Can left ventricular hypertrophy (LVH) be caused by physical exercise?

From the Guidelines

Exercise can cause left ventricular hypertrophy (LVH), but this is typically a normal, beneficial adaptation called "athlete's heart". Regular endurance and strength training causes the heart muscle to thicken and strengthen in response to increased workload, improving cardiac output and exercise capacity 1. This physiological LVH differs from pathological LVH caused by conditions like hypertension or aortic stenosis. The key differences are that exercise-induced LVH maintains normal heart function, has proportional chamber enlargement, and reverses with detraining.

Key Points to Consider

• The cardiovascular and overall health benefits of regular physical activity are well-established 1.
• Increased physical activity has also been associated with improved quality of life in patients with hypertrophic cardiomyopathy (HCM) 1.
• Most athletes develop mild to moderate LVH that doesn't require treatment.
• However, extreme cases may sometimes be difficult to distinguish from hypertrophic cardiomyopathy, a serious heart condition.
• If you're an athlete with significant LVH, your doctor might recommend additional testing to ensure it's physiological rather than pathological.

Exercise Recommendations

• The Physical Activity Guidelines for Americans recommend that adults engage in at least 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity aerobic exercise weekly 1.
• Children should engage in at least 60 minutes of moderate-to-vigorous exercise daily 1.
• Exercise intensity can be gauged by metabolic equivalents of task, % maximum heart rate achieved, or level of perceived exertion on the Borg scale 1.

From the Research

Left Ventricular Hypertrophy and Exercise

• Left ventricular hypertrophy (LVH) is a condition where the muscle wall of the heart's left ventricle becomes thickened, which can increase the risk of heart failure and other cardiovascular problems 2, 3, 4.
• Exercise is generally considered beneficial for cardiovascular health, but its relationship with LVH is complex 3, 5.
• Some studies suggest that exercise can actually contribute to the development of LVH, particularly in individuals with normal blood pressure 3.
• However, other studies have found that exercise can help reduce LVH in individuals with hypertension, especially when combined with antihypertensive medication 2, 5.

Effects of Exercise on Left Ventricular Mass

• A study published in 2020 found that higher levels of physical activity were associated with higher left ventricular mass index in individuals with normal blood pressure, but not in those with hypertension 3.
• Another study published in 2018 found that antihypertensive medication can reduce LVH in hypertensive athletes, even if they continue to engage in intense aerobic exercise 5.
• A 2021 study found that 1 year of exercise training reduced LV myocardial stiffness in patients with LV hypertrophy and elevated cardiac biomarkers 2.

Interaction between Exercise and Antihypertensive Medication

• The use of antihypertensive medication, such as ACE inhibitors and beta blockers, can help reduce LVH and improve cardiovascular outcomes 4, 6, 5.
• Exercise can enhance the effects of antihypertensive medication on reducing LVH and improving cardiovascular health 2, 5.
• However, more research is needed to fully understand the interaction between exercise and antihypertensive medication on LVH and cardiovascular outcomes 4, 6.