You can play sports safely with a heart condition

The people on the pickleball court look like they’re having so much fun, and you may want to join them. Or perhaps you’d like to play softball, handball, or another sport. If you’ve had a heart attack or have another heart condition, you may hesitate. Is it safe?

“Exercise is one of the most powerful tools for cardiovascular health, and for most people it’s safe to participate in sports,” says Dr. James Sawalla Guseh, director of the Cardiovascular Performance Program at Harvard-affiliated Massachusetts General Hospital. The key is to pick the right sport at the right intensity.

Heart conditions

Coronary artery disease, caused by the narrowing of blood vessels that serve the heart, is the most common type of heart disease. Inadequate blood flow during exercise can cause chest pain (angina). A sudden blockage of blood flow in a coronary artery usually leads to a heart attack. Doctors can open blocked arteries by placing stents (tiny mesh tubes that hold blood vessels open) or use bypass surgery to create a new channel around a blockage.

Other types of heart disease include atrial fibrillation, which is an irregular heart rhythm that’s usually treated with medication. Heart valve problems are another type — a valve may be too narrow or not close properly. In some cases, surgery can fix it.

Most people with these heart conditions can safely participate in sports once they’ve gotten the right care. “First we treat the heart disease, and then we gradually reintroduce exercise,” says Dr. Guseh.

Take the first steps

After treatment for a heart attack, doctors often recommend cardiac rehabilitation, which involves supervised exercise training. The professionals you work with will tailor a plan for you. “We work with patients to get them back to physical activity because we know that it will lower the risk of another heart attack,” says Dr. Guseh.

If you’ve had a heart attack or developed another heart condition and you want to start playing sports, see your cardiologist for a medical evaluation. Ask your doctor, “What does my specific heart condition mean for the type and intensity of sport I can play?”

For heart attack survivors, Dr. Guseh considers the severity of the attack, whether blood flow to the heart was fully or partially restored, and how well the heart is working (with medications as needed).

Choose an activity intensity

“Although there’s always risk with high-intensity sports, some people with well-managed heart disease have no restrictions,” says Dr. Guseh. People with reduced heart function should choose a lower-intensity sport — for example, doubles tennis instead of singles tennis.

The intensity of an activity can be measured by how much endurance and strength it requires, ranging from golf and bowling among the lower-intensity options to basketball and cross-country skiing at the high end (see “Endurance demands of various sports”).

Generally, lower-intensity sports are safer than higher-intensity sports. “But if someone wants to do something more challenging, we work with them to achieve it,” says Dr. Guseh.

Monitor your health

Whatever your chosen sport, start slow and ramp up gradually rather than jumping right into high-intensity play. Be aware of warning signs of heart trouble such as

• chest pain with exertion
• lightheadedness, dizziness, or fainting
• shortness of breath that doesn’t match the level of effort
• a racing heart or heart palpitations.

If you experience any of these, stop the activity and get evaluated.

If you have coronary artery disease or valve disease, your risk from playing sports mostly reflects the way the condition can impair your heart’s function. With atrial fibrillation, it’s not so much the disease itself but rather the medications you take for it that pose some risk. People with atrial fibrillation must take blood thinners to prevent strokes. If you get injured when you’re on a blood thinner, it takes longer for bleeding to stop.

“That’s one thing I’m sometimes concerned about with cyclists — crashes and bleeding,” says Dr. Guseh.

Should anyone avoid sports?

There may be heart conditions or individual circumstances that mean a person should not play a sport or engage in a particular activity. “However, with modern cardiology, most heart conditions can be managed, and most sports can be pursued,” says Dr. Guseh. “We can usually find a way for people to get exercise.”

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