Is exercise restriction necessary in patients with pericarditis?

Felix Berglund; Allan L. Klein

doi:10.3949/ccjm.89a.21120

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Figure 1
Cardiac magnetic resonance imaging with gadolinium contrast showing delayed contrast enhancement of the pericardium on fat-suppression imaging sequences in a 47-year-old female with acute pericarditis. The arrows point to the circumferential contrast enhancement of the pericardium. Our experience suggests that complete remission may take as long as 3 to 5 years.
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Figure 2
Proposed algorithm for exercise restriction in pericarditis with or without myocardial involvement, based on European Society of Cardiology and American Heart Association/American College of Cardiology recommendations. The detection of biomarkers of myocardial injury indicates active myocardial inflammation, which necessitates exercise restriction for 3 to 6 months regardless of left ventricular function.

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TABLE 1

Exercise recommendations in patients with isolated pericarditis^{^a}

European Association of Preventive Cardiology⁸
Athletes with pericarditis should not participate in competitive sports during the acute phase. Athletes can return to sport activity only after complete resolution of the active disease. A period of 3 months is considered appropriate to ensure complete clinical and biologic resolution of the disease, but a shorter period (at least 1 month) may be considered in select cases with only mild clinical picture and prompt resolution (class III, level C).⁸
It is reasonable to return to play if the serum biomarkers have normalized, left ventricular function is normal, and there are no resting or exercise-induced frequent or complex ventricular arrhythmias detectable on 24-hr electrocardiography monitoring or exercise electrocardiography (class IIa, level C).⁸

European Society of Cardiology
Return to all forms of exercise including competitive sports is recommended after 30 days to 3 months for individuals who have recovered completely from acute pericarditis, depending on clinical severity (class I, level C).⁹
Participation in leisure-time or competitive sports is not recommended for individuals with a probable or definitive diagnosis of recent pericarditis while active inflammation is present, regardless of age, sex, or extent of left ventricular systolic dysfunction (class III, level C).⁹

American Heart Association/American College of Cardiology
Athletes with pericarditis, regardless of its pathogenesis, should not participate in competitive sports during the acute phase. Such athletes can return to full activity when there is complete absence of evidence for active disease, including effusion by echocardiography, and when serum markers of inflammation have normalized (class III, level C).¹⁰

↵a Explanation of recommendations. Class I recommendation: Evidence or general agreement that a given treatment or procedure is beneficial, useful, effective (ie, is recommended or is indicated). Class IIa recommendation: Weight of evidence or opinion is in favor of usefulness or efficacy (ie, should be considered). Class III recommendation: Evidence or general agreement that the given treatment or procedure is not useful or effective, and in some cases may be harmful (ie, is not recommended). Level of evidence C: Consensus of opinion of the experts or small studies, retrospective studies, registries.