Exercise for adults with congenital heart disease poses many unique challenges. In this presentation from August 12, 2021, Sherrin Gallagher, ACNP, AACC, reviews the importance of exercise and current guidelines for adults with congenital heart disease.
Corrigan Minehan Heart Center
Cardiovascular Performance Program
Explore This Treatment Program
Overview: A Multidisciplinary Approach to Treating Heart Disease in Athletes
The Cardiovascular Performance Program (CPP) at the Massachusetts General Hospital Corrigan Minehan Heart Center offers comprehensive cardiovascular care and physiologic testing for active individuals, ranging from recreational exercisers to professional sports athletes. Our services can be tailored for both healthy individuals and for those with established or suspected heart and vascular disease.
Our goals are to provide comprehensive and timely clinical care, advanced research, education and community outreach. Developed in 2009, our program was the first of its kind and is now an internationally recognized specialized program for athletic patients with cardiovascular disease and/or associated risk factors.
We recognize that athletic patients require unique treatment plans due to the cardiovascular demands of exercise, training-related cardiac adaptations to exercise and special issues specific to sports athletes such as return-to-play decisions. Additionally, we know that many patients diagnosed with cardiovascular disease desire to regain or preserve their activity level and exercise performance. We work with patients to help them reach their goals in a safe and productive way.
Our clinicians are leading experts within sports cardiology and committed to preserving and maximizing our patients’ athletic performance. Clinicians in the CPP work with multiple clinical disciplines from across the Corrigan Minehan Heart Center to provide care. This includes close collaborations with specialists in cardiac imaging, electrophysiology, interventional cardiology and cardiac surgery. Additionally, we collaborate with physicians throughout Mass General, including orthopedists, sports medicine physicians, physical medicine and rehabilitation, neurology, pulmonology and other specialties to deliver multidisciplinary care personalized to each patient’s specific needs.
Comprehensive Heart Care for the Highly Active to the Athletic Professional
The CPP provides comprehensive cardiovascular care to a wide spectrum of athletic patients. We define an athlete as any active individual who enjoys physical activity and exercise or is required to be active on the job.
Athletic patients in our program range from recreational exercisers to professional athletes. We provide care to local and national athletic organizations including U.S. Soccer, US Rowing, the National Football League Players Association, New England Patriots, Boston Bruins, New England Revolution, Boston Athletic Association, and numerous local college and university athletic programs.
There are five fundamental practice areas where our cardiovascular specialists play an instrumental role in the care of athletes and highly active individuals. These core clinical areas are:
- Evaluation of athletes with symptoms suggestive of cardiovascular disease
- Management of athletes with established cardiovascular diagnoses
- Distinguishing “athlete’s heart”, a condition in which the heart changes in structure and function to adapt to exercise training, from cardiovascular disease
- Determining sports eligibility through pre-participation cardiovascular disease screening
- Helping all athletes who wish to improve their performance
State-of-the-Art Approach to Evaluation and Performance Improvement
A key resource in the clinical evaluation of active individuals is our state-of-the-art Cardiopulmonary Exercise Laboratory. This human performance lab was designed to support leading physiology research and to perform complex exercise testing assessments specific to athletes. The lab houses a wide deck treadmill, a fully customizable up-right cycle ergometer and a rowing ergometer to provide personalized testing for our athletes and patients.
The Cardiopulmonary Exercise Laboratory provides physicians across the region referral-based cardiopulmonary exercise testing (CPET) and serves as a resource for athletes without cardiovascular disease wishing to improve performance. As such, visitors to the CPP human performance laboratory span the spectrum of human health and performance ranging from patients awaiting heart transplants to Olympic competitors.
Determining Sports Eligibility
Many high school and collegiate sports require cardiac screening assessments and consultations prior to participation. These evaluations are designed to prevent athletes with known and unknown pre-existing heart conditions from experiencing cardiac events or sudden death before, during or after exercise.
Clinicians in the CPP perform pre-participation screening for individuals of all ages and athletic aspirations. To screen athletes, our cardiologists start with a detailed medical history and physical exam. A 12-lead electrocardiogram, which measures the heart’s electric activity, is also typically performed. When necessary, we draw on Mass General’s leading echocardiography, radiology and genetic laboratories. Using advanced diagnostic techniques such as cardiac MRI and CT scanning, clinicians evaluate for the specific clinical conditions most relevant to athletes:
- Arrhythmogenic right ventricular cardiomyopathy, a disease in which the structure of the heart is abnormal, resulting in irregular heart rhythms
- Coronary anomalies
- Heart valve diseases
- Hypertrophic cardiomyopathy, where the heart muscle thickens abnormally
- Inherited arrhythmias, which lead to irregular heartbeats
Screening results can stop athletes from playing sports their entire lives, so our clinicians consult with the entire multidisciplinary team before making recommendations about participation risk. Many findings are minor and managed with medical therapy in a manner that enables safe sport participation. We also welcome athletes who seek second opinions, and work with patients and their primary doctors to develop a coordinated diagnostic and treatment strategy if needed.
