Randomized Controlled Trial of Moderate‐ and High‐Intensity Exercise Training in Patients With Hypertrophic Cardiomyopathy: Effects on Fitness and Cardiovascular Response to Exercise
Background Moderate intensity exercise training (MIT) is safe and effective for patients with hypertrophic cardiomyopathy, yet the efficacy of high intensity training (HIT) remains unknown. This study aimed to compare the efficacy of HIT compared with MIT in patients with hypertrophic cardiomyopathy...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031399 |
| _version_ | 1797301692802269184 |
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| author | James P. MacNamara Katrin A. Dias Christopher M. Hearon Erika Ivey Vincent A. Delgado Sophie Saland Mitchel Samels Michinari Hieda Aslan T. Turer Mark S. Link Satyam Sarma Benjamin D. Levine |
| author_facet | James P. MacNamara Katrin A. Dias Christopher M. Hearon Erika Ivey Vincent A. Delgado Sophie Saland Mitchel Samels Michinari Hieda Aslan T. Turer Mark S. Link Satyam Sarma Benjamin D. Levine |
| author_sort | James P. MacNamara |
| collection | DOAJ |
| description | Background Moderate intensity exercise training (MIT) is safe and effective for patients with hypertrophic cardiomyopathy, yet the efficacy of high intensity training (HIT) remains unknown. This study aimed to compare the efficacy of HIT compared with MIT in patients with hypertrophic cardiomyopathy. Methods and Results Patients with hypertrophic cardiomyopathy were randomized to either 5 months of MIT, or 1 month of MIT followed by 4 months of progressive HIT. Peak oxygen uptake (V˙O2; Douglas bags), cardiac output (acetylene rebreathing), and arteriovenous oxygen difference (Fick equation) were measured before and after training. Left ventricular outflow gradient and volumes were measured by echocardiography. Fifteen patients completed training (MIT, n=8, age 52±7 years; HIT, n=7, age 42±8 years). Both HIT and MIT improved peak V˙O2 by 1.3 mL/kg per min (P=0.009). HIT (+1.5 mL/kg per min) had a slightly greater effect than MIT (+1.1 mL/kg per min) but with no statistical difference (group×exercise P=0.628). A greater augmentation of arteriovenous oxygen difference occurred with exercise (Δ1.6 mL/100 mL P=0.005). HIT increased left ventricular end‐diastolic volume (+17 mL, group×exercise P=0.015) compared with MIT. No serious arrhythmias or adverse cardiac events occurred. Conclusions This randomized trial of exercise training in patients with hypertrophic cardiomyopathy demonstrated that both HIT and MIT improved fitness without clear superiority of either. Although the study was underpowered for safety outcomes, no serious adverse events occurred. Exercise training resulted in salutary peripheral and cardiac adaptations. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03335332. |
| first_indexed | 2024-03-07T23:26:17Z |
| format | Article |
| id | doaj.art-f4ac8805157d457388a80ac07b1dacdc |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T23:26:17Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f4ac8805157d457388a80ac07b1dacdc2024-02-21T04:31:11ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-10-01122010.1161/JAHA.123.031399Randomized Controlled Trial of Moderate‐ and High‐Intensity Exercise Training in Patients With Hypertrophic Cardiomyopathy: Effects on Fitness and Cardiovascular Response to ExerciseJames P. MacNamara0Katrin A. Dias1Christopher M. Hearon2Erika Ivey3Vincent A. Delgado4Sophie Saland5Mitchel Samels6Michinari Hieda7Aslan T. Turer8Mark S. Link9Satyam Sarma10Benjamin D. Levine11Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas Dallas TX USAInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas Dallas TX USAInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas Dallas TX USAInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas Dallas TX USAUniversity of Texas Southwestern Medical Center Dallas TX USAInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas Dallas TX USAInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas Dallas TX USADepartment of Medicine and Biosystemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of