According to this recent study looking at exercise capacity in patients with HCM, women with HCM demonstrated reduced exercise capacity when compared to men. This paper theorizes that the differences are likely attributable to passive diastolic properties and that these could aid in the development of interventions specifically targeted for women.
These guidelines offer more flexibility for HCM patients that past guidelines, stating that exercise may be permissible for HCM patients, but that it depends on individual situations. The focus should be on the shared decision process between patient and doctor to determine whether exercise may be appropriate for each individual patient. Additionally, annual follow up for adults, with more frequent follow up for adolescents and young adults is also recommended.
Section 5.5.1 of the guidelines focuses on Hypertrophic Cardiomyopathy. These guidelines state:
- The risk of sudden cardiac death or arrest (SCD or SCA) during exercise is likely lower than previously thought and therefore, a total ban on exercise is not warranted.
- Exercise for physical and psychological well-being should be encouraged, following a careful baseline assessment of patients with HCM which should include:
- Personal and family history
- Risk Factors for SCD/SCA
- EKG at rest and during exercise
- Echocardiogram/Degree of Obstruction
- Degree of late gadolinium enhancement indicative of cardiac fibrosis as seen on cardiac MRI
- Exercise testing and blood pressure response to exercise
- ESC Score of HCM Risk
This week, researchers from the eight HCM centers comprising the Sarcomeric Human Cardiomyopathy Registry [SHARE Registry] published a paper that every HCM patient should take to heart.
The sobering findings are that overweight HCM patients have a higher incidence of obstruction, heart failure and atrial fibrillation than their normal weight counterparts. As a result of this study, the researchers suggest heightened attention to weight management and exercise in order to prevent disease-related progression and complications.
A recent study conducted in the U.K. evaluated whether the anti-anginal drug trimetazidine would improve symptoms and exercise capacity for those patients with non-obstructive hypertrophic cardiomyopathy.
Unfortunately, this study which was conducted by Dr. Perry Elliott and his colleagues at University College London, found that trimetatazidine did not improve exercise capacity in these patients. Following the results of this study, trimetazidine will now join ranolazine and spironolactone in the compost heap of drugs which tried and failed to improve HCM symptoms. While a third drug, perhexiline, was found to improve symptoms for non-obstructive HCM, its limitations, including potentially serious side effects, stand in the way of its common usage.
In a companion editorial to this study entitled “Non-Obstructive Hypertrophic Cardiomyopathy-the High Hanging Fruit,” Dr. Sharlene Day of the University of Michigan’s HCM Center discusses the difficulties seen in drug trials related to non-obstructive HCM.
This article by Dr. Stephen Heitner of Oregon Health & Science University covers some simple lifestyle changes that can help HCM patients feel much better. In particular, Dr. Heitner mentions:
- Eating smaller meals and avoiding large carbohydrate rich meals.
- Avoiding dehydration
- Limiting alcohol
- Avoiding exercise after eating
- Engaging in moderate intensity exercise
- Managing weight
- Evaluating and treating sleep apnea and other sleep breathing disorders
- Getting appropriate treatment for anxiety and depression
The above lifestyle changes, combined with appropriate medical treatment, will keep HCM patients feeling their best.
Two articles published this week highlight how attitudes relating to exercise and HCM have changed in recent years. Older recommendations that HCM patients should refrain from exercise appear to be outdated.
The first article, an editorial published in Circulation by Drs. Sara Saberi and Sharlene Day from the University of Michigan’s HCM Center, reviews the statistics relating to sudden death of athletes and questions the long held notion that participation in vigorous activity or competitive sports is dangerous in HCM. This editorial also points out that moderate exercise is the only non-surgical intervention proven to increase exercise capacity in patients with HCM.
A second article from researchers in Australia used the number of a patient’s steps per day as an indicator of HCM disease severity and the patient’s functional limitations.
It seems that the time has come for HCM patients to get up off their couches and get moving!
According to this recent article published in the Journal of the American Heart Association, lifestyle choices can influence the development and/or progression of HCM.
In particular, the authors made the following recommendations:
- Exercise: Recreational exercise should be encouraged in HCM patients.
- This recommendation was largely based on the findings of the recent RESET-HCM study which found that moderate exercise, specifically tailored to each individual patient’s capacity, was beneficial to the patient’s general health and well being. **For an in-depth look at the RESET-HCM study, check out this recent HCMBeat interview with the authors of the study, Drs. Sara Saberi and Sharlene Day.
- Eating and Drinking:
- Patients should avoid large meals and should not exercise immediately after eating.
- Care should be taken to avoid becoming dehydrated.
- Alcohol should only be consumed in moderation.
- Healthy weight should be maintained.
- Hypertension should be treated aggressively, though treatment may be challenging, especially in obstructive HCM.
- Obstructive Sleep Apnea, which may exist in as many as 70% of HCM patients, should be treated to minimize potential for arrhythmia and to improve blood flow.
The same Fitbit you wear to count your steps may soon have an additional purpose: it could detect atrial fibrillation.
Atrial fibrillation is an irregular heartbeat which could cause a stroke if not properly treated. Yet, it often goes unnoticed by a person experiencing it.
This technology could be of great benefit to heart patients. Not only does the Fitbit encourage you to exercise, it might just save your life!
Editor’s note: This is our first interview feature on HCMBeat. In the future, we hope to feature more interviews with other HCM researchers who have published articles of interest to the HCM community.
By now, you have probably already heard the buzz about RESET- HCM – a study about the effects of exercise on HCM patients conducted by Dr. Sara Saberi and Dr. Sharlene Day at the Hypertrophic Cardiomyopathy Clinic of the University of Michigan’s Frankel Cardiovascular Center in collaboration with Dr. Matthew Wheeler and Dr. Euan Ashley of Stanford’s HCM Center. The findings were presented at the American College of Cardiology Conference on March 17, 2017 held in Washington D.C. and were the subject of this feature on HCMBeat.
Recently, Cynthia Waldman of HCMBeat had the opportunity to sit down with Drs. Saberi and Day for a detailed conversation (over Skype) about the study. What follows is a transcript of their conversation (which has been edited for readability).
Results from a recent study conducted at the University of Michigan and Stanford show that patients who participated in a moderate-intensity cardiovascular exercise program showed a small, but statistically significant increase (6%) in exercise capacity over those who did not participate in the program. Of note, no adverse events were reported in any of the 136 adults who participated in the RESET-HCM study over its four-month duration. These results were announced over the weekend at the American College of Cardiology meeting in Washington, D.C.
A companion editorial noted that this study is important for establishing the positive impact of exercise on HCM patients. Now, the need is for future research to establish safe exercise guidelines for HCM patients. Many remain reluctant to exercise due to fear of suffering an adverse event during exercise.
Here is a video interview with one of the authors of the study, Dr. Sara Saberi, discussing the findings at ACC.
Stay tuned to HCMBeat for more about this important work which will hopefully lead to improved quality of life for HCM patients.