Exercise and Transthyretin Cardiac Amyloidosis (ATTR-CM)
Rare DiseasesAmyloidosis

How to Exercise With ATTR-CM

How to Exercise With ATTR-CM
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Updated on October 22, 2025
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Living with transthyretin cardiac amyloidosis (ATTR-CM) can make everyday movement difficult.

When you have this rare heart condition, blood protein deposits form amyloid fibrils that cause the heart to stiffen, so it doesn’t relax and fill as easily between beats. This can lead to shortness of breath, lightheadedness, and swollen legs.

With your doctor’s approval and supervision, however, exercise can be not only safe for many people with ATTR-CM but also beneficial. The key is to work out safely and within your limits while heeding advice from your healthcare team.

The Benefits of Exercise With ATTR-CM

There is no research that tests how exercise specifically affects people with ATTR-CM, though trials are underway.

But there is evidence that exercise is beneficial for people with heart failure, an eventual complication of ATTR-CM.

Exercise benefits for people with ATTR-CM may include:

  • Reduced risk of hospitalization
  • Improved quality of life

In general, says Ajay Vallakati, MBBS, an advanced heart failure and transplant cardiologist at The Ohio State University Wexner Medical Center in Columbus, Ohio, exercise can provide numerous benefits that are important for people with ATTR-CM. These include:

  • Muscle strength
  • Circulation
  • Reducing inflammation
  • Breathing mechanics
  • Stamina and how your body uses oxygen

The Risks of Exercise With ATTR-CM

Poor exercise tolerance, fatigue, and shortness of breath are common in people with ATTR-CM.

 This can make it uncomfortable to exert yourself.

Exercising too hard can also cause exhaustion, chest pain, and lightheadedness, says Anusha Sunkara, MD, an advanced heart failure and transplant cardiologist with Banner Health in Phoenix, Arizona.

Because heart arrhythmias are also common in people with ATTR-CM, your exercise must be monitored carefully to make sure it’s not making symptoms of atrial fibrillation or ventricular tachycardia worse, Dr. Sunkara says.

If you experience dizziness when standing, exercise may also increase your risk of falling, Dr. Vallakati says.

How to Start

It’s essential to consult your doctor and healthcare team before starting any exercise program if you have ATTR-CM. They can help you decide whether it is safe to exercise and what next steps might be.

Determine Your Capacity

Your doctor may start by establishing your baseline and exercise capacity using cardiopulmonary exercise testing (CPET).

“CPET measures how the heart, lungs, blood vessels all work together to take oxygen out of the air and deliver it to the muscles to do work,” Sunkara says.

You perform the CPET on a stationary bike or treadmill under the supervision of healthcare and exercise professionals. The test can show how much oxygen your body can use when you exert yourself. This can help your doctor determine how long and how hard you can exercise.

“It’s the best way to keep someone in the safer aerobic range (of heart rates and exercise intensity),” Sunkara says.

Develop a Program

Your cardiologist may partner with a rehabilitation specialist and exercise physiologist to build your exercise plan, suggest modifications, and monitor your progress, Sunkara says.

“These programs can significantly improve strength, reduce symptoms like lightheadedness, and lower the risk of falls, especially in people with ATTR-CM,” Vallakati says.

Often, cardiac rehabilitation programs begin with low- to moderate-intensity exercises, especially activities that you already like and will do regularly, Sunkara says.

“Many patients haven’t exercised regularly for a while,” she says. “Slow and steady ensures tolerance, safety, and persistence.”

Regular walking is ideal, she says. If you have neurologic, muscular, and joint issues, working on flexibility and stretching is also helpful.

“Resistance and light weight training with more repetitions rounds out a safe and helpful exercise routine,” Sunkara says.

Workouts can take place in a rehab facility or at home, depending on the plan your healthcare team builds with you.

Check In Frequently

It is important to ensure your exercise is monitored and that you report any changes or complications to your healthcare team. ATTR-CM is chronic and progressive, so your capacity for safe activity can change.

Your tolerance and capacity for exercise may increase as you exercise more, Sunkara says. Small studies have shown that some medications, such as tafamidis (Vyndaqel, Vyndamax), may help boost or maintain exercise tolerance, especially if your exercise capacity is already low.

“Similarly, worsening in exercise capacity can be a signal to consider reevaluation of current therapies and alternatives to current treatments,” she says.

Some shortness of breath or a faster heart rate is expected when you exercise. But if you experience symptoms of a more serious condition, stop your exercise and call your doctor. These symptoms include:

  • Chest discomfort
  • Excessive shortness of breath
  • Rapid heart rate that does not go away after 15 minutes of rest
  • Dizziness
  • Weakness

The Takeaway

  • Exercise can boost strength, endurance, and mood for many people with ATTR-CM, though researchers are still studying how different exercise types affect long-term outcomes.
  • Fatigue and shortness of breath are side effects of ATTR-CM that can make exercise difficult and pose risks of complications from overdoing it.
  • Talking to your doctor before exercising with ATTR-CM is vital to determining whether you can exercise and if so, at what intensity and for how long.
  • Your tolerance for exercise may improve or wane depending on your health situation, so it’s important to check in often with your healthcare team.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Marra AM. Exercise Training and Rehabilitation In Cardiac Amyloidosis (ERICA). ClinicalTrials.gov. May 14, 2024.
  2. Jain A et al. Transthyretin Amyloid Cardiomyopathy (ATTR-CM). StatPearls. April 27, 2023.
  3. Bazoukis G et al. Atrial Fibrillation in the Setting of Cardiac Amyloidosis – a Review of the Literature. Journal of Cardiology. September 1, 2024.
  4. Cardiopulmonary Exercise Testing (CPET) Lab. Massachusetts General Hospital.
  5. Shibata A et al. Effect of Tafamidis Therapy on Physical Function in Patients With Wild-Type Transthyretin Cardiac Amyloidosis. Journal of Cardiology. June 1, 2025.
  6. Heart Failure: Exercise and Activity. Cleveland Clinic.
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Anurag Sahu, MD

Medical Reviewer
Castle Connolly Top Doctor

Anurag Sahu, MD, is the director of the adult congenital heart program at Inova Health System in Fairfax, Virginia. Previously, he was an associate professor of medicine as well as an associate professor of radiology at Emory University in Atlanta, where he also served as director of cardiac intensive care.

He attended medical school at the University of Missouri in Kansas City in its combined six-year BA/MD program. He then completed his internal medicine residency at Washington Hospital Center in Washington, DC; fellowship training at Rush University in Chicago; and advanced training in cardiac imaging and adult congenital heart disease at The Ohio State University in Columbus.

Dr. Sahu has published book chapters on cardiovascular imaging as well as a variety of journal articles in publications including The Journal of Heart and Lung Transplant, JACC: Cardiovascular Interventions, and the Journal of Thoracic Imaging.

Among the places that his career has taken him, his favorite was Kauai, Hawaii, where he was the only cardiologist on the island.

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Becky Upham

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Becky Upham has worked throughout the health and wellness world for over 25 years. She's been a race director, a team recruiter for the Leukemia and Lymphoma Society, a salesperson for a major pharmaceutical company, a blogger for Moogfest, a communications manager for Mission Health, a fitness instructor, and a health coach.

Upham majored in English at the University of North Carolina and has a master's in English writing from Hollins University.

Upham enjoys teaching cycling classes, running, reading fiction, and making playlists.

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