Strength-Based Exercise Is Not Associated With Ventricular Arrhythmia in Arrhythmogenic Cardiomyopathy—Towards Safer Exercise Options
Key result
Strength exercise shows no link to sustained VA in arrhythmogenic cardiomyopathy, unlike endurance exercise.
- n=355
Why the study?
Current guidelines restrict high-intensity aerobic exercise and competitive sports in individuals with ACM or P/LP gene variants, but the impact of strength-based exercise is poorly understood.
Does strength-based exercise increase the risk of sustained ventricular arrhythmia in individuals with arrhythmogenic cardiomyopathy?
Study Design
Type
Cohort (n=355)
Structured PICO
Does strength-based exercise increase the risk of sustained ventricular arrhythmia in individuals with arrhythmogenic cardiomyopathy?
P
Population
355 individuals with arrhythmogenic cardiomyopathy or pathogenic gene variants (median age 34 years) evaluated for the association between lifetime exercise exposure and ventricular arrhythmia.
E
Exposure
Strength-based exercise (strength athletes)
C
Comparator
Sedentary lifestyle, endurance exercise (endurance athletes), or a combination (dual athletes)
O
Outcome
Risk of sustained ventricular arrhythmia (VA)hard clinical
Strength-based exercise is not associated with an increased risk of sustained ventricular arrhythmias in patients with arrhythmogenic cardiomyopathy, suggesting it may be a safer exercise option compared to endurance sports.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“There have been a lot of questions about the safety of strength training for people living with or at risk for arrhythmogenic cardiomyopathy. This study opens the door to help researchers further assess this - and supports continued shifts with moving away from blanket recommendations for exercise to support personalized decision-making between physicians and patients.”
Implication
Strength training not linked to VA in ACM; leaves open whether it is safer than endurance exercise pending prospective trials.
Abstract
BACKGROUND: Arrhythmogenic cardiomyopathy (ACM) is a genetic heart disorder characterized by fibrofatty replacement of ventricular myocardium, sustained ventricular arrhythmia (VA), and elevated risk of sudden death. Current guidelines restrict high-intensity aerobic exercise and competitive sports in individuals with ACM or at risk due to pathogenic/likely-pathogenic (P/LP) gene variants; however, the impact of strength-based exercise is poorly understood. OBJECTIVES: This study sought to evaluate the risk of VA in individuals with ACM and/or P/LP ACM gene variants exposed to strength-based exercise. METHODS: Participants were from the Johns Hopkins ARVC Registry. Exercise exposure was assessed via telephone from age 10 through follow-up. Participants were stratified into 4 groups: dual athlete, endurance athlete, strength athlete, and sedentary. Kaplan-Meier curves visualized the impact of endurance vs strength exercise on VA risk. Cox proportional hazards regression tested independent associations between strength exercise and VA. RESULTS: 355 individuals were enrolled, with median age 34 years; 55% were dual athletes, 26% sedentary, 12% endurance athletes, and 7% strength athletes. Overall lifetime risk of VA was higher with increased aerobic exercise (dual + endurance) than without (strength + sedentary). There was no difference between dual vs endurance athletes, nor strength athletes vs sedentary. A multivariable Cox regression showed no association of VA with strength training, whereas risk of endurance exercise was significant. CONCLUSIONS: Our study found no association between strength exercise and risk of sustained VA. These findings support individualized risk stratification and shared decision-making in ACM care and show the need for additional studies to guide recommendations.
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Chiampas et al. (2026) conducted a cohort in Arrhythmogenic cardiomyopathy (n=355). Strength-based exercise vs. Sedentary lifestyle was evaluated on Sustained ventricular arrhythmia. Strength-based exercise (7% of 355 patients) was not associated with sustained ventricular arrhythmia in arrhythmogenic cardiomyopathy, whereas endurance exercise significantly increased risk.