Exercise training in hypertrophic cardiomyopathy: a systematic review, meta-analysis, and meta-regression

Aim. The main objective was to determine the effect of exercise training on bodyweight, functional capacity, echocardiography, blood pressure, heart rate (HR), double product, and NT-proBNP in hypertrophic cardiomyopathy (HCM) patients. Methods. Supervised endurance and concurrent training interventions in obstructive and non-obstructive patients were extracted from PubMed, Web of Science, and Cochrane in December 2025. Random-effects meta-analyses and meta-regressions were performed, and risk of bias was assessed for internal validity. Results. Data from 8 studies with 205 low to moderate risk patients showed that training significantly (all p < 0.05) increased (means (95% CI)): peak VO ₂ (pVO ₂ ) (2.3 (0.76, 3.83) ml·kg ^− 1 ·min ^− 1 ), predicted pVO ₂ (8.1 (2.7, 13.4) %), exercise time (1.0 (0.5, 1.5) min), peak HR (5.2 (0.04, 10.3) bpm), and heart rate reserve (HRR) (5.5 (2.5, 8.5) bpm); and decreased body mass index (BMI) (− 1.12 (− 2.13, − 0.11) kg·m ^− 2 ), and rest HR (− 3.1 (− 5.7, − 0.4) bpm). A lower baseline HRR was associated with broader increments in pVO ₂ (1.3 (0.8, 1.9) ml·kg ^− 1 ·min ^− 1 , R ² = 0.86, p < 0.05, per 10-unit decrease). Maximal wall thickness significantly decreased following training compared to usual care (− 0.9 (− 1.7, − 0.1) mm, p < 0.05). Other echocardiographic features, blood pressure, and NT-proBNP did not change. There were no differences between endurance and concurrent training. No adverse events occurred. Conclusion. Supervised exercise interventions in low to moderate risk HCM patients promote beneficial adaptations. The effect of beta-blockers on HRR and subsequent functional adaptations to training warrants future research. At least 8–12 weeks seem necessary to improve functional capacity, exercise tolerance, cardiac adaptability, and chronotropic competence.