Wednesday 17 May 2023
NIH-backed study could lead to fewer restrictions for those with hypertrophic cardiomyopathy.
Vigorous exercise doesn’t appear to increase the risk of death or life-threatening arrhythmia for people with hypertrophic cardiomyopathy (HCM), according to a study supported by the National Institutes of Health. HCM is a rare inherited disease that causes the heart muscle to thicken and enlarge and affects 1 in 500 people worldwide. It has been associated with sudden cardiac death in young athletes and other young people. However, the study, published in JAMA Cardiology, found that people with the disease who exercise vigorously are no more likely to die or experience serious cardiac events than those who exercise moderately or not at all.
The observational study, the largest and most extensive to explore the relationship between HCM and exercise, was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the NIH, and challenges exercise restrictions which are often recommended for anyone with the disease.
Based on this data, we’re learning that we don’t need to universally restrict HCM patients from participating in strenuous exercise, something that’s so important to all of us, said Rachel Lampert, MD, a professor of medicine at the Yale School. of Medicine in New Haven, Connecticut, one of the study’s lead authors and a practicing cardiologist with arrhythmia expertise in HCM.
People with the condition should talk to a healthcare professional experienced in HCM about getting back on the court, back in the pool, and back on the court if that’s what they want to do, Lampert added. Obtaining an expert assessment is key to determining the degree of risk for all patients with HCM, and is crucial before returning to play.
HCM can make it harder for the heart to pump blood because the thickened ventricles (the heart’s lower chambers) become too stiff. This can cause some people to experience shortness of breath, chest pain, fatigue and, more seriously, a life-threatening irregular heartbeat known as an arrhythmia. In rare cases, HCM can cause sudden death. The condition is typically managed with medications or the use of surgically implanted devices such as an implantable cardioverter-defibrillator (ICD), which can detect an arrhythmia.
Recommendations to limit all exercise for most people with the disease have been based primarily on an abundance of caution in the absence of specific data. To date, there has been a lack of large, detailed, multi-year studies on the health risks of exercise in people diagnosed with HCM.
For the study, the researchers recruited 1,660 people who had HCM or the gene for HCM but had not yet had the disease (8 percent of the total). They ranged in age from 8 to 60 and were recruited from 42 high-volume HCM medical centers in the US and other countries, including the UK, Canada, Australia and New Zealand. About 60% of the participants were male. The study excluded people who couldn’t exercise for established medical reasons, such as those awaiting a heart transplant or with severe asthma.
Participants were divided according to self-reported exercise levels based on a physical activity questionnaire used in research studies. About 15% of participants reported being sedentary, 43% said they did moderate exercise, such as brisk walking, and 42% said they did vigorous exercise, such as running or fast swimming. The researchers then followed the groups for about three years and looked at the occurrence of four major cardiovascular events during that time: sudden deaths, resuscitated sudden cardiac arrests, arrhythmic syncope (which can include fainting or fainting), and appropriate ICD shocks.
To simplify these measurement results, the researchers used a statistical formula that measured a composite of these four events. The researchers found that 77 participants, or 1.5% per year, who reported exercising vigorously died or had serious cardiac events, the same proportion as those who exercised moderately or described themselves as sedentary. . The result was similar for competitive athletes (39% of the vigorous group) and for a subset of 42 youth who participated in interscholastic competitive sports such as baseball, track, soccer, and basketball.
This finding is significant and provides a measure of reassurance that exercise may be safe for people with HCM, said Patrice Desvigne-Nickens, MD, a heart failure and arrhythmias branch medical officer in the Division of Cardiovascular Sciences. of the NHLBI. However, we emphasize that people with this condition should not exercise until they have first received an assessment by an experienced HCM provider about their overall risk of sudden cardiac death. It is important to know that all patients with HCM could potentially be at risk of sudden death.
This study was supported by NHLBI grant 1R01HL125918. The study’s preliminary findings were previously described at an American College of Cardiology meeting in March.
About the National Heart, Lung and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research on heart, lung and blood diseases and sleep disorders that advances scientific knowledge, improves public health and saves lives. For more information, visit www.nhlbi.nih.gov.
About the National Institutes of Health (NIH):NIH, the nation’s medical research agency, comprises 27 institutes and centers and is a component of the United States Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research and is studying the causes, treatments, and cures for common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIH…Turning discovery into health
Vigorous exercise in patients with hypertrophic cardiomyopathy: results of the prospective, observational, multinational, lifestyle and exercise in HCM (LIVE-HCM) study. JAMA Cardiology. doi:10.1001/jamacardio.2023.1042
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