Background: Patients with hypertrophic cardiomyopathy (HCM) are generally restricted regarding participation in competitive sports based on the potential risk of sudden cardiac death and malignant arrhythmias. As a result, they are often inactive and experience the negative consequences of a sedentary lifestyle. Hence, the need arises to strike the right balance between these 2 extremes through personalized exercise prescription. The aims of this study were (1) to assess the characteristics of patients with HCM practicing regular aerobic physical activity compared with sedentary patients; (2) to perform a personalized moderate‐intensity exercise prescription and evaluate its effects. Methods and Results: Patients with HCM were evaluated through clinical assessment, ECG, ambulatory ECG monitoring, echocardiography, and cardiopulmonary testing. A personalized moderate‐intensity exercise prescription was performed, and the same investigations were repeated. Physically active patients with HCM demonstrated better cardiopulmonary functional capacity than sedentary patients (oxygen consumption _peak /kg 32.9±7.4 versus 25.2±7.4 mL/min per kg P ≤0.0001, ventilation/carbon dioxide production slope 26.7±4.3 versus 29.9±5.2 P =0.004), with similar prevalence of ventricular arrhythmias ( P =0.43). Sedentary subjects showed a borderline higher prevalence of obesity ( P =0.07) than physically active subjects. Moderate‐intensity exercise prescription led to improved cardiopulmonary fitness without occurrence of adverse events. Conclusions: Patients with HCM practicing regular aerobic exercise have a better functional capacity in the absence of relevant events than sedentary patients. Conversely, a sedentary lifestyle led to a deterioration of cardiopulmonary functional capacity and fitness. The tailored moderate‐intensity personalized exercise prescription appears to be a feasible approach in carefully selected patients with HCM to counterbalance the negative effects of sedentary behavior without significant major events.

Aims: Normative data for cardiopulmonary exercise testing (CPET) provide benchmarks of aerobic fitness that change throughout the lifespan, with new scaling techniques often developed and differing between adults and children/adolescents. Considering the recent interest in the pediatric population for CPET studies, this systematic review aimed to update pediatric-specific CPET reference values. Methods and results: A systematic review was performed according to the PRISMA guidelines from 1 February 2019, to 31 December 2025, from six scientific databases. Observational studies in any language, presenting data from maximal CPET, and conducted only on healthy participants <18 years old were included. Primary outcomes included reference values for peak oxygen uptake (V̇O2peak), and secondary outcomes included other variables assessed during CPET. Risk of bias was assessed with the 14-point ATS/ACCP statement for CPET and the eight-point JBI Critical Appraisal Tool. 15 studies conducted on 12 083 participants [5886 (49.4%) females] were included, of which recruitment was hospital-based in six studies, community-based in eight studies, and athlete-specific in one study. Six studies reported ethnicity, with most participants classified as white, while one investigation presented exclusive data for obese/overweight or pediatric athletic cohorts. Normative V̇O2peak ranged between 26.0–56.3 mL·kg−1·min−1, peak heart rate between 175–199 bpm, and peak ventilation between 52.2–96.0 L·min−1. Reference equations were developed in 11 studies, with 5 of these studies validating the derived equations. A high heterogeneity was observed between studies of high (n = 2), moderate (n = 10), and low quality (n = 3), with ATS/ACCP statement and JBI Critical Appraisal Tool often disregarded—although quality level did not influence study outcomes. Conclusion: Updated normative values for CPET varied significantly in pediatric cohorts. While female representation matched male, and more studies considering pediatric athletes, showing a positive trend change from previous investigations, obese and overweight children/adolescents, as well as non-white participants, remained underrepresented. Considering the differences in normative data between pediatric cohorts of differing characteristics, clinicians should use reference values derived from cohorts closely matching their patients’ characteristics. PROSPERO registration number: CRD420251137402

Antiplatelet and anticoagulation therapy are commonly used in the general population and sometimes in athletes experiencing cardiovascular disorders. In these cases, the treatment has to be tailored according to the individual bleeding and thrombotic risk profile, also considering the intrinsic risk of sports activities when advising athletes for eligibility for competitive sports. In athletes, it is necessary to pre-assess the individual bleeding risk, considering not only the personal bleeding risk (usually low in athletes) but also the type of sport the athlete would like to practice, with careful consideration in sports where traumatic collisions are highly likely. Additionally, non-steroidal anti-inflammatory drugs are commonly used among athletes, and antiplatelet therapy may further increase the bleeding risk. Therefore, in selected competitive athletes, the default approach for antithrombotic therapy could be personalized. This review discusses the clinical management challenges of competitive athletes under antithrombotic or antiplatelet therapy, focusing on the intrinsic risks of sports practice and the indications for sports eligibility and disqualification.

Cancer therapies have significantly improved survival but are frequently limited by cancer therapy-related cardiovascular toxicity (CTR-CVT). Cardiovascular imaging plays a central role in baseline risk stratification, surveillance during therapy and long-term follow-up. Transthoracic echocardiography (TTE) remains the first-line imaging modality; however, conventional parameters such as left ventricular ejection fraction (LVEF) often fail to detect early myocardial injury. Myocardial deformation imaging, particularly global longitudinal strain (GLS), has emerged as a sensitive marker of subclinical dysfunction across multiple cardiotoxic phenotypes. Cardiac magnetic resonance (CMR) further enhances diagnostic accuracy through tissue characterization techniques, enabling the detection of myocardial edema, inflammation, and fibrosis before overt functional decline. Different anticancer therapies induce distinct pathophysiological mechanisms of injury, each associated with characteristic imaging patterns. Emerging imaging biomarkers and multimodality approaches may improve early detection, the spatial characterization of myocardial injury and individualized surveillance strategies. Pediatric patients represent a uniquely vulnerable population due to their myocardial immaturity, altered pharmacokinetics and prolonged post-treatment life expectancy, resulting in a higher cumulative lifetime cardiovascular risk. In conclusion, a mechanism-based multimodality imaging approach integrating echocardiography, CMR and emerging data-driven technologies is essential to optimize early detection, risk stratification and long-term cardiovascular outcomes in both adult and pediatric cardio-oncology populations.