{
  "abstract": "Background Hypertrophic cardiomyopathy (HCM) is the most common autosomal dominant cardiac disorder, affecting 1 in 500 individuals worldwide. The condition is associated with an increased vulnerability to life threatening complications and adverse outcomes, including heart failure, cerebrovascular accident and sudden cardiac death (SCD). However, HCM is most feared for its association with SCD; therefore, one notable area of discussion pertains to the prescription of high-intensity or vigorous exercise therapies. The appropriateness of such activities for individuals with HCM remains a contentious issue, requiring careful consideration of the potential risks and benefits involved. We conducted a systematic review and meta-analysis to evaluate and compare the longitudinal clinical and functional outcomes for individuals with HCM participating in moderate or vigorous activity compared with usual activity.Methods This study protocol was registered in the PROSPERO registry (CRD420201069317) and the review was conducted as per the PRISMA guidelines. MEDLINE, EMBASE, EBSCO, and the Cochrane Library were searched for relevant studies from inception till May 1st, 2020. Results were synthesised using a random effects meta-analysis. Risk of bias (ROB) assessment was carried out with the RoB 2 and ROBINS-I tool.Results From a total of 6,301 references identified, 155 full tests were assessed and 15 studies (4 RCTs, 4 prospective studies, and 7 retrospective studies) were included in the review. The pooled population across all studies were 10,391 patients, with 3915 and 6476 patients in the exercise and control cohorts, respectively. Regarding exercise cohorts of interest, there was a total of 3, 5 and 3 studies evaluating athletes, high intensity exercise regimes, and moderate intensity exercise regimes, respectively. There was no significant different in the occurrence of sudden cardiac death (Log RR 0.16 (95% CI -0.53 to 0.85, I 2=0.00, P=0.95) (figure 1) or sustained ventricular tachycardia (Log RR -0.06 (95% CI -1.39 to 1.27, I2=0.00%, P=0.93) on follow-up between the exercise and control cohort. There was a statistically significant reduction in all-cause mortality for the exercise cohort in comparison to the control cohort (Log RR -0.42 (95% CI -0.56 to -0.29, I2=0.00%, P<0.05). There were no significant differences in the LVOT gradient on exertion(MD (-)1.81 (95% CI -14.8 to 11.2, I2=74.1%, P=0.79) on follow-up.Conclusion In conclusion, the findings from our systematic review and meta-analysis conveyed no significant differences in adverse events and life-threatening arrhythmias for individuals with HCM who engage in moderate to high-intensity physical activity when compared to usual activity. While these preliminary outcomes are reassuring, an individualised approach with shared decision-making is crucial due to the diverse range of phenotypic expressions associated with this disease along with the methodological limitations of this study.",
  "authors": [
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom, Liverpool, United Kingdom",
        "Department of Cardiology, Royal Albert Edwards Infirmary, WWL NHS Foundation Trust, Wigan, United Kingdom"
      ],
      "name": "Akash Mavilakandy"
    },
    {
      "affiliations": [
        "Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust,, Gloucester, United Kingdom"
      ],
      "name": "Samuel Parker"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Lancaster Infirmary, University Hospitals of Morecombe NHS Trust, Lancaster, United Kingdom"
      ],
      "name": "Saneea Saeed"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom"
      ],
      "name": "Abdulmalik Koya"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Lancaster Infirmary, University Hospitals of Morecombe NHS Trust, Lancaster, United Kingdom"
      ],
      "name": "Amit Shrestha"
    },
    {
      "affiliations": [
        "Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom",
        "Manchester University NHS Foundation hospitals, Manchester, United Arab Emirates"
      ],
      "name": "Aneil Malhotra"
    },
    {
      "affiliations": [
        "Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom",
        "Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark",
        "Department of Cardiology, Lipidology and Internal Medicine with Intensive Coronary Care Unit, Medical University of Bialystok, Bialystok, Poland"
      ],
      "name": "Gregory Lip"
    },
    {
      "affiliations": [
        "Cardiovascular and Genomic Research Institute, City St George’s, University of London, London, United Kingdom",
        "Cardiovascular Clinical Academic Group, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom"
      ],
      "name": "Sanjay Sharma"
    },
    {
      "affiliations": [
        "Department of Cardiology, Amrita Institute of Medical Sciences and Research, Kochi, India"
      ],
      "name": "Hisham Ahamed"
    }
  ],
  "title": "428 The prescription of moderate and high intensity exercise in patients with hypertrophic cardiomyopathy: a systematic review and meta-analysis",
  "uid": "fd3121be-75fc-5eec-b9a4-4bc05634abcd"
}