What is HCM and Why Fitness?

What is Hypertrophic Cardiomyopathy and Why the need for fitness?

Hypertrophic cardiomyopathy (HCM) is a condition where the heart muscle has variable amounts of hypertrophy (thickening) and or muscle scarring. It is present in about 1/500 persons and often has a genetic basis with multiple family members affected. While most patients with hypertrophic cardiomyopathy have a good prognosis, symptoms are common. There are variable risks for fainting or near fainting as well as for sudden death. Symptoms of shortness of breath or chest pain may be due to the imbalance between muscle thickness and blood supply, abnormal muscle relaxation and stiffness, obstruction of blood exiting the heart or abnormal heart rhythm.

For an additional source of information about HCM, a good resource is www.4hcm.org

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)

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  1. It is reasonable for patients with HCM to participate in low intensity competitive sports (e.g., golf and bowling).
  2. It is reasonable for patients with HCM to participate in a range of recreational sporting activities as outlined in Table 4.
  3. 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.

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy

Table 4.

Recommendations for the Acceptability of Recreational (Noncompetitive) Sports Activities and Exercise in Patients With HCM*

Intensity Level

Eligibility Scale for HCM

High
    Basketball (full court) 0
    Basketball (half court) 0
    Body building 1
    Gymnastics 2
    Ice hockey 0
    Racquetball/squash 0
    Rock climbing 1
    Running (sprinting) 0
    Skiing (downhill) 2
    Skiing (cross-country) 2
    Soccer 0
    Tennis (singles) 0
    Touch (flag) football 1
    Windsurfing§ 1
Moderate
    Baseball/softball 2
    Biking 4
    Hiking 3
    Modest hiking 4
    Motorcycling 3
    Jogging 3
    Sailing§ 3
    Surfing§ 2
    Swimming (laps)§ 5
    Tennis (doubles) 4
    Treadmill/stationary bicycle 5
    Weightlifting (free weights) 1
Low
    Bowling 5
    Brisk walking 5
    Golf 5
    Horseback riding 3
    Scuba diving§ 0
    Skating 5
    Snorkeling§ 5
    Weights (nonfree weights) 4

Table 4. – footnotes

  • * Recreational sports are categorized according to high, moderate, and low levels of exercise and graded on a relative scale (from 0 to 5) for eligibility, with 0 to 1 indicating generally not advised or strongly discouraged; 4 to 5, probably permitted; and 2 to 3, intermediate and to be assessed clinically on an individual basis. The designations of high, moderate, and low levels of exercise are equivalent to an estimated >6, 4 to 6, and <4 metabolic equivalents, respectively.

  • Assumes absence of laboratory DNA genotyping data; therefore, limited to clinical diagnosis.

  • These sports involve the potential for traumatic injury, which should be taken into consideration for individuals with a risk for impaired consciousness.

  • § The possibility of impaired consciousness occurring during water-related activities should be taken into account with respect to the individual patient’s clinical profile.

  • Recommendations generally differ from those for weight-training machines (nonfree weights), based largely on the potential risks of traumatic injury associated with episodes of impaired consciousness during bench-press maneuvers; otherwise, the physiologic effects of all weight-training activities are regarded as similar with respect to the present recommendations.

  • Individual sporting activity not associated with the team sport of ice hockey.

  • Adapted with permission from Maron et al.224

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