Physical Activity and Other Health Behaviors in Adults With Hypertrophic Cardiomyopathy

doi:10.1016/j.amjcard.2012.12.018

The American Journal of Cardiology

Volume 111, Issue 7, 1 April 2013, Pages 1034-1039

https://doi.org/10.1016/j.amjcard.2012.12.018 Get rights and content

The clinical expression of hypertrophic cardiomyopathy (HC) is undoubtedly influenced by modifying genetic and environmental factors. Lifestyle practices such as tobacco and alcohol use, poor nutritional intake, and physical inactivity are strongly associated with adverse cardiovascular outcomes and increased mortality in the general population. Before addressing the direct effect of such modifiable factors on the natural history of HC, it is critical to define their prevalence in this population. A voluntary survey, drawing questions in part from the 2007 to 2008 National Health and Nutrition Examination Survey (NHANES), was posted on the HC Association website and administered to patients with HC at the University of Michigan. Propensity score matching to NHANES participants was used. Dichotomous and continuous health behaviors were analyzed using logistic and linear regression, respectively, and adjusted for body mass index and propensity score quintile. Compared to the matched NHANES participants, the patients with HC reported significantly less alcohol and tobacco use but also less time engaged in physical activity at work and for leisure. Time spent participating in vigorous or moderate activity was a strong predictor of self-reported exercise capacity. The body mass index was greater in the HC cohort than in the NHANES cohort. Exercise restrictions negatively affected emotional well-being in most surveyed subjects. In conclusion, patients with HC are less active than the general United States population. The well-established relation of inactivity, obesity, and cardiovascular mortality might be exaggerated in patients with HC. More data are needed on exercise in those with HC to strike a balance between acute risks and the long-term health benefits of exercise.

Section snippets

Methods

A voluntary survey of health behaviors, derived in part from the 2007 to 2008 NHANES, was posted on the HCM Association (HCMA) website (www.4hcm.org) and administered to patients with HC at the University of Michigan. The survey was completed by 110 patients with HC at the University of Michigan (UM HC) and 930 HC patients from the HCMA, and the results were compared to those from 6,228 NHANES survey respondents. Because the UM HC sample contained >96% non-Hispanic white patients, the analyses

Results

The population demographics of the HCMA, UM HC, and NHANES samples are presented in Table 1. The racial differences between both HC cohorts and the NHANES sample were striking, with the HC population predominately non-Hispanic white (96% UM HC, 85% HCMA). The reasons for this are unclear, but speculative explanations include the local demographics of the HC centers at which patients receive education about their disease and information about national support services. More limited access to

Discussion

The present study comprehensively surveyed the health behaviors with well-established cardiovascular risk in a large national sample of those with HC. Drawing questions from a validated NHANES survey instrument allowed statistical comparison of the responses to those of the propensity matched controls. We found significant differences in the lifestyle practices between the HC cohort and general population in several domains. First, those with HC reported a significantly lower consumption of

Acknowledgment

We would like to acknowledge the patients for their study participation and the HCMA staff for their continued dedication to furthering knowledge through their active participation in HC-related research.

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Cited by (81)

