Best Exercises for Hypertrophic Cardiomyopathy

You may have heard conflicting advice about whether exercise is wise when you have hypertrophic cardiomyopathy (HCM) — a genetic condition that makes your heart muscle thick and stiff.

“The goal is for patients with HCM to achieve the same recommended levels of physical activity as the general population, whenever possible,” says Regina Lief, MD, an advanced heart failure and transplant cardiologist at White Plains Hospital in White Plains, New York. “That’s at least 150 minutes of moderate-intensity aerobic exercise per week, 75 minutes of vigorous aerobic exercise per week, or a combination of both.”

Types of Exercise/Movement for HCM

A range of low- to moderate-intensity exercise is generally recommended for people with HCM, but it should be tailored to your individual symptoms and capabilities.

Aerobic Exercise

Aerobic exercise is activity that gets your heart rate up, also referred to as cardio.

“Walking, hiking, cycling, swimming, and using an elliptical machine are often good options because they allow those with HCM to improve their cardiovascular fitness without placing excessive stress on the heart,” says Joe Hribick, DPT, a clinical assistant professor of physical therapy at Lebanon Valley College in Annville, Pennsylvania.

Resistance Training

Light to moderate strength training should also be part of an exercise regimen, as it is important for muscle and bone health. “When done regularly, these forms of exercise can help improve endurance, energy levels, sleep quality, mood, stress management, and overall quality of life,” says Dr. Hribick.

“These activities should be performed with proper breathing and without straining,” Hribick says.

How to Select and Start a Routine

There isn’t one ideal exercise routine for people living with HCM: It largely boils down to individual preference, health status, and physical ability.

The first step is an assessment of your heart health. “Cardiologists use tools such as echocardiograms, cardiac MRIs, and heart rhythm monitors to help risk stratify patients,” says Dr. Lief.

• What is your pulse rate before and right after walking 1 mile?
• How long does it take to walk 1 mile?
• How many standard or modified pushups can you do in a row?
• How good is your range of motion in places like your hips, knees, ankles, shoulders, and elbows?
• What is your waist circumference?

Choosing Your Workout

After you get the green light from your cardiologist, the next step is to determine your own personal fitness goals. For example, do you want to improve your overall health, or gain strength and build more stamina? Are you interested in mastering a new skill, such as learning to swim or do the tango?

Other important considerations: Do you prefer to exercise solo, or would you enjoy a group class or sport? Do you want to be inside or outside? What kind of gear will you need?

“Simple and functional tasks such as walking, jogging, swimming, and body-weight resistance exercises are great recommendations because they do not require much equipment,” says Leo Arguelles, DPT, a cardiovascular and pulmonary physical therapist based in Chicago and a spokesperson for the American Physical Therapy Association.

You may want to try out some different activities and workouts to see what you enjoy and what feels good in your body. It may also help to consult a physical therapist, who can tailor an exercise plan to your individual circumstances.

“Physical therapists offer modifications for cardio and strength training goals and education on breathing techniques,” says Dr. Arguelles. “They educate about overexertion and warning signs to ensure safe progression of intensity during a workout.”

Whatever you choose, experts agree you should take it slowly.

“The most successful exercise program is often the one that is enjoyable enough to become a habit,” says Lief. “Starting slowly and gradually increasing activity is usually better than trying to do too much too soon.”

“The focus should be on consistency and incremental, steady progress,” says Arguelles.

When to Push, When to Stop

There will be some days when you just don’t feel like exercising. If you’re having an “off” day, try taking it down a notch. “If you’re tired or didn’t sleep well, you may do a shorter workout or at a lower intensity,” Arguelles says. “It’s okay if you have to downgrade or modify your exercise regimen by working at a slower pace or decreasing overall intensity or time.”

Hribick says to skip exercising altogether if you experience symptoms such as a fever, severe migraine symptoms, uncontrolled symptoms related to HCM, or anything that substantially affects your ability to safely do the workout. “Exercise should challenge you, but it shouldn’t make you feel unsafe,” he says. “Sometimes recovery is the healthiest choice if your body is giving you signals that you need to rest.”

If you start to feel bad while you’re working out, don’t push yourself. “You might get some discomfort and fatigue when exercising,” says Arguelles. “These symptoms should be relieved if you stop the exercise and rest for a moment.”

If not, get medical attention. Hribick says to never ignore these “red flag” symptoms:

• Chest pain or pressure
• Significant shortness of breath that feels unusual for the activity
• Dizziness or lightheadedness
• Fainting or feeling like you may faint
• Rapid, irregular, or racing heartbeats
• Sudden, severe fatigue during exercise
• Unexplained weakness
• Any symptom that feels significantly different from your normal exercise experience

“Exercise is beneficial for many people with HCM, but it should be performed thoughtfully, monitored appropriately, and customized for the individual,” Hribick says. “The goal is not to avoid activity. It’s to find safe ways to stay active and enjoy all of the physical and mental health benefits that exercise can provide.”