The appropriate amount of exercise for patients with hypertrophic cardiomyopathy (HCM) remains a persistent question. Some concerns are whether exercise could trigger ventricular arrhythmias or induce remodeling. Guideline recommendations continue to be based on expert consensus because of the lack of objective data. Read More >>>
The RESET-HCM study has demonstrated that moderate-intensity aerobic training was safe and effective in patients with HCM, according to results presented by Sara Saberi, MD, MS, in a Featured Clinical Research presentation. The 57 patients randomized to the exercise training group had an increase in the primary endpoint of exercise capacity at 16 weeks compared with the 56 patients in the usual activity group – a mean increase of 1.35 ml/kg/min versus 0.08 ml/kg/min from the mean peak VO2 at baseline of 22 ml/kg/min (p = 0.02).
The patients in the study were ages 18-80 years, with a mean age of 50, and 42 percent were women. Their history included obstructive HCM in 17 percent, implantable cardioverter-defibrillator (ICD) in 34 percent and sustained ventricular tachycardia or aborted sudden cardiac death in 4 percent. The study period was 2010 to 2015.
"The RESET-HCM study has demonstrated that moderate-intensity aerobic training was safe and effective in patients with HCM."
In the exercise training group, patients were given a one-hour consultation with a certified exercise physiologist, a tailored exercise program (including cycling, walking, jogging, swimming or using an elliptical trainer) to perform at home and instruction to increase their duration of exercise. In the first week, they were to exercise 20 minutes three times a week at 60 percent of their heart-rate reserve (calculated by their baseline cardiopulmonary exercise test) and a perceived moderate intensity. For weeks two to four, they were to increase the duration by 5-10 minutes a week, for a maximum of 60 minutes, and exercise four to seven times a week at 70% of their heart-rate reserve and a perceived moderate intensity. This level of exercise was to be maintained through week 16. In the usual activity group, the patients were instructed to continue with their current exercise practice. By 16 weeks, more patients in the exercise training group were exercising regularly, compared with before the study and against the usual activity group (93 percent vs. 28 percent).
No differences were found between the groups for cardiac remodeling or quality of life, based on self-reported questionnaires, other than improvement related to physical function. No major adverse events occurred, including death, aborted sudden cardiac death, appropriate ICD shocks or sustained ventricular tachycardia. Exercise training was not associated with an increase in any non-fatal arrhythmias. They study, however, was not designed to establish long-term safety, stated the investigators.
Further research is required to determine the clinical importance of the improvements in the primary and secondary outcomes in this study, as well as establishing the safety of moderate or higher levels of activity and any potential impact on disease progression. <<< Return to top