Physical activity in hypertrophic cardiomyopathy: from proscription to prescription

Recent preclinical and clinical data suggest that moderate physical activity may be safe and beneficial in patients with hypertrophic cardiomyopathy (HCM). Evidence regarding a safe dose of high-intensity exercise remains limited; however, the marked heterogeneity in the morphology and pathophysiology of HCM implies that some individuals are capable of performing even vigorous exercise, including competitive high-intensity sports. Current data indicate that participation in intense exercise and competitive athletics may be considered in a carefully selected subset of predominantly adult patients with a low-risk profile. Studies evaluating the impact of vigorous exercise or moderate-to-high intensity competitive sports on the natural history of HCM remain few and are underpowered to definitively resolve this issue. Nonetheless, emerging evidence now supports a more liberal approach whereby-after appropriate selection, expert clinical evaluation, and shared decision-making-individuals with a low-risk profile may engage in high-intensity physical activity and competitive sports, leading active and fulfilling lives while minimizing risk.