Exercise recommendations in athletes have been described for the last two decades but these have been confined to elite athletes who are young and competitive and engage in highest echelons of sport. In contrast, the general population engages in recreational or solo exercise and these individuals have a higher prevalence of risk factors for coronary artery disease and cardiovascular abnormalities. It is known that exercise curbs risk factors for atherosclerosis but in addition to that it also reduces inflammation, modulates autonomic tone and improves tissue perfusion and by doing all of this it is associated with a reduction in cardiovascular morbidity and all-cause mortality. Due to the increasing prevalence of a sedentary lifestyle and emerging trend to obesity, hypertension and diabetes, physicians are being encouraged to promote exercise in all individuals including those with serious cardiovascular abnormalities. It is well recognised that the paradox of exercise is such that it may trigger an arrhythmogenic sudden cardiac death or myocardial infarction in a very small proportion of people with underlying cardiovascular concerns. Clearly as we try to promote exercise in everyone, there will be increasing questions and concerns amongst patients and clinicians as to what the correct and safe level of exercise is in any given individuals.

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