High-Intensity Training on Patients with Hypertrophic Cardiomyopathy: A Systematic Review

Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disorder associated with significant morbidity. The role of high-intensity exercise in HCM remains controversial due to concerns about potential adverse effects. This study aims to conduct a systematic review of experimental and observational studies to evaluate the effects of high-intensity training (HIT) on patients diagnosed with HCM. This systematic review was conducted according to the Preferred Reporting Items in the Systematic Review and Meta-analysis Guidelines 2020. A comprehensive search was performed using Proquest, Pubmed, Scopus, and JSTOR databases to identify relevant studies published up to March 2024. Both experimental and observational studies written in English were included in the study. No restrictions were placed on the year, country of publication, or duration of follow-up. Study quality was evaluated using the Effective Public Health Practice Project (EPHPP) tool. A narrative synthesis was also conducted to summarize the findings. A total of 1418 references were identified through the search strategy. After removing 151 duplicates, 1267 records were screened based on title and abstract, resulting in the exclusion of 1253 studies. The full text of 14 articles was assessed for eligibility, of which ten were excluded. Four papers with a total of 2008 sample sizes were included. Significant differences were observed in several echocardiographic parameters. HCM athletes exhibited higher left ventricular end-diastolic volume (96 ± 33 vs. 76 ± 27 mL; p = 0.001, effect size = 0.682) and stroke volume (58 ± 21 vs. 47 ± 17 mL; p = 0.004, effect size = 0.593) compared to non-athletes. Additionally, significant differences were found in left ventricular outflow tract (LVOT) gradients: both resting (p < 0.001, effect size = - 0.192) and provoked (p < 0.001, effect size = - 0.258) LVOT gradients were significantly lower in the vigorous exercise group compared to the non-vigorous exercise group. In contrast, no significant differences were found between HIT and the comparator group in vital signs and functional aerobic capacity. Moreover, no significant differences were observed in arrhythmias, cardiac arrest, or mortality, suggesting that HIT did not increase the risk of arrhythmias or other adverse events compared to the comparator group. HIT improves cardiac function and exercise capacity in patients with HCM without increasing the risk of severe adverse events. These findings support reconsidering the guidelines on physical activity restrictions for individuals with HCM.