Our clinicians offer individual screenings at our facility or group screenings at onsite locations such as schools, universities and clubs. Athletic trainers and sports medicine groups who wish to improve their proficiency in this area can request our consultation services. To request a consultative service for your group, please call 617-643-7117.
One Call Coordinates Care
Our dedicated nurse coordinator is available Monday through Friday from 8:30 am to 5:00 pm to take relevant information about your condition and make a timely appointment with our team. Call 866-644-8910 to speak to a nurse coordinator or request an appointment online.
Referring a Patient
If you are a physician and would like to refer your patient to the CPP, please call 866-644-8910. Our CPP physicians take a collaborative approach patient care, communicating directly with referring providers to discuss treatment options and care recommendations. We see patients as soon as possible, matching them with a specialist best suited to their needs.
Advancing Sports Performance Through Research
The CPP is a leader in the field of sports cardiology research with more than 90 peer-reviewed publications focused on the clinical care and related physiology of the athletic patient. The CPP faculty hold research funding from the National Institutes of Health, the American Heart Association, the Department of Defense and the National Football League Players Association. Studies have focused on:
- Using novel echocardiographic techniques to study the cardiac remodeling that occurs in response to exercise training
- Evaluating ideal methods for pre-participation screening in athletes
- Identifying the most common causes of cardiac arrest during long-distance running races
- Examining the cardiac and metabolic adaptations that can occur in response to marathon training
Harvard Athlete Initiative (HAI)
The CPP faculty have developed a collaborative research relationship with the Harvard University Department of Athletics to provide a platform for the study of competitive athletes. Research work completed within the HAI focuses on several key topics including pre-participation screening and cardiac structural and functional remodeling among competitive athletes. Numerous studies have been conducted and published utilizing repeated measurement longitudinal study design, which permits the establishment of a cause and effect relationship between exercise training and cardiac remodeling.
Investing in the Future of Sports Cardiology
Education is among the most important missions of the CPP. In July of 2012, the CPP sponsored its first full-time sports cardiology fellow (a one-year clinical and research offering). Past and current CPP trainees have developed clinical competencies in sports cardiology and have completed original research work leading to presentation at national meetings and original manuscript publication. Learn more about the CPP Fellowship
Keeping our Community Healthy
The CPP is a health care resource and partner for athletic events in the Boston community and beyond. This is best exemplified by our partnership with the Boston Athletic Association, for which Aaron Baggish, MD, associate director of the CPP program, serves as a co-medical director. Each year prior to the running of the Boston Marathon, CPP staff and a committed group of health care volunteers provide complimentary training in hands-only cardiopulmonary resuscitation (CPR) for the community. Since this program’s inception in 2012, our team has taught more than 10,000 runners and spectators this life-saving skill.
Meet Our Team
- Director, Cardiovascular Performance Program
- Department of Medicine
- Director, Cardiovascular Performance Fellowship Program
- Instructor in Medicine, Harvard Medical School
- Director, Cardiac Performance Program
- Section Head, Heart Failure
- Director, Cardiopulmonary Exercise Testing Laboratory
- Medical Director, Cardiac Transplantation Program
- Department of Medicine
- Associate Chief, Cardiology Division
- Associate Professor of Medicine, Harvard Medical School
- Program Coordinator, Athletes with Arrhythmias Clinic
Our patients describe the personalized, multi-disciplinary care they've received as part of the Corrigan Minehan Heart Center Cardiovascular Program.
A Winning Heart: Allison's Story
Allison Renna, triathlete and mother of three, suffered a heart attack at the age of 36. In this video, Allison talks about the cardiac episode that brought her to Mass General, and her experience with the Cardiovascular Performance Program.
Head Strong, Heart First: Ted’s Story
Ted Kakas, international-level masters rower, has suffered from atrial fibrillation and coronary artery disease. In this video, Ted talks about his appreciation for the Mass General Cardiovascular Performance Program as both an athlete and a patient.
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