Association of duration and intensity of exercise with phenotypic expression in hypertrophic cardiomyopathy
2023, International Journal of Cardiology
There is limited data regarding the impact of exercise on phenotypic expression in hypertrophic cardiomyopathy (HCM). We aimed to investigate whether such an association exists in a cohort of genotype-positive HCM patients.
In this cross-sectional study of genotype-positive HCM families, we used structured questionnaires to obtain data regarding intensity and duration of exercise of participants starting at the age of 10, as well as data regarding exercise recommendations and their impact on quality of life (QOL). The association of cumulative metabolic-equivalent hours of exercise at different ages with different measures of phenotypic expression (maximal wall thickness, left atrial diameter, extent of late gadolinium enhancement) was analyzed.
The study included 109 patients from 55 families, including 43 male (39%) and 90 (83%) phenotype-positive. No association was identified between exercise duration or intensity with any of the phenotypic markers with the exception of greater cumulative exercise associated with younger age at presentation. Similar results were obtained when analysis was limited to exercise until the age of 20, until the age of 30 or only after 30.
Among phenotype-positive patients, 89% recalled receiving recommendations regarding exercise restriction, 29% noted reduction in exercise level following such recommendations and 25% noted this having a significant impact on their QOL.
We found no association between exercise intensity or duration and phenotypic expression in genotype-positive HCM patients. These findings are important for physician-patient discussions and support the recent trend towards more permissive exercise restrictions in HCM.
Exercise recommendations for patients with hypertrophic cardiomyopathy
2023, Progress in Cardiovascular Diseases
Individuals with hypertrophic cardiomyopathy (HCM) have historically been advised to limit exercise and sports participation to mild-intensity activities due to concerns for sudden cardiac arrest (SCA). However, more contemporary data have shown SCA is rare in patients with HCM and emerging data is shifting towards support for the safety of exercise in this patient population. Recent guidelines endorse exercise in patients with HCM after a comprehensive evaluation and shared-decision making with an expert provider.
Cardiopulmonary Exercise Testing in Pediatric Patients With Hypertrophic Cardiomyopathy
2022, JACC: Advances
Exercise stress testing (EST) in pediatric hypertrophic cardiomyopathy (HCM) patients has not well described in a large heterogenous cohort.
The objective of the study was to determine the clinical utility of EST in pediatric HCM.
This was a retrospective single-center analysis of HCM patients younger than 21 years who had EST between January 1, 2000, and January 1, 2019. Clinical, demographic characteristics, and EST data were analyzed, using the last EST during the study or prior to the event in subjects with a primary outcome. The primary composite endpoint included cardiac death, transplant, or arrhythmia requiring implantable cardioverter-defibrillator placement. Outcome analysis was performed using Cox proportional hazard modeling.
The study cohort included 140 patients, 52% with a recognized genetic variant. There were 2 tests aborted due to safety concerns (ST-segment changes, ventricular ectopy). The median age at first EST was 13.6 years. Ninety percent of patients were tested using cycle ergometry, and 44% were on a beta-blocker. The median peak oxygen consumption was 37.1 mL/kg/min (IQR: 12.5 mL/kg/min) or 81.2% predicted, the mean anaerobic threshold was 21.8 Ml (IQR: 8.3 mL), and the median peak power was 2.6 ± 1.1 W/kg or 73.7% predicted. Ectopy during EST was seen in 44% of patients, and 8% had an abnormal blood pressure response to exercise. The endpoint was reached in 12 patients. The presence of any degree of ectopy was a predictor of the composite endpoint (hazard ratio: 5.8; 95% CI: 1.3-26.7).
EST is clinically useful in select pediatric patients with HCM. Ectopy on EST is a risk factor for cardiac death, cardiac transplant, and arrhythmias requiring implantable cardioverter-defibrillator.
Sudden death in young athletes: Is it preventable?
2022, European Journal of Internal Medicine
Sudden death in young athletes is a rare but always dramatic condition. Unlike all other rare diseases, the estimate of its real incidence is made complex not only because of the uncertain number of correctly identified cases (numerator) but also because of the uncertain estimation of the real number of the reference population, the athletes (denominator). New elements of complexity are also emerging with regard to prevention. The current two pillars of prevention are pre-participation screening (proactive strategy) and promoting use / access to the automated external defibrillator (reactive strategy). The standardization of procedures implemented over the past two decades for pre-participation screening can now allow us to assess the impact of this approach. The result is complex to evaluate. While screening may allow the identification of conditions potentially associated with SDA, and therefore the adoption of specific treatments, in about 0.4% of screened subjects, a single study investigated the yield in terms of mortality showing a positive predictive value of 4.7% with 25% sensitivity. Conversely, the reactive strategy appears considerably effective, due to the widespread use of the automated external defibrillators in sports facilities, calling for a homogeneous implementation worldwide. On a broader perspective, the vast attention devoted to SDA prevention in the world of sports represents a major driver for transfer of a reactive prevention strategy to the general population.
Athletic Activity for Patients With Hypertrophic Cardiomyopathy and Other Inherited Cardiovascular Diseases: JACC Focus Seminar 3/4
2022, Journal of the American College of Cardiology
As explored throughout this JACC Focus Seminar series, participation in regular exercise offers significant positive benefits for cardiovascular health. However, patients with underlying inherited cardiovascular diseases, such as hypertrophic cardiomyopathy, have historically been restricted from sports participation because of the risk of sudden cardiac death. Over the last decade, new data has challenged this restrictive approach. Today, the notion of individualized, patient-centered shared decision-making is being progressively adopted to guide patients with an inherited cardiovascular disease to decide if they can undertake regular exercise, or even if they can participate in competitive sports. Here in this part 3 of a 4-part seminar series, we focus on these concepts and recent data with respect to exercise and the heart in patients with hypertrophic cardiomyopathy and other inherited cardiovascular diseases, with particular emphasis on participation in recreational and competitive sports for these individuals.
Hypertrophic Cardiomyopathy and Exercise: Mutually Exclusive or Beneficial?
2022, Clinics in Sports Medicine

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^†: Drs. Reineck and Rolston contributed equally to this study.

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CardiomyopathyPhysical Activity and Other Health Behaviors in Adults With Hypertrophic Cardiomyopathy

Section snippets

Methods

Results

Discussion

Acknowledgment

Lancet

J Am Coll Cardiol

Am J Cardiol

American J Prev Med

Statement on exercise: benefits and recommendations for physical activity programs for all Americans: a statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association

Circulation

Exercise capacity and mortality in black and white men

Circulation

The prognostic value of a nomogram for exercise capacity in women

N Engl J Med

Physical activity and cardiovascular health: lessons learned from epidemiological studies across age, gender, and race/ethnicity

Circulation

Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association

Circulation

The incidence of primary cardiac arrest during vigorous exercise

N Engl J Med

Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology

Circulation

Exercise in hypertrophic cardiomyopathy

J Cardiovasc Transl Res

Incidence, causes, and survival trends from cardiovascular-related sudden cardiac arrest in children and young adults 0 to 35 years of age: a 30-year review

Circulation

Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases

Circulation

Cardiomyopathy
Physical Activity and Other Health Behaviors in Adults With Hypertrophic Cardiomyopathy