November 20, 2025
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Key takeaways:
- Strength training may be as safe as sedentary behavior for people with genetic risk for ventricular arrhythmia.
- These data may have “opened the door” for future guideline-changing research.
NEW ORLEANS — Strength-based exercise may be safe for people with high inherited risk for ventricular arrhythmia, a speaker reported.
Guidelines previously recommended that people with arrhythmogenic cardiomyopathy avoid vigorous exercise, but strength training could be a safe alternative to endurance exercise for them, according to the presentation at the American Heart Association Scientific Sessions.
Evans Osuji, MD, senior resident in internal medicine at Johns Hopkins Bayview Medical Center, presented the results of a study evaluating the impact of strength-based exercise in people with arrhythmogenic cardiomyopathy, an inherited heart disorder linked to increased risk for deadly arrhythmias.
Lili A. Barouch
“Recent shifts in modern cardiology guidelines regarding exercise and sports participation, especially in patients with underlying CVD, now emphasize shared decision-making and generally discourage blanket disqualification from sports for most diagnoses,” Lili A. Barouch, MD, director of the Sports Cardiology Program in the Ciccarone Center for Prevention of Cardiovascular Disease at Johns Hopkins University School of Medicine, told Healio. “However, in arrhythmogenic cardiomyopathy there is strong evidence for increased risk of ventricular arrhythmias and progression to heart failure with high levels of vigorous endurance or competitive exercise. Anecdotally, some sports cardiologists have thought that strength-based exercise, eg, lifting weights or going to the gym, may be less detrimental than endurance exercise, such as running, but to our knowledge, this idea had not been formally studied.
“The most important goal of our study was to assess whether strength-based exercise is associated with sustained ventricular arrhythmia risk in individuals with arrhythmogenic cardiomyopathy or those carrying pathogenic or likely pathogenic arrhythmogenic cardiomyopathy genetic variants,” Barouch said. “We sought to determine if strength training poses a risk comparable to endurance training, or if it may be a safer alternative for patients wishing to remain active. Safer exercise options are especially meaningful for patients who were very active prior to diagnosis of arrhythmogenic cardiomyopathy, and whose quality of life may be negatively impacted by guidelines to abstain from vigorous exercise.”
To better understand the impact of different exercise patterns on ventricular arrhythmia risk among individuals with arrhythmogenic cardiomyopathy and/or a pathogenic/likely pathogenic gene variant, researchers included 355 people from the Johns Hopkins ARVC registry (median age, 34 years; 45% men; 59% probands).
Participants’ exercise exposure was assessed via phone calls starting at age 10 years through follow-up and stratified into one of four categories: dual athlete (55%), endurance athlete (12%), strength athlete (7%) and sedentary (26%).
Fifty-five percent of participants had ventricular arrhythmia at last follow-up (median age, 44 years).
The researchers observed greater lifetime risk for ventricular arrhythmia in people doing more aerobic exercise — the dual athlete and endurance athlete groups — than in those doing less of it — the strength athlete and sedentary groups (P < .001).
There were no significant differences in ventricular arrhythmia risk between dual athletes and endurance athletes, or between strength athletes and sedentary participants, according to the study.
After conducting a multivariable Cox regression analysis, the researchers reported no significant association between strength training and ventricular arrhythmia risk, whereas risk was significant with endurance exercise (HR = 1.45; 95% CI, 1.13-1.85; P = .004).
“Those who did endurance exercise had more arrhythmias than those who were sedentary, as expected, but adding strength exercise did not worsen their risk, so that strength athletes did just as well as sedentary people, and ‘dual’ athletes who did both types of exercise had similar outcomes to those who did endurance exercise only,” Barouch told Healio. “Our findings have opened the door for future research, which is needed to evaluate in more detail the safety of strength exercise in arrhythmogenic cardiomyopathy.”
For more information:
Lili A. Barouch, MD, can be reached at barouch@jhmi.edu.
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Sources/Disclosures
Source:
Osuji E, et al. FS.08 Featured science in EP. Presented at: American Heart Association Scientific Sessions; Nov. 7-10, 2025; New Orleans.
Disclosures:
Barouch and Osuji report no relevant financial disclosures.
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