Kasiak P; Department of Internal Medicine and Cardiology, Warsaw, Poland.

Vascular Health & Risk Management. 22:575333, 2026.

Although physical activity has beneficial effects for health, athletes
also suffer from cardiovascular diseases (CVD). The type and prevalence of
CVD in athletes depend on their age, but typically include hypertrophic
cardiomyopathy, arrhythmias, and valve diseases. In pediatric athletes <18
years old, congenital heart diseases (CHD) are prevalent, while in master
athletes >35 years old, coronary artery disease (CAD) is the most common.
Cardiopulmonary exercise testing (CPET) is a gold standard to evaluate
cardiorespiratory fitness (CRF). Although CRF is most often identified as
peak oxygen uptake ([Formula: see text]O2peak), CPET provides a
multidimensional assessment through several other cardiorespiratory
variables. CVD aggravates CRF and reduces [Formula: see text]O2peak. While
there is no universal pattern of alteration in the remaining CPET
parameters, the specific deviations depend on the type of CVD. Therefore,
precise monitoring of changes in CPET scores is crucial for risk
stratification, adjusting exercise intensity, enabling safe sports
participation, and authorizing return to sport after treatment. Among
athletes, CPET plays a pivotal role across all fields. Therefore, this
review aimed to evaluate the value of CPET in 1) identification of risk
factors of CVD among athletes, considered as changes in CRF, 2) monitoring
of treatment, and 3) making shared decisions on returning to sport. A
special focus was placed on the needs of emerging age groups – pediatric
and master athletes. Additionally, evidence gaps and directions for future
research were discussed.