ObjectiveWe examined the extent and nature of the psychological difficulty experienced by athletic adults with hypertrophic cardiomyopathy (HCM), correlates of that difficulty and coping mechanisms.MethodsA survey assessed athletic history and psychological impact of exercise restrictions. LASSO penalised linear regression identified factors associated with psychological difficulty. Semistructured interviews provided deeper insight into the nature and origins of psychological difficulty.Results54 individuals (33% female, mean age 55.9) completed the survey. The majority were recreational athletes at the time of restriction (67%). There was a drop in athleticism after diagnosis, including time spent exercising (p=0.04) and identification as an athlete (p=0.0005). Most respondents (54%) found it stressful and/or difficult to adjust to exercise restrictions. Greater psychological morbidity was associated with history of elite or competitive athletics, athletic identity and decrease in time spent exercising. 16 individuals (44% female, mean age 52.4) were interviewed. Long-term effects included weight gain and uncertainty about exercising safely. The role of exercise in interviewees' lives contracted significantly after restriction, from multiple functions (eg, social, stress relief, fitness) to solely health maintenance. Interviewees reported a unique form of social support: having family and friends participate with them in lower intensity exercise. Lack of understanding from family or friends and avoiding exercise completely were detrimental to coping.ConclusionsAthletic adults with HCM experience multifaceted, lasting difficulty adjusting to exercise recommendations. These data can guide clinicians in identifying patients at highest risk for distress and in helping to bolster coping and adaptation.

Stress and burnout among surgeons have received increasing attention in recent years. 1 In response, our department created a wellness program, Balance in Life, to address the physical, psychological, social, and professional needs of surgical trainees. 2 Program initiatives include a 24-hour refrigerator stocked with snacks, a peer mentorship program, and annual team-building retreats. Another central component is the existence of an innovative weekly facilitated-group intervention.The effectiveness of group therapy has been documented in a range of therapeutic, motivational, and organizational settings. 3 Within our program, categorical surgical residents are assigned to 90-minute group sessions that are facilitated by a licensed clinical psychologist with expertise in working with high-performance teams and delivering evidence-based interventions. Time is protected for each resident class to attend the group session once every 6 weeks throughout their training. A typical session format includes greeting/agenda setting (15 minutes), curriculum topic review (30 minutes), open discussion (30 minutes), and mindfulness exercises (15 minutes).Group participants are encouraged to share stressors with peers and to work together to formulate coping strategies. In addition to feeling validated and supported by peers, residents are equipped with a toolkit of skills designed to positively influence work relationships, system operations, and patient outcomes. The curriculum was created to address issues relevant to all trainees and is tailored toward postgraduate year (Box). Statements made by participants are confidential, but issues may be shared with the program director with the consent of group members.

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