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 with heavy weights or isometric exercises, can cause acute spikes in blood pressure that put sudden stress on the aortic wall, potentially triggering a dissection in susceptible individuals 1. Endurance training, while also increasing risk, typically causes more sustained but less extreme elevations in blood pressure. The mechanism of risk differs as endurance activities like running or cycling create prolonged hemodynamic stress rather than the acute pressure spikes seen in strength training.
Key Considerations
- Individuals with known aortic conditions, such as aortic aneurysms, Marfan syndrome, or bicuspid aortic valves, should be particularly cautious with both types of exercise 1.
- Modified exercise programs with lower intensity, proper breathing techniques to avoid Valsalva maneuvers, and careful monitoring are recommended to reduce the risk of this potentially life-threatening condition.
- The 2022 ACC/AHA guideline for the diagnosis and management of aortic disease suggests avoiding intense isometric exertion or exercises that require the Valsalva maneuver, as they can produce acute increases in systolic blood pressure to over 300 mm Hg 1.
- Light weightlifting and low-intensity aerobic exercise are considered safe and likely improve both physical and mental health, but recommendations for exercise intensity should be individualized based on underlying aortic pathology, aortic diameter, and other high-risk features 1.
From the Research
Types of Exercises Associated with Increased Risk of Aortic Dissection
- Strength training: There is evidence to suggest that heavy exercise, which may include strength training, is associated with an increased risk of acute aortic dissection 2.
- Endurance training: While endurance training is generally considered beneficial for cardiovascular health, excessive endurance exercise may pose risks, including an increased prevalence of coronary atherosclerosis 3.
Risk of Dissection
- The risk of dissection is thought to be different for various types of exercises, with blood pressure elevation during exercise being a potential factor associated with an increased risk of acute aortic dissection 2.
- However, there is limited evidence to suggest that either strength or endurance training is specifically associated with a higher risk of dissection, and more research is needed to establish threshold values for physical exercise beyond which sports can become harmful 3.
Key Factors Affecting Outcomes in Acute Type A Aortic Dissection
- Age, extent of the pathology, existence of connective tissue disorders, hypertension, diabetes mellitus, and surgeon experience are all factors that can significantly affect outcomes in acute type A aortic dissection 4.
- Timing of recognition of the pathology is also crucial, with a 1% increase in mortality rate for each hour delay in management 4.