Contact Sports: A Heart-Healthy Guide for People with Cardiac Conditions

Quick take

Most people in cardiac rehab should prioritise non-contact exercise. Full contact and collision sports (e.g., rugby, boxing, MMA, ice hockey) carry higher risks: blows to the chest or head, sudden bursts of effort, and unpredictable impacts. If you’re on blood thinners, have aortic disease, a recent myocarditis, an ICD/pacemaker, or certain cardiomyopathies, full contact is usually not advised. For many, safer alternatives like touch/tag versions, pad-work (no sparring), and skills drills give you the enjoyment and fitness without the collision risk. Aim for Borg RPE 9–13 for most drills; progress cautiously.

“Courage is grace under pressure.” — Ernest Hemingway

What counts as “contact” or “collision” sport?

Contact sports involve deliberate or frequent physical contact with other players or the playing environment. Collision sports add high-force impacts by design.

• Collision: rugby union/league, boxing, kickboxing/MMA, ice hockey, wrestling.

• Contact: basketball, lacrosse, Gaelic football, water polo, some martial arts, some forms of football.

• Safer alternatives: touch/tag rugby, non-sparring pad-work, technical martial arts drills, small-sided conditioned games that reduce speed and impact.

Who should avoid full contact (or get specialist clearance first)?

• Anyone on anticoagulants (warfarin or DOACs). Higher bleeding risk makes contact/collision sports generally unsuitable.

• Aortic disease (e.g., Marfan/Loeys-Dietz, significant aortic root dilation). Impacts and surges in blood pressure raise risk.

• Recent myocarditis/pericarditis or recent significant cardiac event/procedure without formal return-to-play clearance.

• Arrhythmogenic cardiomyopathy (ARVC/ACM). High-intensity sport is contraindicated.

• Uncontrolled arrhythmias, decompensated heart failure, uncontrolled severe hypertension, or concerning symptoms.

• ICD/pacemaker: risk of device/lead damage with chest impacts; most should avoid contact/collision sports.

Protective padding helps for some recreational contexts, but individual medical advice is essential.

These recommendations come from contemporary guidance and consensus statements; decisions should be personalised in consultation with your cardiac rehab team.

If contact is still a goal: shared-decision pathway

• Comprehensive review with your cardiologist/exercise professional (diagnosis, meds, imaging, exercise test).

• Discuss sport-specific risks (chest blows, head injury, sudden sprints, heat).

• Agree clear red-flags and a graded plan (see “Progression” below).

• Consider protective kit (sternal/chest guards), rule modifications, and role choice (e.g., positions with less collision exposure).

Shared decision-making is essential where evidence is limited and individual preferences matter.

Warm-up and cool-down (longer than usual)

• Warm-up 12–15 minutes: easy mobility and pulse-raisers, then progressive drills (RPE 8→11).

• Include rehearsal of sport-specific cuts, pivots, and decelerations at sub-max effort.

• Cool-down 8–10 minutes: gentle movement, breathing drills, and large-muscle stretches to normalise HR/BP.

Borg RPE and pacing guide (6–20 scale)

• Technique drills, pad-work (no sparring), and conditioned games: RPE 9–13 (light–moderate).

• Short match-play or higher-tempo drills (for cleared participants only): RPE 12–14, brief exposures, full recovery.

• Avoid “maxing out” (RPE ≥17) and avoid Valsalva/straining.

RPE targets help you control intensity when HR is affected by medication (e.g., beta-blockers).

Modifications to make contact sports safer (where appropriate)

• Choose non-contact formats first: touch/tag, walking-basketball, pad-work without sparring.

• If sparring is allowed by your clinician, use heavier head/torso protection, larger gloves, and strict control (no body-shots to device site; no head contact).

• Avoid scrums/rucks/mauls in rugby; play non-contested versions or positional roles with lower collision risk.

• If you have an ICD/pacemaker, avoid chest blows; use purpose-made protective padding; never let kit straps rub over the pocket; discuss any contact exposure with your device team.

Equipment & environment

• Properly fitted mouthguard, head/torso protection, ankle/knee support if advised.

• Hydrate well and avoid extreme heat/cold.

