Sports Cardiology: From Athletes to Advanced Technologies for Cardiovascular Prevention and Exercise Prescription

Dear Colleagues,

This Special Issue of Medicina aims to stimulate a debate on the latest advancements in sports cardiology. This field is experiencing continuous growth due to advancements in technical and scientific knowledge regarding the interplay between physical exercise and cardiovascular health issues.

Over the past decades, sports cardiology has emerged as a distinct discipline at the intersection of cardiovascular medicine and sport sciences. Initially driven by the imperative to prevent sudden cardiac death (SCD) in athletes, the field has evolved from focusing solely on pre-participation screening and risk stratification to a broader vision that includes optimizing cardiovascular health and prescribing exercise as a therapeutic intervention.

Historically, pre-participation evaluations have focused on detecting structural and electrical heart diseases using basic tools, such as the 12-lead ECG and echocardiography. However, advancements in cardiac imaging (e.g., cardiac MRI and stress echocardiography) and genetic testing have refined our ability to distinguish physiological adaptations (such as the athlete’s heart) from pathological conditions. At the same time, the emergence of shared decision-making frameworks has shifted the paradigm from rigid exclusion criteria to individualized risk-benefit assessments, especially in athletes with cardiovascular conditions.

In recent years, wearable devices and artificial intelligence (AI) algorithms have opened up new frontiers in continuous cardiovascular monitoring. These innovations hold promise for the early detection of arrhythmias, dynamic assessment of training loads, and personalized exercise prescriptions. Despite their potential, challenges remain regarding validation, data accuracy, and integration into clinical practice.

Future directions in sports cardiology include refining pre-participation screening with advanced cardiac imaging, genetic testing, and biomarkers to better distinguish physiological adaptations from early cardiomyopathies. Personalization of exercise prescription will be key, using precision medicine approaches to tailor programs based on individual cardiovascular risk profiles, genetic data, and physiological responses. The integration of wearable devices, artificial intelligence, and telemedicine promises to enable continuous monitoring, early arrhythmia detection, and safer return-to-play decisions. A special focus is needed on master athletes to address aging-related cardiovascular changes and balance the benefits and risks of lifelong exercise. Finally, implementing shared decision-making models and fostering multidisciplinary collaboration among cardiologists, sports physicians, and exercise scientists will ensure safer and more inclusive athletic participation.

We are pleased to invite colleagues and researchers to collaborate by submitting original articles, reviews, and commentaries on emerging topics in sports cardiology. Contributions from multidisciplinary perspectives are highly encouraged to enrich the scientific and clinical understanding of this rapidly advancing field.

Dr. Massimiliano Bianco
Guest Editor

Dr. Fabrizio Sollazzo
Guest Editor Assistant

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