, and how can athletes and physicians manage them responsibly? In practice, existing guidelines for patients and the general population only partially address the needs of athletes, causing them to risk falling through the cracks.
Unexplained decline in performance
A new guideline has therefore been developed describing the most common heart problems in athletes over the age of 35. European and American physicians and researchers collaborated on this effort, led by Eijsvogels and Guido Claessen of Jessa Hospital in Hasselt, Belgium. One important point is that symptoms may present differently in athletes. ‘In addition to typical complaints such as chest pain or pronounced shortness of breath during exertion, a sudden, unexplained decline in athletic performance can be a sign of coronary artery calcification’, says Claessen.
The guideline encourages shared decision-making between the physician and athlete. ‘Together, they review possible treatment options, considering not only risks, prognosis, and symptoms, but also the athlete’s personal goals’, Eijsvogels explains. ‘It’s not about giving a black‑and‑white recommendation, but about tailored care.’ In this way, medical safety and athletic goals can be better balanced.
Growing attention
The number of people participating in intensive sporting events, such as marathons, triathlons, and cycling races, has increased significantly in recent years. This raises the question of whether there is an upper limit to the health benefits of exercise. Eijsvogels is also one of the lead investigators of the FIT‑HEART consortium, funded by the Dutch Heart Foundation, which studies the effects of long-term and very intensive exercise on heart health in recreational and elite athletes.
The new guideline contributes to a more uniform and evidence‑based approach to the care of athletes with heart problems worldwide.
About the publications
Masters athletes with abnormal cardiovascular findings: a clinical consensus statement of the European Association of Preventive Cardiology of the ESC and the American College of Cardiology. T. M.H. Eijsvogels, J. H. Kim, V. L. Aengevaeren, F. D’Ascenzi, T. W. Churchill, E. H. Dineen, M. Sanz-de la Garza, S. Gati, G. Halasz, K. Haugaa, H. Heidbuchel, A. La Gerche, R. Lampert, S. Krishnan, V. Maestrini, M. W. Martinez, M. Papadakis, F. Perone, D. Phelan, S. Sharma, P. D. Thompson, A. L. Baggish, G. Claessen.
The article was published in:
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European Heart Journal: DOI: 10.1093/eurheartj/ehag040.
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The Journal of the American College of Cardiology: DOI: 10.1016/j.jacc.2026.03.025.
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