Safety and efficacy of physical activity in hypertrophic cardiomyopathy patients: a systematic review and metanalysis
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Key result
Exercise safely improves fitness by ~1.8 ml/kg/min in HCM patients without increasing MACE risk.
- RR 1.01
- 95% CI 0.72-1.41
- P=0.97
- n=2,217
Why the study?
To critically synthesize contemporary evidence regarding HCM and physical activity, focusing on the incidence of MACE in athletic populations and implications for future clinical management.
Does structured exercise improve cardiorespiratory fitness and prevent MACE in patients with hypertrophic cardiomyopathy?
Population
2217 patients with HCM across 8 studies
Comparison
Exercise group (n=1204) vs control group (n=1013)
Design
Systematic review and meta-analysis
Authors
Discussion
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Implication
Supports individualized exercise over universal restriction in HCM; reinforces emerging consensus on moderate activity safety.
Key Points
- This work aims to synthesize evidence on the safety and efficacy of physical activity in hypertrophic cardiomyopathy (HCM) patients.
- Conducted a systematic review and meta-analysis of 8 studies
- Included 2217 patients with HCM, with 1204 in the exercise group and 1013 in the control group
- Analyzed incidence of major adverse cardiovascular events and cardiorespiratory fitness
- Exercise did not increase the risk of major adverse cardiovascular events (RR 1.01, p = 0.97)
- Significant improvement in cardiorespiratory fitness (+1.76 ml/kg/min in VO2 peak, p < 0.0001)
- Supports inclusion of supervised exercise in clinical management
Study Design
Type
Meta-Analysis (n=2,217)
Multicenter
Yes
Structured PICO
Does structured exercise improve cardiorespiratory fitness and prevent MACE in patients with hypertrophic cardiomyopathy?
P
Population
2,217 patients with confirmed diagnosis of hypertrophic cardiomyopathy (HCM) pooled from 8 studies (4 RCTs, 4 observational), mean age ranging from 42 to 58 years.
I
Intervention
Structured exercise interventions of any intensity and duration (moderate- to vigorous aerobic training, 12-24 weeks for RCTs, long-term for observational studies).
C
Comparator
Control group receiving usual care, stop training, or sedentary/non-athletes.
O
Outcome
Incidence of major adverse cardiovascular events (MACE), including sudden cardiac death, resuscitated cardiac arrest, sustained ventricular tachycardia, and appropriate implantable defibrillator shocks.composite
Main Result
Effect estimate: RR 1.01 (95% CI 0.72-1.41)
Absolute Event Rate: 0% vs 0%
p-value: p=0.97
Structured and supervised exercise is safe and significantly improves cardiorespiratory fitness in patients with hypertrophic cardiomyopathy, supporting individualized exercise prescriptions over universal restriction.
Limitations
- High risk of bias across multiple domains in the included studies, affecting data validity.
- Small sample sizes in most studies limit statistical power and generalizability.
- Short follow-up durations do not adequately assess long-term safety and sustainability of benefits.
- Substantial risk of bias across multiple domains affecting both RCTs and observational studies
- Small sample sizes of most available studies
- Short intervention periods
- Heterogeneous training programs
- Incomplete assessment of disease progression
Cite This Study
Borrelli et al. (2026) conducted a meta-analysis in Hypertrophic Cardiomyopathy (n=2,217). Structured or supervised physical activity vs. Control group with no exercise was evaluated on Major adverse cardiovascular events (MACE) incidence (RR 1.01, 95% CI 0.72-1.41, p=0.97). Exercise was safe and did not increase the risk of major adverse cardiovascular events (RR 1.01), while improving cardiorespiratory fitness by +1.76 ml/kg/min in patients with hypertrophic cardiomyopathy.
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