What lifestyle modifications should I recommend to patients diagnosed with hypertrophic cardiomyopathy?

For patients diagnosed with hypertrophic cardiomyopathy (HCM), lifestyle modifications should focus on safe physical activity, dietary management, weight control, and avoidance of factors that may exacerbate symptoms or increase risk.

Physical activity: Patients should be encouraged to engage in moderate-intensity aerobic exercise tailored to their symptoms and functional capacity, avoiding high-intensity or competitive sports that may increase the risk of arrhythmias or sudden cardiac events. Exercise should be performed to the point of slight breathlessness but not to exhaustion, and patients with significant symptoms or obstruction should have individualized exercise plans developed in consultation with cardiology specialists. Muscle-strengthening activities on two or more days per week are also recommended if tolerated. Those unable to perform moderate activity due to comorbidities should exercise to their maximum safe capacity ²,⁵.

Diet and weight management: Advise a heart-healthy diet consistent with cardiovascular disease prevention guidelines, such as the NHS Eat Well Guide, emphasizing reduced saturated fat intake (7-10% of total energy), increased mono- and polyunsaturated fats (e.g., olive or rapeseed oil), high intake of fruits and vegetables (at least 5 portions daily), whole grains, and limited salt (<6 g/day). Maintaining a healthy weight is important to reduce cardiac workload and associated comorbidities. Referral to dietetic services may be appropriate for individualized nutritional advice ²,⁵,⁶.

Avoidance of exacerbating factors: Patients should avoid dehydration and excessive alcohol intake (no more than 14 units per week, spread over several days), as these can worsen symptoms. Smoking cessation should be strongly encouraged. Patients should also avoid strenuous isometric exercises and competitive sports due to increased risk of arrhythmias and sudden cardiac death in HCM (Ommen et al., 2020).

Additional considerations: Patients should be educated about their condition, symptom monitoring, and when to seek medical advice. Cardiac rehabilitation programs with tailored exercise and education components may be beneficial. Sexual activity can generally be resumed when comfortable and does not provoke symptoms [1, (Ommen et al., 2020)].