Contraindicaciones para la práctica deportiva. Documento de consenso de la Sociedad Española de Medicina del Deporte (SEMED-FEMEDE) / Contraindications of sports practice. Consensus document of the SPANISH Society of Sports Medicine (SEMED-FEMEDE)

La función principal de la medicina del deporte es el cuidado de la salud del deportista, no solo desde el punto de vista del tratamiento, sino también desde el de la prevención. Los reconocimientos médicos para la aptitud deportiva, una de las atribuciones principales de esta especialidad, están destinados a descubrir patologías, enfermedades o alteraciones que pueden afectar a la salud, y abarcan desde las situaciones que pueden desencadenar incidentes mortales hasta las que, sin poner en riesgo la vida, pueden afectar la salud o el rendimiento del deportista. La realización adecuada de reconocimientos para el deporte implica el diagnóstico de problemas médicos que deben analizarse, entre otros puntos de vista, desde la óptica de la aptitud para la práctica deportiva, y el médico encargado debe disponer de una guía que le oriente sobre la decisión de autorizar o no la práctica de deporte, y en caso de no autorización, la temporalidad de esta y el riesgo asumible de participación en algunos deportes. Las contraindicaciones para la práctica deportiva mejor conocidas son las de origen cardiovascular, tratadas extensamente en la literatura, pero también existen contraindicaciones del resto de aparatos y sistemas del organismo, entendiendo que el deportista es un ser completo y que el ejercicio físico afecta a todo su conjunto. Este documento, además de recoger dichas contraindicaciones, analiza los aspectos legales que afectan a los profesionales en los que recae la responsabilidad de realizar los reconocimientos y los aspectos documentales que les son propios

Main purpose of sports medicine is reaching the health care of the athlete, not only from the point of view of treatment, but also from the point of view of prevention. The performance of preparticipation medical sports evaluation, one of the main attributions of this specialty, is aimed at the discovery of pathologies, diseases or alterations that may affect health. They might range from situations that can trigger deadly incidents, to those without putting life at risk, can affect the health or performance of the athlete. Adequate implementation of preparticipation medical sports evaluation implies the diagnosis of medical problems that must be analyzed, from other points of view such as the perspective of fitness for sport practice. In addition, the doctor in charge must have a guide for clearance for sports practice. In case of non-authorization, time for non-sports activities must be recommended in order to decrease injury risks. Cardiovascular pathologies are the best known contraindications in sport practice, treated extensively in the literature. However, there are also contraindications secondary to problems or issues of the rest of apparatus organs and systems of the organism, knowing that the athlete represents an entity in which physical exercise affects all their sets. This document highlights those contraindications already discussed above and analyzes the legal aspects of sports practice contraindications. Medical professionals are responsible for managing the pre-participation medical sports evaluation as well as the documentary aspects that support it

Efecto de un programa de ejercicio físico individualizado sobre el perfil lipídico en pacientes sedentarios con factores de riesgo cardiovascular / Effect of an individualised physical exercise program on lipid profile in sedentary patients with cardiovascular risk factors

El ejercicio físico (EF) se ha convertido en una herramienta de capital importancia en la reducción del riesgo cardiovascular (RCV). Objetivos: Evaluar la eficacia de un programa de EF no supervisado sobre la condición física y el perfil lipídico. Diseño: La muestra final incluyó a 49 hombres y mujeres sedentarias con dislipemia, sobrepeso u obesidad tipo1 y no fumadores. Debían realizar durante 4meses: andar 30-60min cada día y 3días a la semana: 30min de bicicleta estática a una intensidad del 40-60% de la capacidad funcional máxima, abdominales isométricos y estiramientos estáticos. Antes y después de realizar el programa de EF se evaluó la antropometría, la condición física (Test de los 6min) y el perfil lipídico. El objetivo era conseguir un gasto calórico entre 1.200-2.000kilocalorías/semanales. Resultados: Al finalizar el programa se observó en ambos sexos una disminución del colesterol total (p<0,02), del colesterol LDL (p<0,01), del colesterol VLDL (p<0,01), de los triglicéridos (p<0,05) y un aumento del colesterol HDL (p<0,05). También se constató un aumento de la distancia recorrida en el test de los 6 min: hombres 52m (p<0,002) y mujeres 39,5m (p<0,002) y una disminución de la percepción de fatiga (escala de Borg): hombres en 1,19 (p<0,01) y mujeres en 0,96 (p<0,01). No hubo cambios antropométricos. Conclusiones: El EF prescrito mejoró el perfil lipídico (alcanzando al final del estudio valores dentro de los rangos de normalidad) y la condición física en la muestra estudiada. Se consiguió una adherencia al mismo de un 64% de los participantes (AU)

