What type of exercise, Strength Training (ST) or Endurance Training (ET), is associated with an increased risk of aortic dissection?

From the Guidelines

Both strength and endurance training are associated with an increased risk of aortic dissection, but the risk is thought to be different between these exercise types. Strength training, particularly when involving heavy weightlifting or isometric exercises, can cause acute spikes in blood pressure that place sudden stress on the aortic wall, as noted in the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. This rapid increase in pressure can potentially trigger a dissection in susceptible individuals. Endurance training, while also associated with risk, typically causes more sustained but less extreme elevations in blood pressure. The different hemodynamic responses explain why the risk profiles vary between these exercise modalities.

Some key points to consider when evaluating the risk of aortic dissection with exercise include:

• The type of exercise: strength training versus endurance training
• The intensity of the exercise: high-intensity strength training poses a greater risk than low-intensity aerobic exercise
• The individual's underlying health conditions: those with known aortic disease, connective tissue disorders, or uncontrolled hypertension are at higher risk
• The use of proper breathing techniques to avoid Valsalva maneuvers, which can further increase the risk of dissection

According to a more recent study published in 2025, for athletes with unexplained thoracic aortic aneurysms, competitive sports participation can be considered with shared decision-making, but with strength sports, concerns of static afterload stress on the aorta may lead to consideration of reductions to moderate-intensity strength training 1. Therefore, it is essential to approach exercise recommendations on an individual basis, taking into account the person's specific health status and risk factors for aortic dissection.

From the Research

Types of Exercises Associated with Increased Risk of Aortic Dissection

• Strength training is associated with an increased risk of aortic dissection, as evidenced by studies that have shown a causal link between intense weight lifting and acute aortic dissection 2, 3.
• Endurance training, on the other hand, produces only a modest rise in arterial blood pressure, except at the highest levels of exertion, and its association with aortic dissection is less clear 3, 4.
• The risk of dissection is thought to be different for strength and endurance training, with strength training posing a greater risk due to the acute rises in blood pressure that occur during intense exertion 3.
• Therefore, the correct answer is: Strength training.

Key Findings

• Weight lifting related acute aortic dissection appears to be a real phenomenon, with increasing evidence for the association of extreme exertion with this catastrophic aortic event 2.
• Moderate aortic dilatation confers vulnerability to exertion-related aortic dissection, and individuals with known aortic dilatation should be cautioned to refrain from weight lifting or strenuous exertion 2, 3.
• Blood pressure elevation during exercise may be associated with an increased risk of acute aortic dissection, but no controlled trials have longitudinally evaluated the effect of exercise on survival or the risk of aortic dissection in patients with thoracic aortic disease 4.