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Randomized Controlled Trial
. 2025 May 14;46(19):1803-1815.
doi: 10.1093/eurheartj/ehae919.

High intensity exercise programme in patients with hypertrophic cardiomyopathy: a randomized trial

Joyee Basu  1   2 , Dimitra Nikoletou  1 , Chris Miles  1   2 , Hamish MacLachlan  1   2 , Gemma Parry-Williams  1   2 , Fred Tilby-Jones  1 , Paulo Bulleros  1   2 , Zephryn Fanton  1   2 , Claire Baker  1 , Shane Purcell  1   2 , Carmen Lech  1   2 , Tracy Chapman  1   2 , Peter Sage  1   2 , Shams Wahid  1   2 , Nabeel Sheikh  3 , Shruti Jayakumar  1 , Aneil Malhotra  1   4   5   6 , Tracey Keteepe-Arachi  1   2 , Belinda Gray  1   2 , Gherardo Finocchiaro  1   2 , Gerald Carr-White  3 , Elijah Behr  1   2 , Maite Tome  1   2 , Jamie O'Driscoll  4   7 , Irina Chis Ster  1 , Sanjay Sharma  1   2 , Michael Papadakis  1   2
Affiliations
Randomized Controlled Trial

High intensity exercise programme in patients with hypertrophic cardiomyopathy: a randomized trial

Joyee Basu et al. Eur Heart J. .

Abstract

Background and aims: The feasibility and impact of high intensity exercise programmes in patients with hypertrophic cardiomyopathy (HCM) are unknown. This study was conducted to determine the feasibility of a high intensity exercise programme and explore safety and efficacy outcomes in patients with HCM.

Methods: Participants were randomized to a 12-week supervised exercise programme (n = 40) in addition to usual care, or usual care alone (n = 40). All participants underwent assessment at baseline and 12 weeks. The exercise group was re-evaluated 6 months post-programme. Feasibility was assessed by (i) recruitment, adherence, and retention rates; (ii) staffing ratios; (iii) logistics; and (iv) acceptability of the intervention. The primary exploratory safety outcome was a composite of arrhythmia-related events. Exploratory secondary outcomes included changes in (i) cardiorespiratory fitness; (ii) cardiovascular risk factors; and (iii) quality of life, anxiety, and depression scores.

Results: Overall, 67 (84%) participants completed the study (n = 34 and n = 33 in the exercise and usual care groups, respectively). Reasons for non-adherence included travel, work, and family commitments. Resource provision complied with national cardiac rehabilitation standards. There was no difference between groups for the exploratory safety outcome (P = .99). At 12 weeks, the exercise group had a greater increase in peak oxygen consumption (VO2) [+4.1 mL/kg/min, 95% confidence interval (CI) 1.1, 7.1] and VO2 at anaerobic threshold (+2.3 mL/kg/min, 95% CI 0.4, 4.1), lower systolic blood pressure (-7.3 mmHg, 95% CI -11.7, -2.8) and body mass index (-0.8 kg/m2, 95% CI -1.1, -0.4), and greater improvement in hospital anxiety (-3, 95% CI -4.3, -1.7) and depression (-1.7, 95% CI -2.9, -0.5) scores, compared to the usual care group. Most exercise gains dissipated at 6 months.

Conclusions: A high intensity exercise programme is feasible in patients with HCM, with apparent cardiovascular and psychological benefits, and no increase in arrhythmias. A large-scale study is required to substantiate findings and assess long-term safety of high intensity exercise in HCM.

Keywords: Cardiac rehabilitation; High intensity exercise; Hypertrophic cardiomyopathy; Sports cardiology.

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Figures

structured graphical abstract
structured graphical abstract
Change in cardiovascular risk factor profile, cardiorespiratory fitness, psychological scores, and occurrence of arrhythmias in individuals with HCM following participation in a 12-week supervised high intensity programme. AT, anaerobic threshold; BP, blood pressure; BMI, body mass index; CV, cardiovascular; HADS, hospital anxiety and depression scale.
Figure 1
Figure 1
Recruitment and adherence flow chart
Figure 2
Figure 2
Change in exercise capacity from baseline to 12 weeks. Box whisker plots depicting raw median, IQR, and range data (clockwise from top left) for the change in maximum exercise time, peak VO2, VO2 at the anaerobic threshold, and time to anaerobic threshold
Figure 3
Figure 3
Change in the means and confidence intervals in (A) maximum exercise time ET, (B) time to anaerobic threshold, (C) VO2/kg at anaerobic threshold, (D) HADS anxiety score, (E) BMI, (F) systolic BP, (G) peak VO2/kg, (H) HADS depression score as estimated by the mixed models applied to the exercise group followed beyond the duration of the trial
See this image and copyright information in PMC

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