Editorial: Physical Activity in the Heat: Closing the Guidance Gap for Adults with Cardiovascular Disease

Regular physical activity remains a central component of cardiovascular disease (CVD) prevention and management [1]. The cardiovascular, metabolic, and psychosocial benefits of physical activity are well established and reflected in both European and North American guidelines [1,2]. However, more frequent and intense heat exposure (e.g., heatwaves or prolonged high temperatures) linked to climate change poses a growing challenge to safe participation in physical activity, particularly among those with CVD [3]. While existing frameworks address safety for athletes, workers, and the general population during physical activity under heat stress, there is a critical absence of dedicated, evidence-based recommendations for adults living with CVD. Existing sports medicine frameworks provide detailed guidance for athletes exercising in hot weather; however, these frameworks primarily target exertional heat illness rather than cardiac complications, which may arise even at modest core temperature elevations (~0.5 °C) in those with CVD [4].