Individualized Exercise Training in Hypertrophic Cardiomyopathy

Exercise intervention trials in patients with hypertrophic cardiomyopathy (HCM) have demonstrated an association with improvement in resting and exercise hemodynamics, ventricular remodeling, and anxiety/depression. However, no randomized controlled trials (RCTs) to date have assessed the effects of exercise intervention in patients with HCM on cardiac myosin inhibitors (CMIs). This trial aims to evaluate the efficacy of a 12-week individualized exercise training program in HCM patients receiving aficamten.

Inclusion Criteria: * Age 18-80 years. * Clinical diagnosis of HCM. * Able to perform endurance and resistance exercise. * Currently on stable dose of aficamten * Not meeting current guideline recommended physical activity recommendations (150-300 minutes of moderate-vigorous physical activity/week, strength training ≥2 times weekly). * Adequate clinical stability has been achieved (in the judgment of the investigator) to allow participation in study assessments and intervention. * Signed informed consent indicating that the patient understands the purpose of the study, the procedures required and is willing to participate. Exclusion Criteria: * Residual left ventricular outflow tract obstruction (peak gradient ≥50mmHg at rest). * Sustained ventricular arrhythmias or ICD shock within 6 months. * Pregnancy. * Severe valvular stenosis. * Large pericardial effusion. * Recent acute myocarditis (\< 3 months). * Recent acute coronary syndrome or coronary artery bypass \< 6 months. * Recent cardiac medication changes for management of cardiomyopathy. * Patients with investigational intracardiac devices.