High Obesity, Physical Inactivity in HCM Patients Warrant 'Balanced' Risk/Benefit Advice

March 09, 2013

SAN FRANCISCO, California — Patients with hypertrophic cardiomyopathy (HCM) are less physically active than the general US population and have higher rates of obesity, according to new survey results [1]. In addition, the exercise restrictions imposed by HCM have a negative impact on emotional well-being in most individuals, suggesting there is a need to further investigate the risks and benefits of exercise in this patient population, say researchers.

The results of the survey were presented here today at the American College of Cardiology 2013 Scientific Sessions. They were published online in the American Journal of Cardiology earlier this year.

Speaking with heartwire , Dr Sharlene Day (University of Michigan, Ann Arbor), the lead author who is presenting the results, noted that the American Heart Association (AHA) issued recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases in 2004. The American College of Cardiology Foundation (ACCF) and the AHA, along with other organizations and societies, later published a 2011 document on the diagnosis of HCM and provided treatment recommendations.

In the 2011 recommendations, the writing group stated that almost any sport at an advanced competitive level should be off-limits for patients with HCM, with the exception of light competitive sports such as golf. The writing group did suggest it was safe for HCM patients to engage in a range of recreational sports, including cycling, "modest hiking," lap swimming, doubles tennis, and bowling, but sports where participation is intense or contains elements of bursts of physical activity should be avoided.

Day said that HCM is a heterogenous disease, with some patients at the far end of the spectrum with severe disease, while others might be less at risk for sudden cardiac death. However, disease severity does not always correlate with sudden cardiac death or other adverse events, so the guidelines are justifiably conservative. "There is lots of uncertainty because there are very little data to support the safety of patients participating in sports and recreational activities," said Day. "We know that intense exercise can trigger events, but many events occur when individuals are not doing anything at all."

To heartwire , Day said that patients referred to her clinic are often advised by other physicians not to participate in physical activity, while others are restricting themselves, with patients worried about "dropping dead" if they exercise. The conundrum is that such physical inactivity leads to obesity, as documented in their survey of 110 HCM patients from the University of Michigan (UM) and 930 HCM patients enrolled in the national HCM Association (HCMA).

The average body-mass index (BMI) of the HCM patients from UM and HCMA was 32 and 30, respectively. In the propensity-matched sample of patients participating in the National Health and Nutrition Examination Survey (NHANES), the average BMI was 29. However, whereas one-third of the NHANES subjects were obese, 55% of the UM patients and 40% of the HCMA patients were obese (p<0.05 vs NHANES).

Day said the HCM patients were less likely to smoke or drink alcohol but much less likely to exercise, either through work-based physical activity or recreational activities. She added that many of these patients were quite functional and the exercise restrictions were based not on disease severity, but instead self-restriction. Of those who were not engaging in physical activity because of concerns about their HCM, almost two-thirds said this lack of participation had a negative effect on their emotional well-being.

The results of the survey, according to Day, underline the importance of balancing of the physical and emotional benefits of exercise with the potential risks.

"I think it's important to have a balanced conversation about exercise, to tell patients about the guidelines and where they come from," said Day. "It's a personalized approach, and we treat each patient a little bit differently." She noted that 10% of those surveyed are still participating in sports at a competitive recreational level. For these patients, Day advises them to stay physically active throughout the week, to avoid the "weekend-warrior" syndrome (something she advises for everybody), and to be responsible, such as alerting teammates to their condition and knowing the location of automated external defibrillators.

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