Vigorous Exercise in Patients With Hypertrophic Cardiomyopathy
Authors: Lampert Rachel , Ackerman Michael J. , Marino Bradley S. , Burg Matthew , Ainsworth Barbara , Salberg Lisa , Tome Esteban Maria Teresa , Ho Carolyn Y. , Abraham Roselle , Balaji Seshadri , Barth Cheryl , Berul Charles I. , Bos Martijn , Cannom David , Choudhury Lubna , Concannon Maryann , Cooper Robert , Czosek Richard J. , Dubin Anne M. , Dziura James , Eidem Benjamin , Emery Michael S. , Estes N. A. Mark , Etheridge Susan P. , Geske Jeffrey B. , Gray Belinda , Hall Kevin , Harmon Kimberly G. , James Cynthia A. , Lal Ashwin K. , Law Ian H. , Li Fangyong , Link Mark S. , McKenna William J. , Molossi Silvana , Olshansky Brian , Ommen Steven R. , Saarel Elizabeth V. , Saberi Sara , Simone Laura , Tomaselli Gordon , Ware James S. , Zipes Douglas P. , Day Sharlene M. ,   LIVE Consortium, Abrahms Dominic , Ashley Euan , Aziz Peter , Batra Anjan , Cerrone Marina , Colan Steven , Erickson Christopher , Ferhaan Ahmad , Gollob Michael J. , Johnsrude Christopher , Kannankeril Prince , Kanter Ronald , Li Walter , Masri Ahmad , Murphy Ann , Nandi Deipanjan , Perez Marco , Perry James , Popjes Eric , Rao Roopa , Rosenthal David , Sanatani Shubhayan , Semsarian Chris , Shah Maully , Skinner Jonathan , Tardif Jill , Towbin Jeffrey , Turer Aslan , Webster Gregory , Wever-Pinzon Omar , Wong Timothy 
Published: May 2023

Importance

Whether vigorous intensity exercise is associated with an increase in risk of ventricular arrhythmias in individuals with hypertrophic cardiomyopathy (HCM) is unknown.

Objective

To determine whether engagement in vigorous exercise is associated with increased risk for ventricular arrhythmias and/or mortality in individuals with HCM. The a priori hypothesis was that participants engaging in vigorous activity were not more likely to have an arrhythmic event or die than those who reported nonvigorous activity.

Design, Setting, and Participants

This was an investigator-initiated, prospective cohort study. Participants were enrolled from May 18, 2015, to April 25, 2019, with completion in February 28, 2022. Participants were categorized according to self-reported levels of physical activity: sedentary, moderate, or vigorous-intensity exercise. This was a multicenter, observational registry with recruitment at 42 high-volume HCM centers in the US and internationally; patients could also self-enroll through the central site. Individuals aged 8 to 60 years diagnosed with HCM or genotype positive without left ventricular hypertrophy (phenotype negative) without conditions precluding exercise were enrolled.

Exposures

Amount and intensity of physical activity.

Main Outcomes and Measures

The primary prespecified composite end point included death, resuscitated sudden cardiac arrest, arrhythmic syncope, and appropriate shock from an implantable cardioverter defibrillator. All outcome events were adjudicated by an events committee blinded to the patient’s exercise category.

Results

Among the 1660 total participants (mean [SD] age, 39 [15] years; 996 male [60%]), 252 (15%) were classified as sedentary, and 709 (43%) participated in moderate exercise. Among the 699 individuals (42%) who participated in vigorous-intensity exercise, 259 (37%) participated competitively. A total of 77 individuals (4.6%) reached the composite end point. These individuals included 44 (4.6%) of those classified as nonvigorous and 33 (4.7%) of those classified as vigorous, with corresponding rates of 15.3 and 15.9 per 1000 person-years, respectively. In multivariate Cox regression analysis of the primary composite end point, individuals engaging in vigorous exercise did not experience a higher rate of events compared with the nonvigorous group with an adjusted hazard ratio of 1.01. The upper 95% 1-sided confidence level was 1.48, which was below the prespecified boundary of 1.5 for noninferiority.

Conclusions and Relevance

Results of this cohort study suggest that among individuals with HCM or those who are genotype positive/phenotype negative and are treated in experienced centers, those exercising vigorously did not experience a higher rate of death or life-threatening arrhythmias than those exercising moderately or those who were sedentary. These data may inform discussion between the patient and their expert clinician around exercise participation.