Medicine Kyushu University Fukuoka JapanUniversity of Texas Southwestern Medical Center Dallas TX USAUniversity of Texas Southwestern Medical Center Dallas TX USAInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas Dallas TX USAInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas Dallas TX USABackground Moderate intensity exercise training (MIT) is safe and effective for patients with hypertrophic cardiomyopathy, yet the efficacy of high intensity training (HIT) remains unknown. This study aimed to compare the efficacy of HIT compared with MIT in patients with hypertrophic cardiomyopathy. Methods and Results Patients with hypertrophic cardiomyopathy were randomized to either 5 months of MIT, or 1 month of MIT followed by 4 months of progressive HIT. Peak oxygen uptake (V˙O2; Douglas bags), cardiac output (acetylene rebreathing), and arteriovenous oxygen difference (Fick equation) were measured before and after training. Left ventricular outflow gradient and volumes were measured by echocardiography. Fifteen patients completed training (MIT, n=8, age 52±7 years; HIT, n=7, age 42±8 years). Both HIT and MIT improved peak V˙O2 by 1.3 mL/kg per min (P=0.009). HIT (+1.5 mL/kg per min) had a slightly greater effect than MIT (+1.1 mL/kg per min) but with no statistical difference (group×exercise P=0.628). A greater augmentation of arteriovenous oxygen difference occurred with exercise (Δ1.6 mL/100 mL P=0.005). HIT increased left ventricular end‐diastolic volume (+17 mL, group×exercise P=0.015) compared with MIT. No serious arrhythmias or adverse cardiac events occurred. Conclusions This randomized trial of exercise training in patients with hypertrophic cardiomyopathy demonstrated that both HIT and MIT improved fitness without clear superiority of either. Although the study was underpowered for safety outcomes, no serious adverse events occurred. Exercise training resulted in salutary peripheral and cardiac adaptations. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03335332.https://www.ahajournals.org/doi/10.1161/JAHA.123.031399arrhythmiascardiac outputexercisefitnesshigh intensityhypertrophic cardiomyopathy |
| spellingShingle | James P. MacNamara Katrin A. Dias Christopher M. Hearon Erika Ivey Vincent A. Delgado Sophie Saland Mitchel Samels Michinari Hieda Aslan T. Turer Mark S. Link Satyam Sarma Benjamin D. Levine Randomized Controlled Trial of Moderate‐ and High‐Intensity Exercise Training in Patients With Hypertrophic Cardiomyopathy: Effects on Fitness and Cardiovascular Response to Exercise Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease arrhythmias cardiac output exercise fitness high intensity hypertrophic cardiomyopathy |
| title | Randomized Controlled Trial of Moderate‐ and High‐Intensity Exercise Training in Patients With Hypertrophic Cardiomyopathy: Effects on Fitness and Cardiovascular Response to Exercise |
| title_full | Randomized Controlled Trial of Moderate‐ and High‐Intensity Exercise Training in Patients With Hypertrophic Cardiomyopathy: Effects on Fitness and Cardiovascular Response to Exercise |
| title_fullStr | Randomized Controlled Trial of Moderate‐ and High‐Intensity Exercise Training in Patients With Hypertrophic Cardiomyopathy: Effects on Fitness and Cardiovascular Response to Exercise |
| title_full_unstemmed | Randomized Controlled Trial of Moderate‐ and High‐Intensity Exercise Training in Patients With Hypertrophic Cardiomyopathy: Effects on Fitness and Cardiovascular Response to Exercise |
| title_short | Randomized Controlled Trial of Moderate‐ and High‐Intensity Exercise Training in Patients With Hypertrophic Cardiomyopathy: Effects on Fitness and Cardiovascular Response to Exercise |
| title_sort | randomized controlled trial of moderate and high intensity exercise training in patients with hypertrophic cardiomyopathy effects on fitness and cardiovascular response to exercise |
| topic | arrhythmias cardiac output exercise fitness high intensity hypertrophic cardiomyopathy |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031399 |
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