Exercise can be difficult for people with hypertrophic cardiomyopathy (HCM), a condition characterized by abnormal thickening of the heart. muscle.e60dc2a1-f33c-4a05-9b50-8e3e8e597629033d0432-49df-4f7b-83dd-99ba94f9 most people with HCM can safely perform mild to moderate intensity exercise. When it comes to vigorous exercise and competitive sports, additional guidance from your cardiologist may be necessary, but people with HCM are not automatically restricted from these activities. HCM continues to evolve, work with your healthcare team to determine what exercise is appropriate for you if you have HCM and how you may benefit from modifying your exercise routine. Safety Exercise can pose possible risks for people who have HCM. “Exercise, especially intense exertion, can, in theory, trigger arrhythmias (abnormal heartbeats),” says Dr. Aldo L. Schenone, a cardiologist and HCM specialist at the Montefiore Einstein Center for Heart and Vascular Care in New York. York.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bad5b559-9713-489e-a724-9202f4df2894 These arrhythmias may be driven by factors present in some cases of HCM, such as inducible left ventricular outflow tract obstruction (LVOT) or increased reactivity. of the sympathetic nervous system, which controls the fight-or-flight response, he says. body.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295bbc15e2-dd9c-4b3e-9294-638395c86432 For people with obstructive HCM, Dr. Schenone says vigorous exercise can trigger the blockage or worsen it. People with HCM may also have problems with the function of their smaller blood vessels or the response of the blood vessels that supply the heart, says Schenone. possible risks, there are strategies that can help people with HCM stay safe during exercise: Get evaluated. “Before starting or intensifying exercise, people with HCM should undergo a thorough evaluation by an HCM specialist,” says Schenone. Consider your surroundings. People with HCM should exercise in a space that can provide rapid resuscitative effort in the event of a sudden cardiac death (SCD) event. Schenone says people with HCM should also avoid strenuous exercise where they are alone and in environments that could be fatal if they lose consciousness. “The ideal is to exercise as a couple or in environments with surveillance or quick access to medical care,” he says. Be careful with the heat. People with HCM may experience symptoms such as difficulty breathing, dizziness, and even fainting with high temperatures. Schenone recommends engaging in exercise or strenuous activities during cooler hours, such as the morning or evening, rather than in the midday heat, as well as switching to climate-controlled indoor environments. Stay hydrated. Getting enough fluids is essential.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291acddd82-6b98-4167-99e3-b9cddf39a8bd “Dehydration or low intravascular volume can exacerbate symptoms, particularly in those with LVOT obstruction,” it says Schenone. “Drink fluids throughout the day, not just when you exercise, and anticipate increased needs in the heat or during exertion. Rehydrate after activity with fluids and electrolytes.” HCM Symptoms During Exercise Symptoms According to Richard Bach, MD, a cardiologist at WashU Medicine at Barnes-Jewish Hospital in St. Louis, some possible symptoms that people with HCM may experience during exercise include: Dizziness Lightheadedness Feeling like you’re going to faint When these symptoms appear, he advises stopping the activity causing them or reducing your overall intensity level. Listen to your body, he says. Dr. Bach says that if you feel dizzy, it’s probably a good idea to sit or lie down to make sure you don’t pass out, and loss of consciousness is a reason to seek emergency medical treatment. “A relatively quick evaluation can determine a cause that may need intervention,” he says. However, these symptoms are less common than difficulty breathing and a feeling of tightness or discomfort in the chest, Bach says. Schenone offers similar recommendations. “Respect your symptoms. If chest tightness, lightheadedness, syncope (fainting), near syncope, palpitations, or unusual fatigue occur, discontinue activity,” it says. It is also possible that some symptoms are related to a person’s fitness level and not to HCM. For example, Bach says that shortness of breath and chest discomfort can also be related to someone not having the stamina or aerobic capacity to exercise as vigorously as they intend, so it’s important to increase training intensity gradually. Also contact your healthcare team. “If someone feels limited by the symptoms they experience when starting an exercise program, it would be prudent to consult with their cardiologist to see if their medical treatment can be adjusted,” Bach says. Exercise Guidelines for HCM Guidelines for the management and exercise of HCM include the following:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ad5a7b6b-db4b-4974-b32f-0eac48a397da People with HCM should try to