• Play on good surfaces; avoid crowded, chaotic training where collisions are more likely.

Absolute stop signs (during or after play)

• Chest pain or discomfort; unusual breathlessness; dizziness, fainting, or near-syncope; palpitations that won’t settle; new neurological symptoms after a head knock; bleeding that’s hard to control (especially if on blood thinners). Stop immediately and seek medical advice.

Progression (for those medically cleared)

Week 1–2 — Skills only, no contact• 20–40 minutes of mobility, footwork, ball-handling or pad-work. RPE 9–11.

Week 3–4 — Controlled drills• Add short, pre-planned change-of-direction drills and partner shadowing. RPE 10–12.

Week 5–6 — Conditioned games or light sparring tech (no head/body shots)• Small-sided games with strict rules to reduce collision speed; or pad-drills with movement cues. RPE 11–13.

Week 7+ — Brief contact exposures (only if agreed in advance)• Short controlled scenarios, long rests, stop if any symptom. RPE 12–14.

Return more slowly, or stop the plan entirely, if symptoms appear or recovery is poor.

Special situations

• On anticoagulants (warfarin/DOACs): avoid contact/collision; choose non-contact versions. If you do fall/hit your head, seek urgent assessment.

• Aortic disease/Marfan or a dilated aorta: avoid contact/collision; favour sub-max aerobic exercise and controlled strength work.

• ICD or pacemaker: most should avoid contact/collision due to device/lead damage risk; if doing any sport with potential impacts, get specialist advice, wait at least ~6 weeks after implant before return, and use padding.

• Myocarditis/pericarditis or recent COVID-related myocarditis: no sport during acute illness; graded return only after medical clearance—typically after 3–6 months depending on findings.

• Cardiomyopathies (HCM/ARVC/DCM): exercise is beneficial, but contact/collision and high-intensity competitive play may be restricted; follow specialist guidance and shared decision-making.

A simple session (non-contact format)

• Warm-up (12–15 min): walk-jog/step patterns, dynamic mobility, light technical skills (RPE 8–10).

• Skills block (10–15 min): footwork, ball-handling, pad-work, grappling drills without throws (RPE 10–12).

• Conditioning (10–15 min): small-sided, rule-modified games or shadow rounds (RPE 11–13).

• Cool-down (8–10 min): slow movement and breathing; large-muscle stretches.

Health challenge

• Short-term (2 weeks): Book two non-contact skills sessions per week (30–45 min), keeping average RPE at 10–12.

• Long-term (8–12 weeks): Progress to three sessions/week with one longer skills session (45–60 min), and—if cleared—add one carefully controlled, low-collision conditioned game.

Track RPE, symptoms, and recovery in a simple diary.

“Success is the sum of small efforts, repeated day in and day out.” — Robert Collier

FAQs

Can I do contact sport if I’m on aspirin only?

Possibly, but bruising risk is still higher. Discuss with your clinician and club; many still prefer non-contact formats.

Can I wear a chest guard over an ICD?

Yes, purpose-made padding can reduce impact risk, but it does not make full contact “safe.” Always get device-team clearance first.

Is heading a football OK on blood thinners?

Avoid intentional head impacts when anticoagulated. Prioritise non-contact play.

How hard should I train?

Use Borg 6–20. Most drills RPE 9–13; avoid maximal efforts unless specifically cleared.

Key references (for readers who want the detail)

1. 2020 ESC Guidelines on Sports Cardiology and Exercise in Patients with CVD. Eur Heart J. 2021;42:17–96. Oxford Academic

   
   

2. BHF guidance on anticoagulants and sport (warfarin/DOACs). British Heart Foundation+1

   
   

3. ACC/AHA expert materials on myocarditis/COVID return-to-play and ICD considerations. JACCAmerican College of Cardiology+1

   
   

4. ESC/EAPC recommendations for CHD and sports; anticoagulation and contact-sport caution. Heart University

   
   

5. Marfan/related aortopathy resources on avoiding collision/contact sports. marfan.orgLeeds Teaching Hospitals NHS Trust

   
   

This blog post was written by Jamie Pickett, Clinical Exercise Physiologist, with AI assistance.