Efficacy and safety of exercise for hypertrophic cardiomyopathy: a systematic review and meta-analysis.
Level 2 - randomized trial
Systematic review and meta-analysis combining randomized controlled trials (n=3) and observational studies (n=4).
PubMed 42269051 · doi:10.1080/08998280.2026.2667666
What was done
A systematic review and meta-analysis searched PubMed, Web of Science, Scopus, Embase, and CENTRAL up to April 2025 for studies assessing exercise in hypertrophic cardiomyopathy (HCM). Seven studies (3 randomized controlled trials and 4 observational studies) with 9,702 total patients were included. Continuous outcomes were pooled as mean differences (MDs) or standardized mean differences (SMDs) and dichotomous outcomes as risk ratios (RRs), all with 95% confidence intervals (CIs).
What was found
Compared to controls, exercise was significantly associated with increased peak VO2 (MD: 1.78 mL/kg/min; 95% CI [0.98, 2.59]; P < 0.01), increased VO2 at anaerobic threshold (MD: 1.27 mL/kg/min; 95% CI [0.34, 2.20]; P < 0.01), reduced body mass index (MD: -0.67 kg/m2; 95% CI [-1.17, -0.18]; P < 0.01), reduced echocardiographic left ventricular wall thickness (MD: -0.56 mm; 95% CI [-1.01, -0.11]; P = 0.01), improved quality of life physical factor (SMD: 0.66; 95% CI [0.34, 0.97]; P < 0.01), and lower all-cause mortality (RR: 0.71; 95% CI [0.60, 0.85]; P < 0.01). Arrhythmia risk was not increased.
Why it matters
These findings suggest that structured exercise is safe and physiologically beneficial in patients with hypertrophic cardiomyopathy, challenging traditional blanket restrictions on physical activity.
Limits
Only 3 of the 7 studies were randomized controlled trials, and the mortality reduction was primarily driven by observational studies susceptible to residual confounding. Specific exercise prescriptions, adherence rates, and long-term safety endpoints were not detailed in the abstract.
Cited by
- supports Recent evidence indicates that patients with hypertrophic cardiomyopathy can safely train, and animal data suggests that exercise training at a young age may prevent the full expression of the disease.