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Exercise prescription in individuals with hypertrophic cardiomyopathy: what clinicians need to know
  1. Sabiha Gati1,2,
  2. Sanjay Sharma3,4
  1. 1Cardiovascular Medicine, Imperial College London, London, UK
  2. 2Department of Cardiology, Royal Brompton Hospital, London, UK
  3. 3Cardiovascular Clinical Academic Group, St George's University of London, London, UK
  4. 4St George's University Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Sabiha Gati, Dept. of Cardiology, Royal Brompton Hospital, London, London, UK; s.gati{at}rbht.nhs.uk

Abstract

Hypertrophic cardiomyopathy (HCM) is the most frequently cited cause of exercise-related sudden cardiac death (SCD) in young individuals and has claimed the lives of some high-profile athletes. The circumstantial link between exercise and SCD from HCM has resulted in conservative exercise recommendations which focus on activities that should be avoided rather than the minimal amount of physical activity required to reap the multiple rewards of exercise. Consequently, most patients with HCM are confined to a sedentary lifestyle through fear of SCD, with accruing risk factors such as obesity and low cardiorespiratory fitness that confer a worse prognosis. Recent exercise programmes in asymptomatic and symptomatic individuals with HCM have shown that mild and moderate exercise is safe and accompanied by increased functional capacity and improved quality of life. Population studies also reveal that individuals with HCM in the higher quartiles of self-reported physical activity have lower total cardiovascular mortality compared with those in the lower quartiles. The impact of vigorous exercise on the natural history of HCM is unknown, although current experience suggests that affected adults with mild morphology and absence of high-risk factors may partake in such activity without adverse events. This review highlights the evidence base that has resulted in a paradigm shift in the approach to exercise in HCM and liberalised recent international exercise guidelines in HCM. Practical tips for prescribing exercise in symptomatic patients and relevant precautions are provided to aid clinicians when recommending exercise as part of the management plan for all patients with HCM.

  • diagnostic imaging
  • cardiomyopathy, hypertrophic
  • cardiac rehabilitation

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Footnotes

  • Twitter @s_gati

  • SG and SS contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.