What are the contraindications for participating in rowing crew according to American Medical Society for Sports Medicine (AMSSM) and National Collegiate Athletic Association (NCAA) guidelines?

Contraindications for Rowing Crew Participation

Rowing is classified as a Class IIIC sport (high static, high dynamic) with dramatic blood pressure elevations, and athletes with certain cardiovascular conditions—particularly aortic diseases, Marfan syndrome, and related connective tissue disorders—are absolutely contraindicated from participation due to the extreme hemodynamic demands and risk of catastrophic aortic events.

Understanding Rowing's Cardiovascular Demands

Rowing imposes among the most extreme cardiovascular loads of any competitive sport 1:

• High static and high dynamic components (Class IIIC) create both significant volume and pressure loads on the heart 1
• Blood pressure rises are dramatic during rowing, more so than virtually any other sport due to the combination of both high static and dynamic effort 1
• The sport requires sustained intense physical exertion with repetitive high-force movements

Absolute Contraindications (Must Not Participate)

Aortic and Connective Tissue Disorders

Athletes with the following conditions should NOT participate in rowing under any circumstances 1:

• Marfan syndrome (regardless of aortic size or other features)
• Loeys-Dietz syndrome
• Vascular Ehlers-Danlos syndrome
• Familial thoracic aortic aneurysm (TAA) syndrome
• Unexplained aortic aneurysm
• Any related aortic aneurysm disorder

These athletes are prohibited from "any competitive sports that involve intense physical exertion or the potential for bodily collision" 1. Rowing clearly meets this criterion as a Class IIIC sport with intense physical exertion.

Bicuspid Aortic Valve (BAV) with Aortic Dilatation

Athletes with BAV and significant aortic enlargement face strict restrictions 1:

• Markedly dilated aorta (>45 mm): Cannot participate in ANY competitive sports 1
• Severely dilated aorta (z-score >3.5-4 or >43 mm in men, >40 mm in women): Cannot participate in any sports with potential for bodily collision 1

Chronic Aortic Dissection

Athletes with chronic aortic dissection or branch vessel arterial aneurysm/dissection should not participate in any competitive sports 1.

Relative Contraindications (Restricted Participation)

Mild-Moderate Aortic Dilatation

Athletes with mildly dilated aortas may only participate in low-intensity sports (Class IA), NOT rowing 1:

• Aortic root dilatation with z-score >2 or diameter >40 mm (or >2 SD from mean for age <15 years) 1
• These athletes are restricted to Class IA sports only (low static, low dynamic)—rowing is Class IIIC and therefore prohibited

Post-Surgical Aortic Repair

Athletes with surgical correction of aortic root/ascending aorta can only participate in Class IA sports without bodily collision 1. Rowing exceeds this classification and is contraindicated.

Additional Cardiovascular Considerations

Infiltrative Cardiomyopathies

Athletes with clinical expression and high-risk features of infiltrative cardiomyopathies (Fabry, sarcoidosis, amyloidosis, hemochromatosis) should not participate 1:

• Heart failure symptoms
• Ventricular arrhythmias
• Decreased LV systolic function (ejection fraction <40%)

Congenital Heart Disease

Athletes with certain repaired congenital heart disease face restrictions 1:

• Severe systemic RV dysfunction
• Severe RV outflow tract obstruction
• Recurrent or uncontrolled atrial/ventricular arrhythmias
• These athletes should be restricted from all competitive sports except possibly Class IA 1

Hypertension

Athletes with systemic hypertension require careful evaluation 1:

• Uncontrolled hypertension is a relative contraindication
• Athletes should avoid substances that increase blood pressure (stimulants, energy drinks, tobacco, alcohol, illicit drugs) 1

Clinical Pitfalls and Key Points

Common mistakes to avoid:

• Do not assume mild aortic dilatation is safe for rowing—even z-scores of 2-2.5 restrict athletes to lower-intensity sports than rowing 1
• Do not clear athletes with Marfan syndrome for "low-impact" rowing—the hemodynamic stress, not impact, is the primary concern 1
• Do not overlook family history—family history of aortic dissection at diameters <50 mm is a specific contraindication even with normal personal aortic dimensions 1

Essential pre-participation screening should identify:

• Personal or family history of connective tissue disorders
• Known aortic abnormalities or bicuspid aortic valve
• Symptoms suggesting cardiovascular disease
• Prior cardiac surgery

The extreme hemodynamic demands of rowing (Class IIIC) make it one of the most restricted sports for athletes with cardiovascular abnormalities 1. When in doubt, comprehensive cardiovascular evaluation including echocardiography is warranted before clearance.