Exercise Guidelines After Spontaneous Coronary Artery Dissection (SCAD)
After SCAD, you should permanently avoid competitive sports and high-intensity activities, starting instead with low-intensity walking at 40-60% heart rate reserve, progressing gradually over months under medical supervision, while monitoring closely for any recurrent symptoms. 1
Initial Recovery Phase (First 1-2 Weeks)
Begin with walking as your primary exercise mode immediately after discharge. 1 Target a heart rate of 40-60% of your heart rate reserve during these initial sessions. 1 You must be able to converse comfortably during activity without breathing difficulty—this is your safety marker. 1
Start with low-intensity exercise of limited duration and increase progressively only based on tolerance. 1 Exercise sessions should be completed with reserve, meaning you should finish feeling you could have done more. 1
Progressive Advancement (Weeks to Months)
Increase exercise intensity gradually to a maximum of 85% heart rate reserve, and only if well tolerated. 1 More intense training should only be considered after a graduated and progressive increase in rehabilitation training load. 1
Before advancing your exercise program, you must undergo: 1
- Maximal exercise testing to evaluate exercise tolerance and detect inducible ischemia
- Evaluation of left ventricular function
- Assessment for exercise-induced electrical instability
The European Society of Cardiology emphasizes that exercise should be prescribed in a graduated fashion, with careful monitoring at each stage. 2
Long-Term Activity Parameters
Target moderate-intensity leisure physical activity for at least 30 minutes on most days of the week. 1 This typically means brisk walking or similar activities where you can maintain conversation. 2
Permanently Restricted Activities
You must permanently avoid: 1
- All competitive sports, particularly those with extreme power and endurance demands
- Activities involving burst exertion (sprinting, heavy lifting, high-intensity interval training)
- Systematic isometric exercise such as heavy weightlifting
- Extreme environmental conditions during exercise
This restriction is critical because SCAD has been documented to occur during intense weightlifting and burst activities. 3 The mechanism involves sudden increases in coronary artery wall stress that can trigger dissection. 3
Critical Warning Signs Requiring Immediate Exercise Cessation
Stop exercising immediately and seek medical attention if you experience: 1
- New chest pain, pressure, or discomfort
- Dyspnea (shortness of breath) beyond normal exertional breathlessness
- Syncope (fainting) or near-syncope
- Faintness or nausea after exercise
- Inability to finish exercise sessions you previously tolerated
- Inability to converse during activity due to breathing difficulty
Additional concerning signs include: 1
- Chronic fatigue developing over days
- New sleeplessness
- Joint aches and pains or muscle cramping that persists
Medical Management Supporting Safe Exercise
You must be on optimal medical therapy before advancing exercise intensity. 1 This includes:
- Aspirin 75-100 mg daily for secondary prevention
- Statin therapy with goal LDL-cholesterol <55 mg/dL
- Aggressive blood pressure control
These medications reduce your risk of recurrent events and plaque instability during exercise. 2
Cardiac Rehabilitation Participation
Enrollment in a dedicated cardiac rehabilitation program is strongly recommended. 4 A specialized SCAD cardiac rehabilitation program demonstrated significant benefits including: 4
- Reduction in recurrent chest pain from 62.9% to 37.1%
- Improvement in exercise capacity (metabolic equivalents increased from 10.1 to 11.5)
- Significant improvement in depression scores
- Lower major adverse cardiac event rate (4.3% vs 26.2% in non-participants)
The program should include: 4
- Supervised exercise rehabilitation with gradual progression
- Psychosocial counseling (27-29% of SCAD patients require social work or psychiatry referrals)
- Cardiovascular disease education
- Peer group support
Target participation duration is 6 months minimum. 4
Common Pitfalls to Avoid
Do not assume you can return to your pre-SCAD exercise level. Research shows that 48.5% of SCAD patients performed aerobic exercise ≥3 times/week before their event, and many were highly active. 5 This previous activity level does not predict safety for return to the same intensity. 5
Do not ignore cardiovascular risk factors. Despite being younger and predominantly female, 70% of SCAD patients have ≥1 cardiovascular risk factors including hyperlipidemia (34.3%), hypertension (32.8%), and elevated body weight (47% overweight or obese). 5 These require aggressive management. 1
Avoid the misconception that SCAD only occurs once. The recurrence rate necessitates permanent activity modification, not just temporary restriction during recovery. 4