Sport practice in hypertrophic cardiomyopathy: running to stand still?

During the last decades, the practice of sport and hypertrophic cardiomyopathy (HCM) were considered as incompatible, since evidence was not sufficient to gauge the risk associated to repeat and/or vigorous exercise across the spectrum of HCM. Additionally, it was acknowledged thatrisk stratification tools developed for HCM were not derived from athlete cohorts. Recent epidemiological studies focused on HCM both in the general population and in athletes, however, have de-emphasized the contribution of this condition to the risk of sport-associated sudden death, supporting the possibility of allowing the practice of some sports, even at professional level, for certain low-risk HCM categories. We hereby analyze the complex interaction of vigorous and continuative exercise with HCM, revising the available evidence for sports eligibility in HCM, the challenges and limitations of shared decision-making, as well as the potential harms and benefits of a highly personalised exercise schedule in subjects diagnosed with this complex disease.