Strength training not linked to heart problems for people with arrhythmogenic cardiomyopathy
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People living with arrhythmogenic cardiomyopathy (ACM), a heritable heart condition that can significantly increase the risk of sudden cardiac death, are advised to avoid high-intensity aerobic exercise. However, questions remain about whether higher-intensity strength training, which affects the heart differently than endurance exercise, could be less risky.
Now, through the Johns Hopkins Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) Registry, investigators conducted one of the first studies to assess the separate effects of strength versus endurance exercise on the heart in ACM. They found that strength training was not associated with an increased likelihood of developing sustained ventricular arrhythmia among people living with or genetically at risk for the condition.
The findings were published in JACC: Clinical Electrophysiology.
"There have been a lot of questions about the safety of strength training for people living with or at risk for arrhythmogenic cardiomyopathy," says Lili Barouch, M.D., the senior study author and director of the sports cardiology program at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease.
"This study opens the door to help researchers further assess this—and supports continued shifts away from blanket exercise recommendations to support personalized decision-making between physicians and patients."
About 1 in every 1,000 to 5,000 people worldwide are estimated to have arrhythmogenic cardiomyopathy. The condition is caused by mutations in certain genes that support the heart's ability to contract and pump blood throughout the body.
The high demands of heart-pumping exercise, like sprinting and cycling, can put extra stress on affected heart cells and cause damage over time or lead to sudden cardiac arrest or death for individuals at greatest risk. These types of events often occur between a person's 20s and 40s.
Physicians have known about the risks of high-intensity aerobic exercise, but they haven't had data to inform or help patients make decisions about strength training—which doesn't put the same type of stress on the heart.
To better assess links between strength activities and heart problems among people with arrhythmogenic cardiomyopathy, researchers partnered with 355 participants in the Johns Hopkins ARVC registry to inquire about their physical activity levels from childhood (age 10) through enrollment in the study. They then compared the type of exercise they did with incidents of ventricular arrhythmia.
A ventricular arrhythmia in this study was classified as ventricular tachycardia—or a sustained, rapid heartbeat—lasting more than 30 seconds at 100 beats per minute or higher; ventricular fibrillation or flutter; sudden cardiac arrest or sudden cardiac death; or use of an implantable cardiac device. Some 55% of participants experienced a ventricular arrhythmia. Among those who did, about half occurred when they first enrolled in the study—which often followed a diagnosis or cardiac event.
Participants, who were U.S. adults, had a median age of 34 when they first joined the study and 44 when the study concluded. Interviews were conducted by phone. To assess the associations between physical activity and increased risk of heart problems, investigators grouped exercise levels into four categories: endurance, strength training, dual (endurance and strength) or sedentary.
Endurance athletes participated in at least four hours of weekly vigorous aerobic activities, such as cycling, swimming or running. Strength athletes participated in at least two hours of weekly strength-based training activities, such as weightlifting, climbing or martial arts. Dual athletes participated in both endurance and strength activities or mixed activities. The sedentary group included participants who did not meet criteria for the strength or endurance groups.
Based on this review, endurance athletes were 58% more likely to experience a ventricular arrhythmia than those in the sedentary or strength groups. There was no further increased risk of ventricular arrhythmia among dual athletes compared with endurance athletes. There were also no significant increased risks of ventricular arrhythmia for strength athletes compared with the sedentary group.
More than half of study participants (55%) were dual athletes, followed by those in the sedentary (26%), endurance (12%) and strength (7%) groups. Participants were split almost evenly among men and women, and 70% had an arrhythmogenic cardiomyopathy diagnosis.
Overall, participants completed an average of six hours of weekly aerobic exercise before enrolling in the study and about two hours each week a few years later. Similarly, participants completed an average of more than 2.75 hours of weekly strength-training activities before enrolling in the study and just under an hour each week a few years later.
"We know how important physical activity is to many people living with or at risk for arrhythmogenic cardiomyopathy," says Cindy James, Ph.D., ScM, research director at the Johns Hopkins ARVC Program and Johns Hopkins Center for Inherited Heart Diseases.
"This is one of many reasons why research in this area is critical to inform shared medical decisions to support a person's physical health and overall well-being."
More information
Strength-Based Exercise is Not Associated with Ventricular Arrhythmia in Arrhythmogenic Cardiomyopathy – Towards Safer Exercise Options, JACC Clinical Electrophysiology (2026).
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