What to Know About Strength Training, Arrhythmogenic Cardiomyopathy: Lili Barouch, MD

People with arrhythmogenic cardiomyopathy (ACM) may face increased risk of ventricular arrhythmias and worsening heart function with exercise, making activity guidance important. In an interview with The American Journal of Managed Care^®, Lili Barouch, MD, director of sports cardiology and professor of clinical medicine at Johns Hopkins Medicine, discussed her team’s retrospective study examining whether strength training and endurance exercise have different effects. Earlier research often grouped exercise together, despite the distinct ways these activities load the heart. The team investigated strength exercise as a potential option for patients seeking to remain active while limiting risks associated with high levels of endurance activity.

The researchers divided participants into 4 groups: those doing both types of exercise, endurance only, strength only, and neither. Endurance exercise was associated with worse outcomes than being sedentary, consistent with prior concerns about repeated stress on the right ventricle, which ACM often affects. Strength exercise, by contrast, was not linked to more ventricular arrhythmias in the study. Participants reporting strength exercise alone had outcomes similar to those who did neither. The findings covered strength activity up to about four hours weekly; the team said there were too few participants exercising longer to draw conclusions about higher amounts.

Barouch cautioned that this retrospective study cannot prove strength training is safe for every person with ACM. Current guidelines do not yet distinguish strength from endurance exercise; she hopes prospective research may eventually inform updates. In her practice, she discusses 2 to 4 hours of weekly strength exercise as a potentially preferable alternative to high levels of endurance activity, tailoring advice to each patient. Patients should consult their cardiology team before changing exercise. She also emphasized shared decision-making: clinicians and patients weigh personal goals, benefits, and risks together. This approach supports autonomy and informed choices about exercise, mental well-being, and health. Findings are informative, but not conclusive for individual care.

“Shared decision-making is really important to see what the goals of the patient are, help educate them about their condition and about what we know, and come to a shared decision about what’s going to be best, weighing all the risks and benefits as opposed to just handing down the decision,” she said. “That’s been very important for patient autonomy, and patients really feel they’re involved in their health care decisions that way and respond well to that.”