Efficacy and Safety of Exercise Rehabilitation in Patients with Hypertrophic Cardiomyopathy

Background: While physical rehabilitation has been shown to be beneficial and safe for patients suffering from heart failure, data on rehabilitation for hypertrophic cardiomyopathy (HCM) patients is limited.

Methods: 45 HCM patients suffering from effort limitation participated in an exercise rehabilitation program. Exercise capacity was measured in metabolic equivalent (METS) units and functional status was defined according to the New-York Heart Association. We studied distinguishing parameters of those who benefited from exercise training and compared the functional benefit of rehabilitation in HCM to that of dilated cardiomyopathy (DCM) patients. Self-reported measurements addressed the quality of life and daily life function.

Results: Of the 45patients referred for exercise training, 32 completed at least 3 months of rehabilitation and data from 2 sequential exercise tests were recorded. Overall, a significant increase in exercise capacity (from mean 5.3 to 6.7 METs, p=0.01),was achieved at higher peak heart rates. Eighteen patients (56%) who showed improvement in exercise capacity did not differ in their NYHA class, clinical, ECG or echo-Doppler parameters but had a lower exercise capacity at baseline (4.3 ± 1.6 vs. 6.7 ± 2.8 METs, p<0.01).No significant arrhythmias or adverse events were recorded in HCM patients during participation. The program improved the subjective perception of functional capacity and quality of life. Only 4 patients (9%) discontinued their participation due to discomfort during or following training. The improvement in exercise capacity was comparable between HCM and a reference group of DCM patients suggesting a non-specific effect of physical conditioning.

Conclusions: Exercise rehabilitation appears to be applicable and safe in HCM. It mainly benefits patients suffering from significant functional limitation. Larger prospective studies are needed to validate these findings and better characterize patients expected to benefit the most from these programs.