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Basu, J; Nikoletou, D; Miles, C; MacLachlan, H; Parry-Williams, G; Tilby-Jones, F; Bulleros, P; Fanton, Z; Baker, C; Purcell, S; Lech, C; Chapman, T; Sage, P; Wahid, S; Sheikh, N; Jayakumar, S; Malhotra, A; Keteepe-Arachi, T; Gray, B; Finocchiaro, G; Carr-White, G; Behr, E; Tome, M; O’Driscoll, J; Chis Ster, DI; Sharma, S; Papadakis, M. European Heart Journal.

Background and aims: The feasibility and impact of high intensity exercise programmes in patients with HCM is unknown. This study was conducted to determine the feasibility of a high intensity exercise programme and explore safety and efficacy outcomes in patients with HCM. Methods: Participants were randomised to a 12-week supervised exercise programme (n=40) in addition to usual care, or usual care alone (n=40). All participants underwent assessment at baseline and 12-weeks. The exercise group was re-evaluated 6-months post programme. Feasibility was assessed by 1) recruitment, adherence, and retention rates; 2) staffing ratios; 3) logistics and 4) acceptability of the intervention. The primary exploratory safety outcome was a composite of arrhythmia-related events. Exploratory secondary outcomes included changes in 1) cardiorespiratory fitness; 2) cardiovascular risk factors; 3) QoL, anxiety and depression scores. Results: 67 (84%) participants completed the study (n=34 and n=33 in the exercise and usual care groups respectively). Reasons for non-adherence included travel, work, and family commitments. Resource provision complied with national cardiac rehabilitation standards. There was no difference between groups for the exploratory safety outcome (p=0.99). At 12-weeks, the exercise group had a greater increase in peak VO2 (+4.1ml/kg/min, 95%CI 1.1,7.1) and VO2 at anaerobic threshold (+2.3ml/kg/min, 95%CI 0.4, 4.1) lower systolic BP (-7.3mmHg, 95%CI -11.7,-2.8) and BMI (-0.8kg/m2, 95%CI -1.1,-0.4), and greater improvement in hospital anxiety (-3, 95%CI -4.3,-1.7) and depression (-1.7, 95%CI -2.9,-0.5) scores, compared to the usual care group. Most exercise gains dissipated at 6-months. Conclusions: A high intensity exercise programme is feasible in patients with HCM, with apparent cardiovascular and psychological benefits, and no increase in arrhythmias. A large-scale study is required to substantiate findings and assess long-term safety of high intensity exercise in HCM.