High-Intensity Exercise Safe in Hypertrophic Cardiomyopathy

TOPLINE:

A 12-week supervised high-intensity exercise programme was feasible for patients with hypertrophic cardiomyopathy (HCM), leading to potential improvements in cardiorespiratory fitness, cardiovascular risk factors, and psychological outcomes, without an increased risk for arrhythmias.

METHODOLOGY:

• This study examined the feasibility and impact of an individualised high-intensity exercise programme in patients with HCM recruited at three tertiary centres in London between 2018 and 2019.
• Patients (40 per group) were randomly assigned to undergo a 12-week supervised high-intensity exercise programme along with usual care (median age, 48 years; 90% men) or receive usual care alone (median age, 44 years; 77.5% men).
• The exercise group participated in two 1-hour supervised exercise sessions per week, along with 1 hour of home-based exercise. All participants were assessed at baseline and 12 weeks, and the exercise group was re-evaluated 6 months after the completion of the programme.
• Feasibility was evaluated on the basis of recruitment, adherence, and retention rates, staffing, logistics, and intervention acceptability.
• The primary safety outcome included a composite of cardiovascular death, cardiac arrest, implantable cardioverter defibrillator therapy, exercise-induced syncope, sustained or non-sustained ventricular tachycardia, and sustained atrial arrhythmias.

TAKEAWAY:

• In the exercise group, 85% of patients completed the programme with at least 75% attendance in the exercise sessions, and 64.7% achieved the maximum target heart rate reserve of 85%.
• The composite primary safety outcome did not differ significantly between the two groups.
• Compared with the usual care group, the exercise group had a greater increase in peak oxygen consumption (mean difference [MD], +4.1 mL/kg/min), lower systolic blood pressure (MD, −7.3 mm Hg) and body mass index (MD, −0.8), and lower scores for anxiety (MD, −3) and depression (MD, −1.7; P < .01 for all).
• At 6 months, no arrhythmic events or increase in the prevalence of non-sustained ventricular tachycardia were observed. Physical activity levels and most of the observed improvements returned to baseline levels.

IN PRACTICE:

“Caution is obviously warranted in individuals with adverse clinical features such as outflow obstruction, exercise limitation, or ventricular arrhythmias, in whom more systematic data are needed to standardise practice and acquire confidence in exercise prescription. However, there is little doubt that the ‘HCM equal no sports’ taboo is crumbling — a major achievement for individuals with HCM and their families,” authors wrote in an accompanying editorial.

SOURCE:

The study was led by Joyee Basu, BMBCh, MA, PhD, University of London, London, United Kingdom. It was published online on March 3, 2025, in European Heart Journal.

LIMITATIONS:

This study may have experienced sampling bias as 290 individuals from the initial cohort were excluded and 125 individuals declined participation. The predominance of male and White participants restricted the extrapolation of findings to other patients. The findings may not be applicable to patients with advanced pathologies, as most participants did not exhibit a severe phenotype of HCM or significant left ventricular outflow tract obstruction.

DISCLOSURES:

Three authors received research grants from Cardiac Risk in the Young. Several other authors reported having leadership roles, advisory roles, or financial ties with various organisations and companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.