Exercising With Hypertrophic Cardiomyopathy (HCM): What You Need to Know

Despite possible risks, there are strategies that can help people with HCM stay safe during exercise:

• Get evaluated. “Before initiating or intensifying exercise, people with HCM should undergo a thorough evaluation by an HCM specialist,” says Schenone.
• Consider your environment. People with HCM should exercise in a space that’s able to provide prompt resuscitative effort in case of a sudden cardiac death (SCD) event. Schenone says people with HCM should also avoid strenuous exercises where they’re alone and exercising in settings that could be deadly if they lose consciousness. “Ideally, exercise with a partner or in settings with monitoring or rapid access to medical care,” he says.
• Be careful in the heat. People with HCM can experience symptoms like shortness of breath, dizziness, and even fainting in hot temperatures. Schenone recommends performing exercise or exertional activities during cooler times like the morning or evening rather than the midday heat, as well as shifting to indoor environments that are climate controlled.
• Stay hydrated. Getting enough fluids is essential.

  [1]

   “Dehydration or low intravascular volume may exacerbate symptoms, particularly in those with LVOT obstruction,” says Schenone. “Drink fluids throughout the day, not just around exercise, and anticipate increased needs in heat or during exertion. Rehydrate after activity with fluids and electrolytes.”

According to Richard Bach, MD, a WashU Medicine cardiologist at Barnes-Jewish Hospital in St. Louis, some possible symptoms people with HCM may experience during exercise include:

• Dizziness
• Lightheadedness
• Feeling like you’re going to pass out

When these symptoms appear, he advises stopping the activity that’s bringing them on or reducing your overall intensity level. Listen to your body, he says.

Dr. Bach says if you feel lightheaded, it’s likely a good idea to sit or lie down to make sure you don’t pass out, and loss of consciousness is a reason to seek emergency medical treatment. “Relatively prompt evaluation can determine a cause that might need intervention,” he says.

However, these symptoms are less common than shortness of breath and a tight feeling or discomfort in the chest, says Bach.

Schenone offers similar recommendations. “Respect your symptoms. If chest tightness, lightheadedness, syncope (passing out), near-syncope, palpitations, or unusual fatigue occur, cease activity,” he says.

It’s also possible that some symptoms may be related to a person’s degree of physical fitness rather than HCM. For instance, Bach says shortness of breath and chest discomfort can also be related to someone not having the stamina or aerobic capacity to exercise as vigorously as they’re attempting, which is why it’s important to build workout intensity gradually.

Communicate with your healthcare team, too. “If someone feels limited by the symptoms they're experiencing as they're starting an exercise program, it would be wise to confer with their cardiologist in order to see whether their medical therapy could be adjusted,” says Bach.

• People with HCM should try to engage in mild to moderate exercise (not for competitive purposes). Mild exercise includes activities like light chores and slow walking while moderate exercise includes activities like social dancing and doubles tennis.

  [8]

  [9]

• Vigorous exercise may also be safe, as long as you first receive an evaluation from a medical professional to help balance the possible risks and benefits. This process should be repeated annually. Vigorous exercise includes activities like running and jumping rope.

  [9]

• People with HCM shouldn’t be universally barred from vigorous exercise or competitive sports.
• For people who are physically able, competitive sports are possible after receiving an evaluation from a healthcare provider with experience helping athletes with HCM. You should seek reapproval every year, after a doctor has helped you carefully balance the possible risks and benefits.

It is unclear, however, whether sports participation really increases the risk of sudden cardiac death among people who have already been diagnosed with HCM. Bach says earlier data on SCD among young sport athletes “raised concern that vigorous, intense exercise from competitive sports could be a trigger, causing cardiac arrest.” However, based on more recent data, “it may not necessarily be as risky as was previously believed to participate in high-level, intense, competitive sports,” he says.

• Most individuals with HCM can safely engage in mild- to moderate-intensity exercise, and while vigorous exercise or competitive sports may require more guidance, people with HCM are not automatically restricted from these activities.
• To exercise safely, people with HCM should first receive an evaluation from a specialist.
• You can reduce the risk of problems by exercising in a safe environment, staying hydrated, and avoiding higher temperatures. Pay close attention to symptoms such as lightheadedness, and be ready to stop.
• The risk of sudden death due to exercise may be smaller than previously understood, but caution is still important when exercising with HCM.