Advanced Program – HCM Fitness for Patients with Hypertrophic Cardiomyopathy (HCM)

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UHN’s hcmfitness.ca Website
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It is important that you read all of the following terms and conditions carefully. This Terms of Use Agreement (“Agreement”) is a legal agreement between you and University Health Network (“UHN”) which is the owner and operator of the Website. This Agreement outlines the terms and conditions under which you may access and use the Website and all written and other materials displayed or made available through the Website such as videos, audio clips, articles, pictures, illustrations, links to third party sites, etc. By using the Website, you accept to be bound by the terms and conditions of this Agreement. If you do not accept these terms and conditions, you must not use the Website. UHN may revise this Agreement at any time without telling you before. Using the Website after UHN makes changes to the terms means that you agree to and accept the revised terms.

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The information presented on this website is in no way intended as medical advice or as a substitute for medical treatment. this information should only be used in conjunction with the guidance and care of your physician. consult your physician before beginning any diet, nutrition, exercise or fitness plan offered through the website. Your physician should allow for proper follow-up visits and individualize your diet, nutrition, exercise or fitness plan as appropriate. Nothing stated or presented on the website is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider if you have any questions regarding a medical condition, your diet, nutritional supplements, an exercise regimen, or any other matter related to your health and well-being.

Health and medical concerns

This Website includes information and instruction relating to exercise and fitness. Before participating in any exercise program or fitness plan that may be described or made accessible in or through the Website, we strongly recommend that you consult with a physician or other healthcare provider. Not all exercises are suitable for everyone. As with any exercise program, if at any point during your workout you begin to feel faint, dizzy, or have physical discomfort, you should stop immediately. You are responsible for exercising within your limits and seeking medical advice and attention as appropriate. UHN and affiliates are not responsible for any injuries that result from participating in the exercises shown in this program.

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If you experience any discomfort or pain during an exercise routine you must immediately cease the activity and seek the assistance of a physician.

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I acknowledge that my participation in the exercise program carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. I understand that the specific risks can and do vary from one activity to another and that these risks range from: (a) minor injuries such as scratches, bruises, and sprains, to (b) major injuries such as eye injury or loss of sight, joint or back injuries, disfigurement, heart attacks, broken bones, torn ligaments and concussions to (c) catastrophic injuries including paralysis and death.

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If you are a Stable Cardiac Patient or an HCM Patient, It is strongly suggested you read these guidelines to understand what level of participation is encouraged, how to navigate your level of exercise intensity and other important safety considerations.

It is encouraged that most stable cardiac patients participate in the American Heart Association (AHA) “Recommendations for Physical Activity in Adults”.

Adults engage in at least 150 minutes of moderate intensity aerobic activity weekly.

Or alternatively, 75 to 150 minutes of vigorous-intensity aerobic exercise weekly.

Cardiac Patients, in particular, patients with HCM who wish to participate at that level are encouraged to discuss their level of participation and Sudden Cardiac Death risk assessment with their Cardiologist or a Cardiologist who specializes in HCM.

AHA Guidelines also encourage 2 sessions of muscular strengthening a week.

Listen to Your Body.

Stop immediately if you develop shortness of breath, chest pain or light headedness with any of your activities.

For Cardiac Patients and HCM Patients, Be Aware of the additional safety considerations:

Do not exercise in extreme environmental conditions such as heat, cold or high humidity.
Ensure you stay well-hydrated before, during and after exercise.
Avoid the Valsalva maneuver, which is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one’s mouth.
Keep your exercise program under 60 minutes. A high volume of exercise can increase the fight or flight response.

Determining Level of Intensity for most HCM Patients:

Exercise intensity can be gauged by level of perceived exertion on the Borg scale. It is suitable for many with HCM to participate in exercises that feel light exertion of 7 to 12, moderate exertion of 13 to 14 or vigorous exertion of ≥15. It is recommended that consultation with an expert physician to determine the risk with activities above 15.

The Borg Scale of Perceived Exertion

20	Maximum Exertion
19	Extremely Hard
18
17	Very Hard
16
15	Hard
14	Somewhat Hard
13
12	Light
11
10	Very Light
9
8	Extremely Light
7
6	No Exertion

Recommended
range to stay within.

If considering low-intensity sports, the aerobic component would not exceed heart rate would be greater than 50% of maximum, or level of perceived exertion would be no higher than 12 on the Borg scale.
Some initial period of supervised exercise may be warranted in some patients because of an abnormal blood pressure response to exercise, a history of ventricular arrhythmias triggered by exercise, or heart failure.
Children with HCM can typically participate in physical education at school, with an exception made that the child not be graded and not be timed or scored for performance. The presence of AEDs near playgrounds and/or facilities can provide a level of reassurance.
Competitive sports are not suggested for HCM patients with an Implantable Cardioverter Defibrillator (ICD).

Determining if Participation in Vigorous Recreational and/or Competitive Sports is suitable for HCM patients:

As disease expression differs between individuals with HCM and the demand by various sports is extensive, it is best to consult with an expert HCM physician before participation in vigorous recreational and/or competitive sports. It is also advised that consultation be repeated annually.

ICD Safety Considerations:

It’s advised that those with an ICD avoid vigorous recreational or completive sports It’s important to avoid activities that could potentially damage the device. You will find “Alternative Exercise Suggestions for Patients with an ICD” listed within each exercise with the Move Well section.
A general rule of thumb is to avoid exercises on the same side of the ICD, that bring the arm over head or the arm out laterally at shoulder level extending behind the shoulder.

Now Let’s Get Moving:

When beginning your exercise program it is best to start with the Beginner Program, especially if you are new to exercise. The Beginner Program offers a way to connect and work with foundational movements. This program will lead you effectively and safely into more dynamic movement patterns outlined in the Intermediate and Advanced Programs.
Within each program, on occasion you will be offered a progression exercise that can be used when its predecessor is mastered. These progression exercises are labeled with a P.
It is suggested to complete your fitness program anywhere from three to four times a week until the exercises are mastered (approximately two to four weeks). Upon mastery (when it feels too easy), continue on to the following programs. These programs can be done at home, while traveling and do not require much space.
Here is our web page of Suggested Equipment.
Check out our Cardiovascular Fitness Recommendations web page for more information before starting your cardio program.

Customizing your Fitness:

The fitness programs here are focused on developing optimal fitness for patients with HCM, while also working on developing functional fitness.

That being said, you may be looking to move beyond these programs or are experiencing unique challenges that are preventing you from exercising comfortably.

Challenges can arise from due to postural challenges, injuries, sitting for long periods of time and from the stresses of daily life. Either way, here are some additional resources to help you move ahead:

If you live in the Toronto area or would be interested in Online zoom personal training sessions, you can consult with the creator of this Heart Health by Design website, Sarah Harris owner and personal trainer at Wellness by Design. Sarah is a highly skilled personal trainer who an expert in postural correction and developing safe and effective functional fitness.
The book, “How to Eat, Move and Be Healthy” by Paul Chek is a comprehensive guide to holistic fitness and will help you further customize your workouts, enhance nutrition and optimize other healthy lifestyle considerations.
Also check out our Resources web page.
If you experience pain and/or muscular discomfort with this program, consult your physician to rule out any heart health concerns. Thereafter, consulting with a physiotherapist or chiropractic doctor, could help with diagnosis and elevate muscular discomfort.

Start the Move Well Program:

Move Well Program