Exercise can be tricky for people who have hypertrophic cardiomyopathy (HCM) , a condition characterized by abnormal thickening of the heart muscle.e60dc2a1-f33c-4a05-9b50-8e3e8e597629033d0432-49df-4f7b-83dd-99ba94f9c810e60dc2a1-f33c-4a05-9b50-8e3e8e597629524a9091-bb0c-415a-a66f-2c0b81fb3076 Most people with HCM can participate in mild- to moderate-intensity exercise safely. When it comes to vigorous exercise and competitive sports, there may be a need for additional guidance from your cardiologist, but people with HCM aren’t automatically restricted from these activities.e60dc2a1-f33c-4a05-9b50-8e3e8e597629033d0432-49df-4f7b-83dd-99ba94f9c810 As research on exercise and 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 fitness routine.e60dc2a1-f33c-4a05-9b50-8e3e8e59762995c712bd-27c2-4495-ab69-6adbc81c47f2
How to Stay Safe During Exercise Safety Exercise may pose possible risks for people who have HCM. “Exercise, especially intense effort, may in theory trigger arrhythmias (abnormal heartbeats),” says Aldo L. Schenone, MD , a cardiologist and HCM specialist at the Montefiore Einstein Center for Heart and Vascular Care in New York.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bad5b559-9713-489e-a724-9202f4df2894 These arrhythmias can be driven by factors present in some cases of HCM, like inducible left ventricular outflow tract (LVOT) obstruction or heightened reactivity of the sympathetic nervous system, which controls the fight-or-flight response, he says.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b5e59e05-a567-4fbc-b2f5-bc95ca1b1f62 In LVOT obstruction cases, blood has trouble exiting the heart’s left lower chamber to supply blood to the body.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295bbc15e2-dd9c-4b3e-9294-638395c86432 For people with obstructive HCM, Dr. Schenone says vigorous exercise may trigger obstruction or make it worse. People with HCM may also have problems with the function of their smaller blood vessels or the response of their blood vessels that supply the heart, says Schenone.e60dc2a1-f33c-4a05-9b50-8e3e8e597629401037a7-c491-49da-9d72-14b5d5e13416 Despite possible risks, there are strategies that can help people with HCM stay safe during exercise: Get evaluated. “Before initiating or intensifying exercise, people with HCM should undergo a thorough evaluation by an HCM specialist,” says Schenone. Consider your environment. People with HCM should exercise in a space that’s able to provide prompt resuscitative effort in case of a sudden cardiac death (SCD) event. Schenone says people with HCM should also avoid strenuous exercises where they’re alone and exercising in settings that could be deadly if they lose consciousness. “Ideally, exercise with a partner or in settings with monitoring or rapid access to medical care,” he says. Be careful in the heat. People with HCM can experience symptoms like shortness of breath, dizziness, and even fainting in hot temperatures. Schenone recommends performing exercise or exertional activities during cooler times like the morning or evening rather than the midday heat, as well as shifting to indoor environments that are climate controlled. Stay hydrated. Getting enough fluids is essential.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291acddd82-6b98-4167-99e3-b9cddf39a8bd “Dehydration or low intravascular volume may exacerbate symptoms, particularly in those with LVOT obstruction,” says Schenone. “Drink fluids throughout the day, not just around exercise, and anticipate increased needs in heat or during exertion. Rehydrate after activity with fluids and electrolytes.”
HCM Symptoms During Exercise Symptoms According to Richard Bach, MD , a WashU Medicine cardiologist at Barnes-Jewish Hospital in St. Louis, some possible symptoms people with HCM may experience during exercise include: Dizziness Lightheadedness Feeling like you’re going to pass out When these symptoms appear, he advises stopping the activity that’s bringing them on or reducing your overall intensity level. Listen to your body, he says. Dr. Bach says if you feel lightheaded, it’s likely 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. “Relatively prompt evaluation can determine a cause that might need intervention,” he says. However, these symptoms are less common than shortness of breath and a tight feeling or discomfort in the chest, says Bach. Schenone offers similar recommendations. “Respect your symptoms. If chest tightness, lightheadedness, syncope (passing out), near-syncope, palpitations, or unusual fatigue occur, cease activity,” he says. It’s also possible that some symptoms may be related to a person’s degree of physical fitness rather than HCM. For instance, Bach says 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’re attempting, which is why it’s important to build workout intensity gradually. Communicate with your healthcare team, too. “If someone feels limited by the symptoms they’re experiencing as they’re starting an exercise program, it would be wise to confer with their cardiologist in order to see whether their medical therapy could be adjusted,” says Bach.
