[Sports cardiology 2021 - what's new?]

The recently published guidelines "Sports cardiology and exercise in patients with cardiovascular disease" (2020) are the first of a kind by the European Society of Cardiology (ESC). The guidelines provide comprehensive training recommendations for patients with cardiovascular diseases or risk factors, covering the entire spectrum of cardiovascular diseases with case-specific recommendations for recreational and competitive sports.The ESC recognizes exercise as an essential part of both prevention and therapy of cardiovascular diseases, that - comparable to drug therapies - requires correct prescription.The initial cardiac examination is used for individual risk stratification and is indispensable for individualized training recommendations addressing training frequency, duration and intensity, as well as type of sport.Thus, the question is not whether a patient with cardiovascular disease shall be allowed to exercise, but rather how he can safely perform it. Only in exceptional cases exercise therapy is (temporarily) contraindicated.COVID-19 can lead to cardiovascular complications even in asymptomatic and mild disease courses. Before resuming intense sporting activities, different return-to-sports protocols have been introduced. The current consensus is that the extent of these examinations should be based on symptoms, severity and duration of COVID-19 and that individual return-to-training recommendations should be given.