Fit Hearts, Better Outcomes? A Systematic Review and Meta-Analysis of Exercise Intensity and Peak VO2 in Hypertrophic Cardiomyopathy.

Background: This study aimed to systematically review and analyze the available evidence on the safety and efficacy of physical activity (PA) in patients with HCM. Methods: We conducted a systematic search of PubMed, Cochrane, and Web of Science databases up to March 30, 2025. Fourteen studies (4 RCTs) were included in the qualitative synthesis and ten in the quantitative synthesis, totaling 10478 patients. Results: The meta-analysis demonstrated a significant improvement in peak VO2 in the moderate intensity PA (MIPA) group, with a mean difference of 1.77 mL/kg/min (95% CI: 0.93 to 2.60, I2 = 38.2%, p = 0.19), while changes in body mass index were not significant (MD: -0.66 kg/m2; 95% CI: -1.77 to 0.44; I2 = 62%; p = 0.07). No significant differences were observed in the occurrence of non-sustained ventricular tachycardia (NSVT) (OR = 1.54, 95% CI: 0.93 to 2.52, I2 = 28.3%, p = 0.24), atrial fibrillation (OR = 0.89, 95% CI: 0.77 to 1.03, I2 = 28.6%, p = 0.23), or syncope (OR = 1.23, 95% CI: 0.72 to 2.10, I2 = 25.6%, p = 0.24) between the MIPA and sedentary group. Additionally, the occurrence of NSVT between the high-intensity PA and MIPA group showed no significant difference (OR = 1.19, 95% CI: 0.60 to 2.36, I2 = 0%, p = 0.99). Conclusion: The results suggest that regular exercise does not increase the risk of NSVT, AF, or syncope while enhancing peak VO2, indicating that regular exercise is safe and beneficial in HCM patients.