Lifestyle modification: Diet, exercise, sports and other issues

Abstract

Patients with hypertrophic cardiomyopathy face a lifetime of living with a heart condition that is at once heterogeneous, often unpredictable, and poorly understood. Lifestyle adjustments are essential to controlling symptoms, and factors such as diet, fluid intake, caffeine, alcohol and exercise can all have profound effects on patient well-being. However, because HCM physiology can vary widely from patient to patient, physician recommendations must be personalized to each individual patients physiology. Hydration should be encouraged for patients with dynamic LVOT obstruction, but diuretics and strict regulation of fluid balance may be needed when congestion is present. Moreover, although exercise has myriad health benefits, it carries acute risks in HCM patients. Professional guidelines prohibit competitive sports and vigorous recreational activities, and this may have implications on a patients employment. However, strict exercise proscriptions are not warranted, and in most cases exercise should be encouraged as a component of a healthy lifestyle. As with nearly all aspects of HCM patient care, recommendations about lifestyle are not simple but require ongoing conversations tailored to individual patients. These conversations need to be placed in the context of each patients physiology, their risks, and informed by the patients overall life goals. Discussion with the patient and family, often repeated over multiple visits, will be necessary in order to develop the trust and partnership that leads to effective management.