engage in mild to moderate exercise (not for competitive purposes). Mild exercise includes activities such as light chores and slow walking, while moderate exercise includes activities such as social dancing and stunts. tennis.e60dc2a1-f33c-4a05-9b50-8e3e8e59762981f47ebf-f8fa-4ac5-a13a-d64059e3 d086e60dc2a1-f33c-4a05-9b50-8e3e8e59762931b3770f-4091-465f-b5c8-5a77f6cc75bc Vigorous exercise can also be safe, as long as you first receive an evaluation from a medical professional to help balance the possible risks and benefits. This process must be repeated annually. Vigorous exercise includes activities such as running and jumping rope.e60dc2a1-f33c-4a05-9b50-8e3e8e59762931b3770f-4091-465f-b5c8-5a77f6cc75bc People with HCM should not be universally prohibited from vigorous exercise or competitive sports. For physically able people, competitive sports are possible after receiving an evaluation from a health care provider with experience helping athletes with HCM. You should apply for new approval every year, after a doctor has helped you carefully weigh the possible risks and benefits. The benefits of exercise for HCM Benefits The benefits of exercise for people with HCM are not that different from the benefits of exercise for the general population, Bach says. However, some of the symptoms that people with HCM may experience, such as fatigue, shortness of breath, and chest discomfort, may be related to poor physical condition, changes that occur when people are inactive.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296a5d8a47-40f2-4227-8e93-338f88255bfd Exercise can help with these symptoms, Bach says, and since they are more likely to occur in people with HCM, exercise may be even more impactful for them. Additionally, exercise is good for overall heart health as it improves circulation and strengthens the heart muscle, which is critical for people with HCM because the condition weakens the heart. heart.e60dc2a1-f33c-4a05-9b50-8e3e8e597629303f2d22-cba4-4e79-8829-0a86eb577a00e60dc2a1-f33c-4a05-9b50-8e3e8e597 6299caa4bc8-ca6e-4ee7-8272-a6fd850fe9aee60dc2a1-f33c-4a05-9b50-8e3e8e59762984598f5b-f92a-4294-b5d5-b4e5cef22637 Exercise can also contribute to healthy control of weight, lower blood pressure, and help control blood sugar, all of which are risk factors for coronary heart disease. with HCM, so it may be beneficial to use strategies such as exercise that can help address these issues rather than focusing exclusively on how exercise benefits HCM. notoriously associated with cases of sudden cardiac death (SCD), especially in young athletes. These deaths occur more frequently in young adults who were not previously diagnosed with HCM. people who have already been diagnosed. with HCM. Bach says previous data on SCD among young athletes “raised concern that vigorous, intense exercise from competitive sports could be a trigger leading to cardiac arrest.” However, based on more recent data, “it may not necessarily be as risky as previously believed to participate in high-level, intense, competitive sports,” he says. More recent studies suggest that people with HCM who participate in competitive sports are not at increased risk for SCD. in 1 to 6 athletes per 100,000.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292d69485f-aece-4995-94ba-3285e13464dd Bach says there is enough uncertainty to say there may still be an increased risk of SCD from playing sports among people with HCM, which is why people with HCM you should periodically evaluate your risk for SCD. SCD.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ff348450-5a7d-43a0-b5d3-e5d8e5ae4d41 Installed inside the body, this device helps monitor the heart, delivering an appropriate electrical shock if need.e60dc2a1-f33c-4a05-9b50-8e3e8e59762979444665-14f4-4763-ad1c-d6e3565d25be Conclusion Most people with HCM can safely perform mild to moderate intensity exercise, and while vigorous exercise or competitive sports may require more guidance, People with HCM not automatically restricted from these activities. To exercise safely, people with HCM must first receive an evaluation from a specialist. You can reduce your risk of problems by exercising in a safe environment, staying hydrated, and avoiding higher temperatures. Pay close attention to symptoms such as lightheadedness and be prepared to stop. The risk of sudden death from exercise may be lower than previously thought, but it is still important to use caution when exercising with HCM. Resources We Trust Cleveland Clinic: Is vigorous exercise in patients with hypertrophic cardiomyopathy less risky than previously thought? American Heart Association: Is exercise safe for people with an inherited heart condition? Mayo Clinic: New Clinical Guideline for Hypertrophic Cardiomyopathy Recommends New Drug Therapy and Regular Exercise NYU Langone Health: Lifestyle Changes for Hypertrophic Cardiomyopathy Harvard Health Publishing: Advances in the Management of Hypertrophic Cardiomyopathy
Exercising with hypertrophic cardiomyopathy (HCM): what you need to know
