Individualized Exercise Training in Hypertrophic Cardiomyopathy

Habitual exercise has been shown to improve longevity and reduce mortality. Patients with HCM often have reduced exercise tolerance as the disease progresses. Cardiopulmonary exercise testing (CPET) is often performed to assess quantitative exercise capacity in clinical testing, but questions remain on normative values and how to accurately predict prognosis in individuals with HCM. Peak oxygen consumption (peak VO2) measured by CPET is the gold standard for assessing cardiorespiratory fitness and is an important prognostic marker in cardiovascular health. Prior RCTs have demonstrated that 12 to 20 weeks of exercise training can safely improve peak VO2, hemodynamics, and quality of life in selected patients with HCM. However, existing exercise trials have not included individuals actively treated with CMIs, which represent an emerging standard of care. Further, these exercise intervention trials have not universally included resistance training, despite recommendations in current guidelines. This study aims to evaluate whether an individualized exercise regimen combining endurance and resistance training provides additive improvements in exercise capacity and quality of life for HCM patients on aficamten.

Inclusion criteria

• Age 18-80 years.
• Clinical diagnosis of HCM.
• Able to perform endurance and resistance exercise.
• Currently on stable dose of aficamten
• Not meeting current guideline recommended physical activity recommendations (150-300 minutes of moderate-vigorous physical activity/week, strength training ≥2 times weekly).
• Adequate clinical stability has been achieved (in the judgment of the investigator) to allow participation in study assessments and intervention.
• Signed informed consent indicating that the patient understands the purpose of the study, the procedures required and is willing to participate.

Exclusion criteria

• Residual left ventricular outflow tract obstruction (peak gradient ≥50mmHg at rest).
• Sustained ventricular arrhythmias or ICD shock within 6 months.
• Pregnancy.
• Severe valvular stenosis.
• Large pericardial effusion.
• Recent acute myocarditis (< 3 months).
• Recent acute coronary syndrome or coronary artery bypass < 6 months.
• Recent cardiac medication changes for management of cardiomyopathy.
• Patients with investigational intracardiac devices.