Hypertrophic cardiomyopathy (HCM) is a genetic condition that makes the heart’s left ventricle thick and stiff, which prevents blood from circulating well. HCM doesn’t always cause noticeable symptoms. But it’s one of the most common causes of sudden cardiac death in people under 35 (including young competitive athletes).

People diagnosed with HCM are naturally left wondering whether they should avoid physical activity altogether. Studies show that only around 45 percent of those with HCM get enough physical activity. But if you’re careful, you can still enjoy the benefits of exercise to improve your health and quality of life with HCM.

1. Talk to Your Doctor Before You Exercise

Cardiologists (heart doctors) used to tell people with HCM not to exercise as a precaution, but that guidance has changed. Doctors now advise people with HCM to speak with their healthcare providers about finding the right exercise program based on their needs. After all, physical activity helps people with hypertrophic cardiomyopathy avoid the heart problems linked to a sedentary lifestyle, like hypertension (high blood pressure), obesity, and high cholesterol.

Cardiologists used to tell people with HCM not to exercise, but that guidance has changed. Doctors now advise working with a healthcare provider to find the right exercise program.

It’s crucial to work with your cardiologist on an individualized exercise prescription. Overall, the American Heart Association encourages regular exercise for people with HCM. However, some people need to be monitored before starting an exercise program. Your cardiologist may want you to stick to a certain level of exercise intensity, depending on your condition.

Learn How To Monitor Your Target Heart Rate

One way to measure exercise intensity involves the percentage of heart rate reserve (HRR). Your HRR is calculated by subtracting your resting heart rate from your maximum predicted heart rate. Resting heart rate describes how many times your heart beats per minute when resting (like first thing in the morning before getting out of bed).

You can get an idea of your maximum predicted heart rate by subtracting your age in years from the number 220. You then simply subtract your resting heart rate from your maximum heart rate to get your heart rate reserve.

To measure your heart rate:

1. Firmly press the three middle fingers of one hand against your wrist, neck, or elbow or the top of your foot. Apply enough pressure so that you can feel a gentle pulsing sensation.
2. While watching a clock or timer, count how many beats you feel for 30 seconds.
3. Double that amount, and you’ll get your heart rate per minute.

You could also use a more high-tech alternative to measure your heart rate. For instance, some wearables — like an Apple Watch or a chest strap created for fitness monitoring — keep a digital record of your heart rate that you can then share with your cardiologist. Keep in mind that these may not be as accurate as measuring your heart rate using the method above.

Once you know your HRR, you can monitor how you feel during different levels of exercise and stick to the goals your healthcare provider recommends for you.

If you’re not sure how to calculate your HRR or want reassurance, ask your healthcare provider for help at your next follow-up visit. Although it’s a good way to start knowing your body better, this method isn’t always accurate. A cardiopulmonary exercise test or stress test is the best way to evaluate your risk and determine what kind of exercise is best for you.

People with HCM often take beta-blockers, and that makes HRR methods less useful. Doctors prefer to create exercise plans by evaluating each person individually and deciding together what’s best, rather than using fixed numbers.

2. Ask Your Cardiologist About Safe Exercises

Once you know your target HRR and have a way to track it, you can create a safe exercise plan with your cardiologist. There’s no single best exercise for hypertrophic cardiomyopathy, and you don’t have to get involved in competitive sports — your exercise plan can be tailored to your own preferences and abilities.

Many people with HCM can participate in vigorous exercise with their doctor’s approval after a comprehensive risk evaluation. Also, competitive sports aren’t universally restricted anymore, but you should assess your risk and seek medical counseling before choosing to play them.

Many people with HCM can participate in vigorous exercise with their doctor’s approval after a comprehensive risk evaluation.

There also aren’t blanket hypertrophic cardiomyopathy exercise restrictions. Everyone with HCM will have different exercise recommendations, based on their abilities and limitations. However, general guidelines for safe exercise include:

• Warming up first to increase your heart rate gradually
• Starting with shorter periods of activity and working up to longer workouts
• Not holding your breath when lifting weights or working out
• Not rapidly changing positions, like going from lying down to standing
• Choosing consistent movement over fast bursts, alternating intense activity and rest
• Finishing by cooling down and returning to a resting state

3. Consider Your Environment

If you’re anxious about exercising with HCM, picking the right setting and conditions for exercise can give you peace of mind. It’s a good idea for people with any type of heart disease to avoid exercising in extreme temperatures, especially cold and windy weather.

Reach Out to People Who Can Help You Stay Safe

People with HCM may have arrhythmias (irregular heart rate) that, in some cases, may lead to sudden cardiac arrest. A device called an automated external defibrillator (AED) allows others to administer lifesaving shocks to the heart if an emergency occurs.

Many public places have AEDs readily available and require staff to undergo training so they’re ready to jump into action if needed. Before joining a gym or other exercise facility, ask if they have a defibrillator and staff who know how to use it.

Many public places have AEDs available and staff who can jump into action if needed. Before joining an exercise facility, ask if they have a defibrillator and trained staff.

Some people with HCM have an implantable cardioverter defibrillator or permanent pacemaker to help control an irregular heart rhythm. If you have either device, you may feel more comfortable informing exercise facility staff about your condition. You can also wear a medical ID bracelet or keep a card in your wallet that alerts others to your heart condition if you become unconscious or have an adverse event.

Exercising with a partner, in group classes, or in places with other people around ensures you’re not alone if you need help. If you notice unusual symptoms while exercising, like shortness of breath, lightheadedness, or chest pain, you can take a break, knowing that others are around if you need assistance.

4. Track Your Starting Point and Goals

If you have HCM, be mindful of your starting point when beginning a new exercise routine. If you’re new to exercise or haven’t worked out for a while, you’ll want to take it slow and pay attention to how you feel.

Pace yourself when increasing your frequency, intensity, duration, or type of exercise. You can also keep a detailed log of your workout and resulting heart rate changes, and regularly share it with your cardiology provider to ensure that your exercise plan is on the right track.

Get Medical Advice if You’re Unsure How To Start or Set Goals

Be sure to get regular checkups and keep your doctor informed about any changes to your exercise plan. You may want to start with exercise supervised by a physical therapist or follow a cardiac rehab program. A stress test that monitors your heart rate during exercise will give your cardiologist a better idea of your current exercise capacity so you can observe changes over time.

Exercise isn’t just good for heart health — it’s also good for your mental well-being. People with HCM can enjoy recreational exercise with shared decision-making and guidance from their healthcare team. Instead of staying on the bench, learn about your risk factors and safe level of exercise so you can stay in the game — on your terms.

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On MyHeartDiseaseTeam, people share their experiences with heart disease, get advice, and find support from others who understand.

What tips have worked for you when exercising with hypertrophic cardiomyopathy? Let others know in the comments below.