- Survivors of aortic dissection are at lifelong risk for adverse events that are strongly influenced by blood pressure control and physical activity patterns.
- In a pilot study, there were no deaths, aortic operations, or recurrent dissections in survivors of Type A and B aortic dissection randomized to exercise or usual care.
- Given the substantial attrition in the study, however, larger prospective trials are needed to determine long-term effects on cardiovascular outcomes.
It was feasible for survivors of thoracic aortic dissection (TAD) to engage in a structured exercise program, according to a pilot study.
Among 93 adults post-Type A or B TAD, there were no deaths, aortic operations, or recurrent dissections in participants randomized to guided exercise, consisting of introductory training on a six-exercise circuit and 12 months of subsequent moderate-intensity home exercise, or those assigned to usual care.
And while supervised training did result in exertional hypertension in 39% of cases (defined by systolic blood pressure >180 mm Hg or diastolic blood pressure >100 mm Hg during more than one exercise), this was mitigated by exercise modification, reported Siddharth Prakash, MD, PhD, of the University of Texas Health Science Center at Houston, and colleagues.
“Our findings challenge long-standing assumptions that TAD survivors should avoid moderate physical activity,” they wrote in Circulation: Population Health and Outcomes. “Instead, our data demonstrate that with proper instruction and monitoring, TAD survivors can safely engage in structured exercise without precipitating hypertensive crises or aortic complications.”
In the study, guided exercise consisted of wall sits, hand grips, leg raises, treadmill and stationary bike sessions, and bicep curls, with a 3-minute rest period between exercises. Blood pressure was measured once during each exercise and once during each rest period. Each participant completed the circuit twice.
Going outside the recommended exercise routine, one participant experienced a right iliac artery dissection after engaging in beach volleyball and cycling. The dissection remained stable on follow-up imaging and did not require intervention during the study period, according to the investigators.
Prakash and colleagues explained that survivors of aortic dissection are at lifelong risk for adverse events that are strongly influenced by blood pressure control and physical activity patterns. “Fear of precipitating recurrent dissection, particularly during physical exertion, frequently leads patients to restrict activity, limiting cardiometabolic and psychosocial recovery,” they noted.
Larger prospective trials are needed to determine the effects of exercise post-TAD, the authors acknowledged. They pointed out that the present study was underpowered, having missed its target 126-patient enrollment due to slow recruitment.
Prakash and team attributed enrollment issues to the rarity of TAD, the requirement for an in-person training visit, and eligibility exclusions related to uncontrolled hypertension, physical limitations, symptomatic cardiovascular disease, and access to home exercise equipment.
“Our findings highlight the feasibility of home-based exercise programs but also underscore logistical barriers to conducting multicenter behavioral trials in rare disease populations,” they wrote. “Precision exercise prescriptions tailored to ambulatory hemodynamic profiles with integration of scalable digital health tools may further enhance data quality and optimize exercise safety and adherence in this medically vulnerable population.”
Prakash and colleagues conducted the study at three U.S. academic medical centers from December 2022 to October 2024. Out of 477 screened patients, 93 adults ≥3 months post-Type A or B TAD were randomized to guided exercise or usual care, which consisted of standardized exercise counseling and routine clinic visits.
The cohort had a mean age of 56 years, and 30% were women. Enrollment took place a median 3 years after the index dissections; 76% were Type A TADs and 24% were Type B. The majority of participants had received open repair (74%), while 14% underwent thoracic endovascular aortic repair and 12% had no intervention.
Home exercise adherence was assessed using self-reports. Sixty-five participants ultimately completed study assessments, with 17 lost to follow-up.
The available data did not show significant changes in paired ambulatory blood pressure measurements or Patient-Reported Outcomes Measurement Information System 29-Item Profile quality-of-life scores at 12 months.
“These findings should be interpreted cautiously,” the authors noted. “The study was underpowered to detect modest but clinically meaningful differences, and type II error cannot be excluded. Accordingly, these results are best viewed as preliminary evidence supporting the feasibility of this strategy and informing the design of future clinical effectiveness trials.”
