Exercise is generally considered healthy and beneficial, even for individuals living with cardiovascular disease. However, there is a growing demand for personalized heart health advice that considers individual differences. A Theme Issue on sports and exercise of the Canadian Journal of Cardiology, published by Elsevier, investigates the risks and benefits of physical activity taking socioeconomic, gender, genetic, and demographic factors into account.

Guest Editor of the issue Paul Dorian, MD, MSc, FRCPC, Department of Medicine, University of Toronto, Division of Cardiology, St. Michael’s Hospital, and Sports Cardiology Toronto, Heart & Stroke/Richard Lewar Centre of Excellence in Cardiovascular Research, identifies the following trends and challenges related to cardiovascular health and exercise:

1. An increased demand for access to and expansion of the number of sports cardiologists to make sure that patients who need personalized advice get it .
2. A growing need for research to predict the risks of cardiac events related to sports.
3. A better understanding of the long-term effects of endurance sports on the cardiovascular system.

Dr. Dorian says, “Navigating the complexities of sports cardiology, an emerging specialty, can be challenging. Most people initially consult their family doctor, while sports medicine primarily focuses on musculoskeletal injuries. Sports doctors often lack specialized training in sports cardiology. With limited numbers of qualified specialists available (e.g., fewer than 10 sports cardiologists in Canada), access to this expertise is limited.”

This Theme Issue contains 13 invited papers on the following topics:

• Impact of remote work on exercise and cardiovascular health
• Risks and benefits of exercise, particularly for individuals with heart disease
• Methods for assessing physical activity in clinical settings
• Importance of specialized training for sports cardiologists
• Exercise training in pediatric congenital heart disease
• Cardiovascular benefits and risks of exercise across different populations (race, ethnicity, sex)
• Prevention of exercise-related sudden cardiac arrest
• Sex differences in cardiovascular adaptations to exercise
• Exercise and fitness quantification in clinical practice
• Impact of exercise dose and type on cardiovascular function
• Quantification of training load in endurance athletes
• Acquisition of cardiovascular adaptations to exercise
• Role of genetics in fitness and cardiac remodeling.

The issue highlights disparities in sports participation and related health outcomes between males and females as well as socioeconomic disparities. Women appear to have a lower risk of sudden cardiac death during sports compared to men. Individuals from disadvantaged backgrounds face barriers to sports participation due to financial constraints, time limitations, and limited access to resources. These disparities are often rooted in social-cultural factors rather than purely medical ones. Recognizing and addressing these disparities is crucial for ensuring equitable access to sports and exercise for all individuals.

Dr. Dorian concludes, “In general, exercise at any intensity is very safe and beneficial for heart health for 99.9% of the population. However, for individuals with certain risk factors, such as older people and/or those who smoke, are unhealthy, have diabetes or known heart issues, it is recommended to ask the advice of a specialist when planning to engage in regular or higher-level sports activities, particularly high-intensity ones such as training for a marathon or climbing a mountain.”