{
  "abstract": "Background Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death (SCD) among young individuals and athletes. Despite increasing evidence supporting exercise, uncertainty remains about its safety and efficacy in this population.Methods We systematically reviewed randomised controlled trials (RCTs) comparing structured exercise interventions with usual care in patients with HCM. The primary outcome was peak oxygen consumption (pVO₂). Random-effects meta-analysis and trial sequential analysis (TSA) were applied to assess efficacy and robustness of evidence.Results Four RCTs (n=290) were included, enrolling predominantly low-risk, non-obstructive HCM patients with mild functional limitation (mean left ventricular ejection fraction (LVEF) 66%). Exercise improved pVO₂ (mean difference (MD) 1.81 mL/kg/min; 95% CI 1.01 to 2.61; p<0.01), confirmed by TSA. Exercise also reduced left ventricular wall thickness (MD −0.56 mm; 95% CI −0.97 to −0.16) and body mass index (MD −0.65 kg/m²; 95% CI −1.05 to −0.25) without significant changes in LVEF or left ventricular outflow gradients. No increase was observed in arrhythmias, syncope, SCD or other adverse events. However, the total number of RCTs and participants was small, and all studies primarily involved mild, non-obstructive phenotypes, limiting generalisability.Conclusions In patients with mild, non-obstructive HCM, structured exercise appears safe and improves functional capacity and cardiometabolic parameters without adverse ventricular effects. Larger multicentre RCTs including higher-risk phenotypes are warranted to confirm safety and define optimal training strategies.PROSPERO registration number CRD420251012232.",
  "authors": [
    {
      "affiliations": [
        "Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil",
        "Sírio-Libanês Ensino e Pesquisa, São Paulo, Brazil"
      ],
      "name": "Vinicius Machado Correia"
    },
    {
      "affiliations": [
        "Universidade do Sul de Santa Catarina, Palhoça, Brazil"
      ],
      "name": "Vicente Morales Ribeiro"
    },
    {
      "affiliations": [
        "Universidade do Sul de Santa Catarina, Palhoça, Brazil"
      ],
      "name": "Rafael Henkes Machado"
    },
    {
      "affiliations": [
        "Centro Universitário Redentor, Itaperuna, Brazil"
      ],
      "name": "Maria L R Defante"
    },
    {
      "affiliations": [
        "Centro Universitário Redentor, Itaperuna, Brazil"
      ],
      "name": "Kevlin de Souza"
    },
    {
      "affiliations": [
        "Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil",
        "Sírio-Libanês Ensino e Pesquisa, São Paulo, Brazil"
      ],
      "name": "José Roberto de Oliveira Silva Filho"
    },
    {
      "affiliations": [
        "Internal Medicine, Albert Einstein Israelite Hospital, São Paulo, Brazil"
      ],
      "name": "Douglas Nunes Cavalcante"
    },
    {
      "affiliations": [
        "Albert Einstein Israelite Hospital, São Paulo, Brazil"
      ],
      "name": "Vagner Madrini Junior"
    },
    {
      "affiliations": [
        "Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Rhanderson Cardoso"
    },
    {
      "affiliations": [
        "Cardiomyopathy, Heart Institute FMUSP, São Paulo, Brazil"
      ],
      "name": "Fabio Fernandes"
    }
  ],
  "title": "Exercise training in hypertrophic cardiomyopathy: a meta-analysis of randomised trials with trial sequential analysis",
  "uid": "71ccc5ae-5ce3-5c19-98a6-d7505bc1d375"
}