Physical exercise has become in an important tool in the reduction of cardiovascular risk. Objectives: To evaluate the effectiveness of an unsupervised physical exercise program that on the physical condition and the lipid profile. Method: The final sample included 49 sedentary men and women, who were non-smokers, with dyslipidaemia, overweight, and type1 obesity. The 4-month program included walking for 30-60minutes every day, and for three days a week, 30minutes of cycling at an intensity of 40-60% of maximum functional capacity, as well as isometric abdominals and static stretching. Anthropometrics, physical condition (6minute test), and the lipid profile were evaluated before and after the physical exercise program. The objective was to achieve a caloric expenditure between 1200-2000kcal/week. Results: At the end of the program it was observed, in both sexes, that there was a decrease in total cholesterol (P<0.02), LDL cholesterol (P<0.01), VLDL cholesterol (P<0.01), and triglycerides (P<0.05), and an increase HDL cholesterol (P<0.05). There was also an increase in the distance travelled in the 6minute test of 52m in men and 39.5m in women (P<0.002), plus a decrease in the perception of fatigue on the Borg scale of 1.19 in men, and 0.96 in women (P<0.01). There were no anthropometric changes. Conclusions: The physical exercise improved physical condition and the lipid profile in the sample that has been studied, with 64% of participants continuing to do it (AU)

Effect of an individualised physical exercise program on lipid profile in sedentary patients with cardiovascular risk factors. / Efecto de un programa de ejercicio físico individualizado sobre el perfil lipídico en pacientes sedentarios con factores de riesgo cardiovascular.

Physical exercise has become in an important tool in the reduction of cardiovascular risk. OBJECTIVES: To evaluate the effectiveness of an unsupervised physical exercise program that on the physical condition and the lipid profile. METHOD: The final sample included 49 sedentary men and women, who were non-smokers, with dyslipidaemia, overweight, and type1 obesity. The 4-month program included walking for 30-60minutes every day, and for three days a week, 30minutes of cycling at an intensity of 40-60% of maximum functional capacity, as well as isometric abdominals and static stretching. Anthropometrics, physical condition (6minute test), and the lipid profile were evaluated before and after the physical exercise program. The objective was to achieve a caloric expenditure between 1200-2000kcal/week. RESULTS: At the end of the program it was observed, in both sexes, that there was a decrease in total cholesterol (P<0.02), LDL cholesterol (P<0.01), VLDL cholesterol (P<0.01), and triglycerides (P<0.05), and an increase HDL cholesterol (P<0.05). There was also an increase in the distance travelled in the 6minute test of 52m in men and 39.5m in women (P<0.002), plus a decrease in the perception of fatigue on the Borg scale of 1.19 in men, and 0.96 in women (P<0.01). There were no anthropometric changes. CONCLUSIONS: The physical exercise improved physical condition and the lipid profile in the sample that has been studied, with 64% of participants continuing to do it.

Acute effect of static exercise in patients with aortic regurgitation assessed by cardiovascular magnetic resonance: role of left ventricular remodelling.

OBJECTIVE: In patients with aortic regurgitation (AR), the effect of static exercise (SE) on global ventricular function and AR severity has not been previously studied. METHODS: Resting and SE cardiovascular magnetic resonance (CMR) were prospectively performed in 23 asymptomatic patients with AR. RESULTS: During SE, we observed a decrease in regurgitant volume in both end-diastolic (EDV) and end-systolic (ESV) volume in both ventricles, as well as a slight decrease in LV ejection fraction (EF). Interestingly, responses varied depending on the degree of LV remodelling. Among patients with a greater degree of LV remodelling, we observed a decrease in LVEF (56 ± 4 % at rest vs 48 ± 7 % during SE, p = 0.001) as a result of a lower decrease in LVESV (with respect to LVEDV. Among patients with a lower degree of LV remodelling, LVEF remained unchanged. RVEF remained unchanged in both groups. CONCLUSIONS: In patients with AR, SE provoked a reduction in preload, LV stroke volume, and regurgitant volume. In those patients with higher LV remodelling, we observed a decrease in LVEF, suggesting a lower LV contractile reserve. KEY POINTS: • In patients with aortic regurgitation, static exercise reduced preload volume. • In patients with aortic regurgitation, static exercise reduced stroke volume. • In patients with aortic regurgitation, static exercise reduced regurgitant volume. • In patients with greater remodelling, static exercise unmasked a lower contractile reserve. • Effect of static exercise on aortic regurgitation was assessed by cardiac MR.

Acute effect of static exercise on the cardiovascular system: assessment by cardiovascular magnetic resonance.

