Mountain Biking After SCAD: Exercise Recommendations
Mountain biking after SCAD should be avoided as a competitive sport, but can be cautiously resumed as leisure-time physical activity at moderate intensity after completing cardiac rehabilitation and demonstrating stable cardiac function without inducible ischemia. 1, 2
Competitive vs. Leisure-Time Activity Distinction
For competitive athletes with previous SCAD, the risks likely outweigh the benefits of competitive sports participation. 1 The most recent 2025 American Heart Association and American College of Cardiology guidelines explicitly state that competitive athletes with SCAD should not return to competitive sports. 1
However, this does not mean complete exercise restriction:
- Leisure-time physical activity at moderate intensity for at least 30 minutes on most days of the week is recommended and beneficial. 2
- The key distinction is avoiding the high-intensity, competitive nature of mountain biking while maintaining regular moderate exercise. 2
Initial Recovery Phase: Graduated Return to Exercise
Start with walking as the primary mode of exercise during initial recovery, targeting 40-60% of heart rate reserve. 2 This approach allows you to:
- Complete exercise sessions with reserve capacity remaining 2
- Converse during activity without difficulty breathing 2
- Progress gradually based on tolerance 2
Participate in cardiac rehabilitation after recovery from your SCAD event. 1 This structured program provides:
- Supervised exercise progression 1
- Monitoring for adverse responses 2
- Education about appropriate activity levels 2
Progressive Advancement Guidelines
Increase exercise intensity gradually to 85% heart rate reserve only if well tolerated. 2 The progression should be:
- Low-intensity exercise of limited duration initially 1, 2
- Progressive increases based on individual tolerance 1, 2
- More intense training only after graduated and progressive increase in rehabilitation training load 1, 2
Before advancing exercise intensity, you must undergo maximal exercise testing to evaluate exercise tolerance, presence of inducible ischemia, and exercise-induced electrical instability. 2 Additionally, evaluation of left ventricular function is required. 2
Long-Term Activity Restrictions for Mountain Biking
Permanently avoid activities involving burst exertion and extreme power demands. 2 Mountain biking, particularly on technical terrain, involves:
- Sudden high-intensity efforts during climbs and technical sections
- Burst exertion that characterizes competitive or aggressive riding 2
- Isometric muscle contractions during challenging terrain 2
Activities should be performed without developing new symptoms, particularly chest pain, dyspnea, or syncope. 2 This is critical because:
- SCAD patients are at risk for recurrent dissection 1, 3, 4
- Exercise-triggered SCAD has been reported with significant recurrence rates 1
- The 10-year rate of major adverse cardiac events (including SCAD recurrence) is approximately 47% 4
Critical Monitoring Parameters
Watch for signs of over-exercising, which indicate you need to reduce intensity: 2
- Inability to finish exercise sessions 2
- Inability to converse during activity due to breathing difficulty 2
- Faintness or nausea after exercise 2
- Chronic fatigue 2
- Sleeplessness 2
- Joint aches, pains, or muscle cramping 2
Medical Management Supporting Activity
Maintain aggressive risk factor modification to support safe exercise: 2
- Aspirin 75-100 mg daily for secondary prevention 2
- Statin therapy with goal LDL-C <55 mg/dL 2
- Blood pressure control 2
Practical Approach to Mountain Biking
If you choose to return to mountain biking as leisure activity (not competitive):
Limit yourself to easy, non-technical trails with minimal elevation gain and no burst efforts. 2 This means:
- Flat or gently rolling terrain only
- Avoiding technical features requiring sudden power output
- Maintaining conversational pace throughout the ride 2
- Keeping heart rate below 85% of heart rate reserve 2
Consider alternative cycling options that better align with SCAD exercise recommendations: 2
- Road cycling on flat terrain at steady, moderate pace
- Stationary cycling with controlled intensity
- These allow better heart rate control and avoid the unpredictable demands of mountain biking
Important Caveats
The European guidelines acknowledge that there is little epidemiological evidence on SCAD incidence in athletes and substantial under-appreciation of this entity. 1 Some reports suggest significant rates of recurrence in exercise-triggered SCAD. 1 Given this uncertainty and the potentially catastrophic consequences of recurrent SCAD, a conservative approach to high-intensity activities like mountain biking is warranted, even for leisure purposes. 1, 2
Close follow-up with cardiovascular specialists is essential because SCAD patients remain at risk for recurrent dissection and major cardiovascular events long-term. 3, 4