Current Exercise Recommendations:
The physical limitations caused by the extent of disease and the risk of sudden death, has led to guideline recommendations that suggest patients with HCM restrict their level of physical activity. The evidence to restrict intense physical activity is in part due to data that indicates that HCM is the cause of sudden cardiac death in young athletes in about 1/3 of cases. It is believed that sudden bursts of activity that activate the body’s fight or flight reaction with increased adrenaline release are potentially harmful. Thus physicians treating patients with HCM usually impose significant activity restrictions.
The American College of Cardiology and the American Heart Association guidelines (of which I was a co-author) published in 2011 specify activity recommendations as follows. (J Am Coll Cardiol. 2011;58(25):e212-e260. doi:10.1016/j.jacc.2011.06.011)
Section 6.3.3. Participation in Competitive or Recreational Sports and Physical Activity
—Recommendations (Gersh et al Journal of the American College of Cardiology 2011)
View the Complete Journal
- It is reasonable for patients with HCM to participate in low intensity competitive sports (e.g., golf and bowling).
- It is reasonable for patients with HCM to participate in a range of recreational sporting activities as outlined in Table 4.
- Patients with HCM should not participate in intense competitive sports, regardless of age, sex, race, presence or absence of LVOT obstruction, prior septal reduction therapy, or implantation of a cardioverter-defibrillator for high-risk status
“General recommendations for recreational exercise in patients with HCM should be tailored to the individual’s desires and abilities; however, certain guidelines prevail. For example, aerobic exercise as opposed to isometric exercise is preferable. Patients with HCM should avoid recreational sports in which participation is intense and simulates competitive organized athletics. Also, burst exertion, in which an abrupt increase in heart rate is triggered (e.g., sprinting in half-court basketball), is less desirable than swimming laps or cycling. Finally, it is prudent for such patients to avoid physical activity in extreme environmental conditions of heat, cold, or high humidity, with attention paid to maintaining volume status. Detailed recommendations for individual
sports appear in Table 4.”
Need for Fitness with HCM Patients
Given these restrictions there is a need for HCM patients to maintain good levels of fitness to promote general heath and well being. The HCM Clinic at the Peter Munk Cardiac Centre (PMCC) is the largest in Canada and one of the largest in the world. In the past we have told patients about their restrictions but many patients remain uncertain of what they can do and are disappointed with their resulting level of fitness. This monograph is an attempt to suggest suitable programs for HCM patients designed by myself as an HCM Cardiologist interested in fitness and an expert personal trainer and lifestyle coach Sarah Harris.