New Guidelines Favouring Exercise in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy, a disease with thickening of heart muscle, is an important cause of sudden cardiac death in athletes. But the 2024 Guidelines for Management of Hypertrophic Cardiomyopathy, which is now available online with free access at Journal of American College of Cardiology website seems to encourage exercise for persons with hypertrophic cardiomyopathy. They mention that recent evidence demonstrates benefits outweigh risks in many patients with appropriate assessment. Of course, the wording ‘with appropriate assessment’ is of topmost importance.

As you are aware, exercise is not for everyone with hypertrophic cardiomyopathy. Mild to moderate recreational exercise without competition is tagged green, vigorous recreational activities as yellow and competitive sports as orange, with Class I, IIa and IIb recommendations respectively. Class I is the most accepted recommendation. Class II is where there could be divided opinion among experts, with more agreement in Class IIa and less agreement in Class IIb. If it is deemed harmful, it is tagged red and Class III. There are certainly some persons with severe forms of hypertrophic cardiomyopathy in whom exercise could be harmful and hence Class III.