Is exercise safe for people with an inherited heart condition?

Exercise and Hypertrophic Cardiomyopathy: New Guidelines Bring Clarity

For years, individuals with hypertrophic cardiomyopathy (HCM), a genetic condition causing thickening of the heart muscle, have received conflicting advice about exercise. Recent guideline revisions aim to clarify the situation, highlighting that exercise is not only important but also potentially safe for those with HCM, including some who might safely engage in competitive sports.

Updated Guidelines: Exercise is Beneficial

Published in the American Heart Association journal Circulation, the new guidelines emphasize that mild to moderate recreational exercise is beneficial for people with HCM. Dr. Steve Ommen, medical director of the Mayo Hypertrophic Cardiomyopathy Clinic, underscores that vigorous exercise may also be reasonable with careful annual evaluation.

The guidelines also address elite athletes, stating that HCM should not automatically disqualify them from competitive sports. However, they must undergo thorough evaluations and continuous monitoring.

Understanding Hypertrophic Cardiomyopathy

HCM, a condition where the heart muscle thickens and hinders efficient blood pumping, affects approximately 1 in 500 people. Symptoms include breathlessness and chest pain. Although the annual risk of cardiac arrest for HCM patients is slightly less than 1%, this risk does not seem to be influenced by physical activity levels.

Treatment for HCM includes medications, surgical procedures, and lifestyle modifications. Dr. Ommen emphasizes the importance of exercise, recommending at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous aerobic exercise weekly.

Dispelling Myths About Exercise and HCM

Dr. Matthew W. Martinez, director of the hypertrophic cardiomyopathy and sports cardiology program at Atlantic Health System, notes that past advice has often led to confusion, with patients mistakenly believing they should avoid exercise entirely. This misconception stems from older data suggesting severe restrictions for those with HCM.

However, recent research shows that less than 10% of sudden cardiac deaths in young people are related to HCM, and athletes with HCM do not have a disproportionate risk of death. In fact, the more people with HCM exercise, the better their outcomes tend to be.

Emphasizing Individual Assessment

The 2020 guidelines were the first to explicitly recommend exercise for people with HCM, advocating for shared decision-making between doctors and patients. The updated guidelines now provide more detailed advice on intense exercise, stating that universal restrictions are not necessary for most HCM patients.

A 2023 study in JAMA Cardiology involving 1,660 people with HCM found that vigorous exercise does not increase the risk of death compared to moderate exercise or inactivity. Another study in the Journal of the American College of Cardiology evaluated 76 elite athletes with genetic heart diseases, showing they could safely return to sports after thorough assessments.

Tailored Advice for Safe Exercise

The new guidelines acknowledge the variability of HCM, suggesting that exercise recommendations be personalized. Athletes with HCM should undergo regular evaluations and consult with specialists to determine safe exercise levels.

Dr. Ommen advises patients to ask their doctors specific questions about exercise recommendations, intensity levels, and types of exercises suitable for their condition. Evaluations should consider factors like age, family history, heart scans, and exercise stress tests.

Moving Forward

As research continues, guidelines may evolve, but the current stance is clear: everyone with HCM should have an exercise plan. "Not only is it safe to do it," Dr. Martinez emphasizes, "but you ought to be doing it."