New Insights in Exercise for Arrhythmogenic Cardiomyopathy: A Narrative Review.

Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiac condition and an important cause of sudden cardiac death among athletes. ACM may result in ventricular dysfunction with a high rate of ventricular arrhythmia disproportionate to the degree of cardiac chamber dilatation or dysfunction. Although ACM is genetically mediated for the most part, exercise has been recognized as a key modulator in its prognosis and outcomes. Several knowledge gaps exist surrounding the interaction between this condition and exercise. ACM is a heterogeneous condition with certain genotype-phenotype correlations that may result in differential impact of exercise. In addition, ACM patients traditionally have been relegated to participate in only low-intensity exercise, but this advice lacks objectivity and clear definitions, and no safe exercise thresholds have been proposed. Finally, no consensus has been reached on which exercise advice is to be given for genotype-positive phenotype-negative family members. The aim of this review is to address these concerns, propose a practical approach for exercise prescription in ACM, and provide an up-to-date literature review of the impact of exercise on the various subtypes of ACM.