Lifting Restrictions for Patients with Aortic Aneurysms
Patients with aortic aneurysms should avoid intense isometric exercises and heavy lifting that requires the Valsalva maneuver, as these activities can acutely increase systolic blood pressure to >300 mmHg and potentially increase risk of aneurysm rupture. 1
General Exercise Recommendations
Safe Activities
- Light weightlifting and low-intensity aerobic exercise are considered safe and beneficial for physical and mental health in patients with aortic aneurysms 1
- Moderate intensity aerobic activity (30-60 minutes per session, 3-4 days per week) is reasonable for patients with adequately controlled blood pressure 1
- An intensity of 3-5 metabolic equivalents of task (METs) is recommended for patients with aortic disease 1
Activities to Avoid
- Intense isometric exercises that involve straining or Valsalva maneuver 1
- Heavy lifting, particularly lifting to the point of exhaustion 1
- High-intensity athletic training, which has been shown to be an independent predictor of aortic growth 1
- Strenuous activities that entail maximal exertion 1
Specific Lifting Restrictions
- General lifting restriction of approximately 50 pounds is recommended for patients with thoracic aortic aneurysms 1
- For patients who have undergone aortic surgery or have a history of aortic dissection, even more conservative restrictions may be appropriate, with avoidance of strenuous lifting 1
Individualized Risk Assessment
Recommendations for exercise intensity should be tailored based on multiple risk factors:
- Aortic pathology (type and location of aneurysm) 1
- Aortic diameter and aortic size index 1
- Growth rate of the aneurysm 1
- Age and family history of aortic disease 1
- Presence of high-risk features such as uncontrolled hypertension 1
Post-Surgical Considerations
- Cardiac rehabilitation has been shown to be useful and safe for patients after aortic surgery 1
- Fear of repeat cardiac events may cause patients who have experienced aortic dissection to decrease or stop exercise, but mild-to-moderate intensity exercise may be cardioprotective 1
- A modified cardiac rehabilitation program before surgery may slow the rate of aortic growth in patients with small abdominal aortic aneurysms 1
Benefits of Appropriate Exercise
- Moderate aerobic activity improves overall cardiovascular health in patients with thoracic and abdominal aortic aneurysms 1
- A recent meta-analysis suggests that higher physical activity is associated with a reduced risk of abdominal aortic aneurysm 1
- In animal models of Marfan syndrome, mild and moderate (but not strenuous) aerobic exercise protected the structural integrity of the aortic wall 1
Important Caveats
- Blood pressure must be adequately controlled before initiating any exercise program 1
- Resistance training increases central aortic blood pressure and its benefits for those with aortic aneurysms are less well understood 1
- There is no uniform consensus on the safety of intermediate-level static and aerobic exercise 1
- Patients should be educated about the importance of seeking immediate medical care for any unexpected chest discomfort 1