Can You Exercise With Hypertrophic Cardiomyopathy?

If you have hypertrophic cardiomyopathy (HCM), a type of heart disease that thickens your heart muscle, you may have heard confusing information regarding exercise.

In the past, doctors may have advised against physical activity due to concerns about sudden cardiac death. But new guidelines highlight a shift in thinking.

Can people with hypertrophic cardiomyopathy exercise?

Yes, mild intensity activity is generally safe, says cardiologist Maran Thamilarasan, MD. And, in fact, it’s recommended.

“Historically, you’d hear these stories of young athletes dying suddenly with undiagnosed hypertrophic cardiomyopathy,” shares Dr. Thamilarasan. “The thought was that we should significantly restrict activity. That was the dogma for many years. But now, we recognize that each individual is different and it’s very important to maintain some level of physical activity, both for someone’s mental well-being and their physical fitness.”

Tips for getting started

Dr. Thamilarasan stresses the importance of getting a risk assessment before beginning any exercise routine, especially if you want to be more active. Doing so can help determine how likely it is that you may experience an arrhythmic event (abnormal heart rhythm) while working out.

To determine your overall risk, your doctor will look at factors like:

• Family history
• Left ventricular wall thickness
• Degree of obstruction
• Presence of arrhythmias
• How your heart adjusts to changes (hemodynamic responses)
• Amount of scar tissue (myocardial fibrosis)

Gathering all this information can help your care team make recommendations. They’ll be able to give you guidance on what type of exercise is best for you through a shared decision-making process.

Having a risk assessment can also provide guidance if someone wants to play competitive sports.

“It’s certainly possible that with a good, detailed analysis, it may be possible for someone with HCM to be involved in competitive-level exercise,” says Dr. Thamilarasan. “A consultation with a sports cardiologist is often recommended in these situations.”

In fact, recent research shows that people with HCM who engaged in vigorous exercise weren’t any more likely to have a life-threatening arrhythmia than those who participated in moderate exercise or sedentary activities.

“But these studies don’t represent all types of people with HCM or all types of exercise, so a tailored evaluation with your healthcare team is important,” he clarifies.

Best exercises for HCM

The most recent guidelines from the American Heart Association recommend mild and moderate-intensity activity, like:

• Walking
• Biking
• Swimming in the presence of a lifeguard (if assessment doesn’t suggest a risk for passing out)
• Water aerobics

“Almost all people with hypertrophic cardiomyopathy can engage in such activity to maintain cardiovascular fitness,” says Dr. Thamilarasan. “If you have low markers of risk, then it may be possible to engage in a higher level of activity.”

That means that most people with HCM can adhere to general guidelines that recommend 150 minutes of mild-intensity aerobic exercise each week. Dr. Thamilarasan says it’s not unrealistic to have a goal of 30 to 60 minutes of aerobic activity each day.

“Even if your HCM is higher risk, walking at a slow pace is still good for you,” he adds. “It won’t increase your risk. You can maintain some level of fitness — it’s the intensity of that exercise that we have to be careful of.”

Regardless of your risk level, Dr. Thamilarasan recommends undergoing a yearly evaluation to assess your health so you and your care team can make any necessary adjustments to your exercise routine.

Exercise restrictions for HCM

Your doctor will let you know if there are any exercise restrictions for hypertrophic cardiomyopathy based on your risk assessment.

“If you’re at high risk for arrhythmic events and you have significant obstruction, then we may recommend low-intensity exercise,” says Dr. Thamilarasan.

That may mean you need to avoid high-intensity exercise like weightlifting or HIIT. But you can focus on low-intensity exercise like gentle stretching, yoga, Pilates or walking your dog.

Key takeaways

Exercising daily is important for people who have HCM. But Dr. Thamilarasan stresses that it’s vital that you pay attention to how you’re feeling. Stop exercising immediately if you experience:

• Chest pain
• Lightheadedness
• Dizziness
• Heart palpitations
• Shortness of breath

“Pay attention for anything that makes you feel more out of breath than you should be for that level of activity,” he emphasizes. “Don’t push through it. You need to be mindful of the warning signs.”

Overall, there’s no one-size-fits-all recommendation on exercising with hypertrophic cardiomyopathy. Everyone is different and has a unique set of factors, so work with your doctor to determine the right type and intensity of exercise for you.

“In general, people who don’t exercise in the long run have higher cardiovascular mortality,” concludes Dr. Thamilarasan. “So, if you have HCM, we think there’s a balance to be achieved between managing HCM and exercise to optimize your health.”