Myocarditis is an inflammation in the heart and is one of the heart conditions associated with sudden death in young athletes. When it occurs, myocarditis often has no early symptoms.
Can you exercise with myocarditis?
A young athlete may feel healthy enough to compete, unaware of the problem. Once diagnosed, however, they must limit exercise significantly to reduce complications, including the risk of sudden death.
These limitations can be frustrating, especially in mild myocarditis, and produce few symptoms. Young athletes may be tempted to ignore their doctor’s restrictions on them.
When can you ease back to exercise? Which exercises can be recommended or not? How much training will be possible in the future? The answers are specific to each person, but some fundamental truths can give a better idea of what an active life with myocarditis can look like.
Diagnosis of myocarditis
Several tests diagnose myocarditis, including an electrocardiogram (ECG).
However, in too many cases of exertion-triggered sudden death, there was no apparent reason to perform cardiac tests (i.e., they did not experience unrelated symptoms), so the heart inflammation was left undetected.
A special note for young athletes
When a diagnosis of myocarditis is made in a young athlete, it is usually strongly recommended that they avoid all competitive sports for at least six months, only resuming the competition if heart tests show complete improvement.
Myocarditis often develops simultaneously when young people try to become independent and make their own decisions. Young athletes must understand the risk of deviating from the doctor’s recommendations, namely:
- Young athletes with even mild myocarditis are most prone to sudden death during athletic events.
- Too much exercise can put a child with myocarditis at risk of permanent heart damage and disability.
Early training after a diagnosis
Once myocarditis is diagnosed, exercise is usually limited until there is a complete understanding of the details of one’s condition.
In general, exercise (regardless of degree) is not recommended until the function of the left ventricle in the heart (the large heart chamber that pumps blood to the rest of the body) is normal and there are no abnormal heart rhythms. Although there are no arrhythmias and ventricular function is normal, exercise should not be restarted if there are signs of persistent heart inflammation or dangerous scar tissue.
Lighten up in training
As a person’s condition improves and moderate exercise is considered safe, it can resume physical activity. That said, you should only start training under the careful guidance of your cardiologist.
Once a person has been allowed to return to exercise, they are usually limited to moderate activities for several weeks or months. Moderate exercise can provide benefits in terms of inflammation without the risk of extreme exercise (including facilitating the heart-damaging effects of viral myocarditis).
For many people, cardiac rehabilitation may be prescribed to ensure that they exercise in a controlled setting.
Competitive training should be avoided for at least three to six months and then only returned to under the guidance of a cardiologist. In many cases, athletic competition will have to be postponed significantly longer than this.
Athletes should be thoroughly evaluated before returning to competitive activity with an ECG, stress ECG, Holter monitoring, and echocardiogram. Some cardiologists may recommend a cardiac MRI, although the benefit is not specific at this time.
Athletes with scarring of the heart may be at greater risk of abnormal rhythms and sudden death, and it is not safe to recommend returning to competition.
Long term outlook
The long-term outlook for myocarditis training recommendations will depend on the cause and any permanent heart damage caused by the inflammation.
Many viral causes of myocarditis are self-limiting but can cause permanent damage that can limit physical activity in the future.
Good and bad exercises
The best exercise for recovering from myocarditis will depend on several factors, including persistent heart damage or scarring.
An exercise program should be carefully planned with your cardiologist and starting rehabilitation to monitor activity as safely as possible early when the activity begins.