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Association of physical activity with all-cause and cardiovascular mortality in 7666 adults with hypertrophic cardiomyopathy (HCM): more physical activity is better
  1. Soonil Kwon1,
  2. Hyun-Jung Lee1,
  3. Kyung-Do Han2,
  4. Da Hye Kim2,
  5. Seung-Pyo Lee1,
  6. In-Chang Hwang3,
  7. Yeonyee Yoon3,
  8. Jun-Bean Park1,
  9. Heesun Lee1,
  10. Soongu Kwak1,
  11. Seokhun Yang1,
  12. Goo-Yeong Cho3,
  13. Yong-Jin Kim1,
  14. Hyung-Kwan Kim1,
  15. Steve R Ommen4
  1. 1 Department of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
  2. 2 Department of Biostatistics, Catholic University College of Medicine, Seoul, Republic of Korea
  3. 3 Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  4. 4 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Professor Hyung-Kwan Kim, Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital103 Daehak-ro, Jongno-gu, Seoul 03080, Korea; cardiman73{at}; Dr Steve R Ommen, Mayo Hypertrophic Cardiomyopathy Clinic, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; ommen.steve{at}


Objectives Recommendations on physical activity (PA) for adults with hypertrophic cardiomyopathy (HCM) are not well established. We investigated the association of PA intensity with mortality in the general adult HCM population.

Methods A nationwide population-based cohort of individuals with HCM who underwent health check-ups including questionnaires on PA levels were identified from the years 2009 to 2016 in the National Health Insurance Service database. Subjects who reported no PA at baseline were excluded. To estimate each individual’s PA level, the PA score (PAS) was calculated based on the self-reported questionnaires, and the study population was categorised into three groups according to tertiles of PAS. The associations of PAS with all-cause and cardiovascular mortality were analysed.

Results A total of 7666 participants (mean age 59.5 years, 29.9% were women) were followed up for a mean 5.3±2.0 years. All-cause and cardiovascular mortality progressively decreased from the lowest to the highest tertiles of PA intensity: 9.1% (4.7%), 8.9% (3.8%) and 6.4% (2.7%), respectively (p-for-trend=0.0144 and 0.0023, respectively). Of note, compared with the middle PA group, the highest PA group did not have an increased risk of all-cause and cardiovascular mortality (HR 0.78, (95% CI 0.63 to 0.95) and HR 0.75 (95% CI 0.54 to 1.03), respectively). All subgroup and sensitivity analyses consistently showed that all-cause and cardiovascular mortality did not increase with higher PA levels.

Conclusions Moderate-to-vigorous-intensity PA, in a middle-aged population of patients with HCM, was associated with progressive reduction of all-cause and cardiovascular mortality. The impact of vigorous-intensity PA on a younger age group requires further investigation.

  • cardiology
  • death
  • physical activity

Data availability statement

The data are available from the Korean National Health Insurance Sharing Service (NHISS; database which is open to researchers on request with approval by the IRB.

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Data availability statement

The data are available from the Korean National Health Insurance Sharing Service (NHISS; database which is open to researchers on request with approval by the IRB.

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  • SK and H-JL contributed equally.

  • H-KK and SRO contributed equally.

  • Contributors Conception and design of the work by all the authors under the supervision of H-KK and SO. Data acquisition by SK and K-DH. Data analysis by all the authors. Data interpretations by all the authors. Drafting the work by SK. Revising the work by all the authors. Final approval of the version published by all the authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests H-KK reports research grants from Actelion, Handok Pharmaceuticals, Dae-Woong Pharmaceuticals, Yuhan, Hanmi, ChongKunDang Pharmaceuticals, and Norvatis.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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