Vigorous Exercise in Patients With Hypertrophic Cardiomyopathy

Authors

Rachel Lampert, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
Michael J. Ackerman, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Bradley S. Marino, Department of Pediatric Cardiology, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio.
Matthew Burg, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
Barbara Ainsworth, College of Health Solutions, Arizona State University, Tempe.
Lisa Salberg, Hypertrophic Cardiomyopathy Association, Denville, New Jersey.
Maria Teresa Tome Esteban, St George's Hospital NHS Foundation Trust/St George's University of London, London, United Kingdom.
Carolyn Y. Ho, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
Roselle Abraham, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Seshadri Balaji, Department of Pediatrics, Oregon Health and Science University, Portland.
Cheryl Barth, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
Charles I. Berul, Division of Cardiology, Children's National Hospital, Washington, DC.
Martijn Bos, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
David Cannom, Division of Cardiology, PIH Health Good Samaritan Hospital, Los Angeles, California.
Lubna Choudhury, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Maryann Concannon, Department of Internal Medicine, University of Michigan, Ann Arbor.
Robert Cooper, Department of Cardiology, Liverpool Heart and Chest Hospital/Liverpool John Moores University, Liverpool, United Kingdom.
Richard J. Czosek, Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio.
Anne M. Dubin, Department of Pediatrics, Stanford School of Medicine, Stanford, California.
James Dziura, Yale Center for Analytic Sciences, Yale School of Medicine, New Haven, Connecticut.
Benjamin Eidem, Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
Michael S. Emery, Department of Cardiovascular Medicine, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, Ohio.
N A. Estes, Department of Medicine, Tufts Medical Center, Boston, Massachusetts.
Susan P. Etheridge, Department of Pediatrics, Primary Children's Hospital, Salt Lake City, Utah.
Jeffrey B. Geske, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Belinda Gray, Faculty of Medicine and Health, Royal Prince Alfred Hospital/Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Kevin Hall, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
Kimberly G. Harmon, Department of Family Medicine, University of Washington, Seattle.
Cynthia A. James, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Ashwin K. Lal, Department of Pediatrics, Primary Children's Hospital, Salt Lake City, Utah.
Ian H. Law, Department of Pediatrics, University of Iowa, Iowa City.
Fangyong Li, Yale Center for Analytic Sciences, Yale School of Medicine, New Haven, Connecticut.

Document Type

Journal Article

Publication Date

5-17-2023

Journal

JAMA cardiology

DOI

10.1001/jamacardio.2023.1042

Abstract

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.

Department

Pediatrics

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