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Vigorous Exercise in Patients With Hypertrophic Cardiomyopathy
Rachel Lampert1, Michael J Ackerman2,3,4, Bradley S Marino5,6
1Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
JAMA Cardiology
|May 17, 2023
Summary
Vigorous exercise does not increase the risk of arrhythmias or death in individuals with hypertrophic cardiomyopathy (HCM). This study found similar event rates between vigorous exercisers and those with sedentary or moderate activity levels.
Area of Science:
- Cardiology
- Exercise Physiology
- Genetics
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart condition.
- The safety of vigorous exercise in HCM patients is not well-established.
- Previous assumptions often advised against strenuous physical activity for individuals with HCM.
Purpose of the Study:
- To determine if vigorous exercise increases the risk of ventricular arrhythmias or mortality in individuals with HCM.
- To test the hypothesis that vigorous activity is not associated with a higher event rate compared to nonvigorous activity.
Main Methods:
- Prospective, multicenter observational cohort study.
- 1660 participants (aged 8-60) with HCM or genotype-positive/phenotype-negative status.
- Categorization by self-reported physical activity: sedentary, moderate, or vigorous intensity.
Main Results:
- Vigorous exercise (n=699) was not associated with a higher rate of the composite endpoint (death, cardiac arrest, syncope, ICD shock) compared to nonvigorous exercise (n=961).
- Adjusted hazard ratio for vigorous exercise was 1.01 (95% 1-sided CI: 1.48), below the noninferiority boundary of 1.5.
- Event rates per 1000 person-years were similar: 15.3 for nonvigorous and 15.9 for vigorous exercisers.
Conclusions:
- Vigorous exercise appears safe regarding arrhythmias and mortality in HCM patients treated at experienced centers.
- These findings challenge previous recommendations and support shared decision-making regarding exercise.
- Further discussion between patients and clinicians about exercise participation is warranted.
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