Exercise Guidelines for HCM Guidelines Guidelines for HCM management and exercise 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 like light chores and slow walking while moderate exercise includes activities like social dancing and doubles tennis.e60dc2a1-f33c-4a05-9b50-8e3e8e59762981f47ebf-f8fa-4ac5-a13a-d64059e3d086e60dc2a1-f33c-4a05-9b50-8e3e8e59762931b3770f-4091-465f-b5c8-5a77f6cc75bc Vigorous exercise may 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 should be repeated annually. Vigorous exercise includes activities like running and jumping rope.e60dc2a1-f33c-4a05-9b50-8e3e8e59762931b3770f-4091-465f-b5c8-5a77f6cc75bc People with HCM shouldn’t be universally barred from vigorous exercise or competitive sports. For people who are physically able, competitive sports are possible after receiving an evaluation from a healthcare provider with experience helping athletes with HCM. You should seek reapproval every year, after a doctor has helped you carefully balance the possible risks and benefits.
The Benefits of Exercise for HCM Benefits The benefits of exercise for people with HCM aren’t so different from the benefits of exercise for the general population, says Bach. However, some of the symptoms that people with HCM can experience, such as fatigue, shortness of breath, and discomfort in the chest, may be related to physical deconditioning, changes that occur when people are inactive.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296a5d8a47-40f2-4227-8e93-338f88255bfd Exercise can help with these symptoms, says Bach, and since they’re more likely to occur in people with HCM, exercise may be even more impactful for them. Additionally, exercise is good for heart health in general, improving circulation and strengthening the heart muscle, which is critical for people with HCM because the condition weakens the heart.e60dc2a1-f33c-4a05-9b50-8e3e8e597629303f2d22-cba4-4e79-8829-0a86eb577a00e60dc2a1-f33c-4a05-9b50-8e3e8e5976299caa4bc8-ca6e-4ee7-8272-a6fd850fe9aee60dc2a1-f33c-4a05-9b50-8e3e8e59762984598f5b-f92a-4294-b5d5-b4e5cef22637 Exercise can also support healthy weight management, lower blood pressure, and help manage blood sugar, all of which are risk factors for coronary heart disease .e60dc2a1-f33c-4a05-9b50-8e3e8e5976293b7d2f3f-4227-42e4-99fc-ae1c41da0454 High blood pressure , obesity , and diabetes are also common among people with HCM, so it may be beneficial to use strategies like exercise that can help address these problems rather than focusing exclusively on how exercise benefits HCM.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293afe4206-e50a-4420-8052-0d7f874f7ba9
HCM, Sports, and Sudden Death Sudden Death HCM is notoriously associated with cases of sudden cardiac death (SCD), especially in young athletes. These deaths most often occur in young adults who were not previously diagnosed with HCM.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292d69485f-aece-4995-94ba-3285e13464dd It is unclear, however, whether sports participation really increases the risk of sudden cardiac death among people who have already been diagnosed with HCM. Bach says earlier data on SCD among young sport athletes “raised concern that vigorous, intense exercise from competitive sports could be a trigger, causing cardiac arrest.” However, based on more recent data, “it may not necessarily be as risky as was 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 a higher risk for SCD.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ff348450-5a7d-43a0-b5d3-e5d8e5ae4d41 It’s also worth noting that SCD among athletes under age 35 is fairly rare, occurring in 1 to 6 athletes out of every 100,000.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292d69485f-aece-4995-94ba-3285e13464dd Bach says that there’s enough uncertainty to say that there still may be an increased risk for SCD from playing sports among people with HCM, which is why people with HCM should be assessed for their risk for SCD regularly.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ff348450-5a7d-43a0-b5d3-e5d8e5ae4d41 Installation of an implantable cardioverter-defibrillator (ICD) is a possible prevention strategy in people who are at high risk for 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 needed.e60dc2a1-f33c-4a05-9b50-8e3e8e59762979444665-14f4-4763-ad1c-d6e3565d25be
The Takeaway Most individuals with HCM can safely engage in mild- to moderate-intensity exercise, and while vigorous exercise or competitive sports may require more guidance, people with HCM are not automatically restricted from these activities. To exercise safely, people with HCM should first receive an evaluation from a specialist. You can reduce the 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 ready to stop. The risk of sudden death due to exercise may be smaller than previously understood, but caution is still important 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 Hypertrophic Cardiomyopathy Clinical Guideline Recommends Novel Drug Therapy and Regular Exercise NYU Langone Health: Lifestyle Changes for Hypertrophic Cardiomyopathy Harvard Health Publishing: Advances in Managing Hypertrophic Cardiomyopathy
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