Is exercise safe for people with an inherited heart condition?

多年来, people with a genetic condition causing thickening of the heart muscle, known as hypertrophic cardiomyopathy, have received confusing advice on exercise.

New guideline revisions aim to clear things up. 他们指出，锻炼不仅重要而且健康，而且一些患有这种疾病的人, 如果监控得当, might be able to play sports safely at even elite levels.

的 更新指南, published Wednesday in the 美国心脏协会 journal Circulation, 确认轻度和中等强度的休闲运动对肥厚性心肌病患者有益, 博士说. Steve Ommen是明尼苏达州罗切斯特市梅奥肥厚性心肌病诊所的医学主任.

更新补充说，如果患者得到仔细的年度评估，剧烈运动是“合理的”, 说研究, 谁领导了美国心脏协会和美国心脏病学会委员会，并撰写了新的指导方针.

虽然最新的建议延续了之前的建议，即精英水平的运动员需要接受评估和监控, 它指出，肥厚性心肌病不应该自动取消他们参加竞技体育的资格.

Hypertrophic cardiomyopathy, or HCM, is a genetic condition. 当心肌增厚时, the heart does not squeeze out blood efficiently, leading to symptoms of breathlessness and chest pain. HCM affects an estimated 1 in 500 people, but many cases aren't diagnosed. 每年, 研究表示, HCM患者每年发生心脏骤停的风险略低于1%. That rate seems independent of physical activity, 他说.

HCM is treated through medication and surgical procedures. Patients also are encouraged to live a heart-healthy lifestyle. 这包括锻炼.

“我们对HCM患者的目标是他们能够达到和我们其他人一样的身体活动建议,欧曼说. That means at least 150 minutes a week of moderate-intensity aerobic exercise, 75 minutes a week of vigorous aerobic exercise, 或者两者的结合.

Symptoms might prevent that for some people, 他说, "但没有任何症状, 他们应该在一周的大部分线上电子游戏飞禽走兽里进行低强度到中等强度的锻炼. 这既包括心肺运动，也包括阻力/力量训练."

多年来，关于运动的建议一直困扰着医生和患者. 马修·W. 马丁内斯, 莫里斯敦大西洋健康系统肥厚性心肌病和运动心脏病学项目主任, 新泽西.

"Mild to moderate exercise has really been recommended all along,马丁内斯说。, 谁帮助编写了更新. "But the message that patients have been hearing is, 'Don't exercise.'"

Ommen说，这种误解植根于对风险的旧理解.

In the 1980s, people with HCM were limited to low-intensity sports. 关于猝死的早期数据导致了一种“教条”，即HCM应该取消人们参加竞技体育的资格, 研究表示, “无意中, 不幸的是, got extended to: 'Patients with HCM shouldn't exercise vigorously.'"

最近的研究表明，不到10%的年轻人心脏性猝死与HCM有关，运动员的死亡风险并不不成比例.

Other research suggests that for people with HCM, 你锻炼得越多, 你做得越好,马丁内斯说.

之前的更新, in 2020, 指南是第一次明确指出HCM患者应该锻炼吗, 他说. 适度的运动包括一些活动，比如以一种能引起呼吸和心率轻微增加的速度走路, but you're still able to have a conversation, 马丁内兹说. 剧烈运动包括跑步等活动，这些活动会导致心率和呼吸的大幅增加, where it would be difficult to carry on a conversation.

2020年的更新还强调，作为共同决策过程的一部分，医生和患者需要共同评估风险. 那一年, 建议在综合评估后，HCM患者可能能够参加大学和专业级别的体育运动.

最新研究表明，修订后的指南可以更具体地针对HCM和高强度运动, 马丁内斯说, who is a cardiologist for the New York Jets, Major League Soccer and the National Basketball Players Association.

A 研究 发表在2023年5月的《线上电子游戏飞禽走兽》杂志上的一项研究发现，与适度运动或根本不运动的人相比，剧烈运动并不会增加肥厚性心肌病患者的死亡风险. That 研究 involved 1,660 people with the disease.

不久之后, 另一项研究 appeared in the Journal of the American College of Cardiology. It looked at 76 elite athletes with genetic heart diseases, more than half of whom had hypertrophic cardiomyopathy. 马丁内斯, who was senior author on that work, said it showed that when such athletes were evaluated case-by-case, they could safely return to playing sports without any added risk.

的 guidelines now state that "for most patients with HCM, 没有指出普遍限制剧烈体育活动或竞技体育."

的 update reflects that HCM varies from person to person, 马丁内兹说, so advice can't be one-size-fits-all. "What we're now doing is saying, 'You have a disease. 让我们看看你能安全地做什么，让我们看看随着线上电子游戏飞禽走兽的推移你能做什么.'"

Researchers don't have an abundance of data on the risks to elite athletes, 研究表示, 所以限制是存在的.

"We didn't give the green light for everyone to participate,欧曼说. 该指南强调需要对运动员进行单独评估，并每年与肥厚性心肌病专家会面.

When discussing risks with that doctor, 研究表示, anybody with HCM should be asking questions such as, "What are your recommendations for my physical activity? How much exercise should I be doing? 我可以做什么类型的运动? 以及强度是多少?"

Doctors can evaluate someone's risk based on factors such as their age, 家族病史, 个人历史, heart scans and performance on an exercise stress test, 马丁内兹说.

建议可能会不断变化，因为需要更多的研究来确定对各级HCM患者最安全的方法, 马丁内兹说.

Meanwhile, everyone with HCM needs an exercise plan, 他说. "Not only is it safe to do it, but you ought to be doing it."