PURPOSE: The acute effect of static exercise on the global dynamics of the cardiovascular system is poorly understood. The use of cardiovascular magnetic resonance (CMR) may be useful for evaluating this effect. METHODS: A total of 12 healthy individuals underwent CMR imaging at rest and while performing a maximal sustained static exercise (weight elevation with both legs). We analyzed the effects on left and right ventricular function, ascending aorta dynamics, and venous capacitance using standard cine and phase-contrast sequences. RESULTS: We observed excellent reproducibility in the measurements of the images obtained at rest as well as during static exercise. During exercise, we observed reduced left (-35 ± 8 %, p < 0.001) and right (-44 ± 9 %, p < 0.001) ventricle end-diastolic volumes, reduced left (-35 ± 16 %, p < 0.001) and right (-43 ± 8 %, p < 0.001) ventricle end-systolic volumes (both with a significantly greater reduction in the right ventricle), a reduced superior vena cava cross-sectional area (-20 ± 17 %, p = 0.003), and increased left ventricle wall thickness. We estimated that there was an increase in left ventricle contractility. There were no significant changes in the left and right ventricular ejection fractions. During exercise, we noted a tendency toward decreased aortic distensibility and a reduction of ascending aorta systolic expansion. CONCLUSIONS: In healthy individuals, an acute maximal static exercise produced a reduction in the left ventricle, right ventricle, and superior vena cava volumes as well as signs of increased aortic stiffness without increasing left ventricular systolic wall stress. CMR is feasible and useful in evaluating the hemodynamic effects of static exercise.

Adolescentes con normopeso y obesidad: análisis de las diferencias en la actividad física, resistencia cardiovascular, características familiares y autoevaluación personal / Adolescents with normal weight and obesity: analysis of differences in physical activity, cardiovascular endurance, in family characteristics and in a personal self-assessment

Introducción: La obesidad en edades pediátricas representa un grave problema de salud pública, siendo una de las causas más importantes de morbilidad prematura evitable. En la prevención y tratamiento de la obesidad juegan un papel importante factores como la actividad física. Dicha actividad física puede estar limitada por la propia condición física, el nivel de motivación o autoestima y por otros factores a nivel familiar. El presente trabajo pretende analizar si existen diferencias entre niños con normopeso y obesos respecto a dichos factores. Material y método: Se estudiaron a 146 adolescentes entre 9 y 14 años (110 obesos y 36 con normopeso). Se analizaron los antecedentes familiares (antropometría y nivel socioeconómico de los padres) y personales, el nivel de autoestima y antropometría de los niños (peso, talla, perímetros y pliegues cutáneos), el nivel de actividad física realizada (test PAQ-A) y la condición física (Test de banco de Astrand). Se compararon los resultados de ambos grupos. Resultados: Los niños obesos son más sedentarios y dedican 62, 6 minutos/semana a actividades deportivas, mientras el grupo con normopeso dedica un 50% más de tiempo a dichas actividades (94,5 minutos/semana). Los adolescentes obesos tienen una peor condición física y menor adaptación cardiovascular al esfuerzo así como una peor opinión sobre si mismos a nivel físico pero también como personas. El IMC y peso de los progenitores es signifi cativamente superior en el grupo de obesos y su nivel socioeconómico y educativo es menor en los padres de dicho grupo. Conclusiones: La menor actividad física de los adolescentes obesos hace prioritaria su promoción en este grupo. Dicha promoción debería estructurarse en programas que tengan en cuenta los aspectos diferenciales de estos adolescentes, que tienen una peor condición física, una menor autoestima y pertenecen a familias con niveles socioeconómicos y formativos más bajos, y unos patrones familiares de obesidad característicos

Introduction: The obesity in paediatric ages represents a serious public health problem, being one of the main causes of avoidable premature morbidity. In preventing of overweight, things like practice of physical activity, the physical fi tness, the motivation, the esteem and the family history, play an important role. This paper pretends to analyze if there are diff erences between kids with normal weight and obese children in those listed things. Material and method: 146 teenagers were studied, between 9 and 14 years old. 110 were obese and 36 were normal weight. The family history was analyzed (anthropometry and parents socioeconomic status), the esteem status and the kids anthropometry (weight, height, perimeters and skinfold) the kids, the physical activity made (PAQ-A test), the physical fi tness (Astrand step test). The results from all the groups were compared. Results: The obese children are more sedentary and they spend 62.6 minutes/week for sport activities, while normal weight ones spend fi fty per cent more to do these activities (94.5 minutes/week). The obese children have a worse physical fitness and also a worse cardiovascular adaptation to physical stress, aboveall, they have a worse opinion about themselves, as well as physical conditions like a persons. The progenitor IMC and weight is over in the overweight kids and the socioeconomic and educational status is lower in obese group. Conclusion: The lower practice of physical activities in the obese group, makes prioritary to promote these group. These promotions should be structured as intervention programs which take care of the diff erences of the obese kids. who present worse esteem, worse physical condition, have a lower socioeconomic and educational level families and have a obesity familiy patterns