TAA and exercise

[Robfromwales]

I am sure JulianM will know the answer to this one! Diagnosed 4 months ago with aortic aneurysm in the ascending aorta of 4.9cm and dilated aortic root of I think 4.4 but I bit less sure of that last diameter. Presumed caused by BAV that currently exhibits 20 per cent regurgitation. Anyway the question is…. BP under control through medication at around 110/70 . However given the risks of high blood pressure to the aortic wall - is it ok to exercise where presumably the BP systolic could easily reach 180 or higher? Is it a delicate balance between trying to keep the rest of the heart as healthy as possible even if it means an increased risk to the aortic wall? By the way I am aware of not doing strenuous exercises and weights and I would be sensible in starting any exercise slowly. Thoughts well come!

[Cliff_G]

Hi Rob,

As above, appropriate exercise is good. You want to keep your peripheral circulation good, and your whole pulmonary-cardio-vascular circuit working well.

As you already know, certain exercise is not good, specifically anything that raises BP, such as weight lifting, other isometric exercise, and anything too competitive, or requiring explosive effort.

A good guide is on the IRAD site. It covers post-dissection patients, but you would not go far wrong reading it and adopting the 3 to 5 METs criterion. livingwithdissection.iradon...

Even when doing gentle cardiovascular exercise, it is vital to warm up properly over about 15 minutes. What this does is to gently open up all the small blood vessels which then keeps the BP needed to circulate blood within a sensible range. With COVID, the BHF have produced online cardiac rehab classes. bhf.org.uk/informationsuppo... You would again not go far wrong with these.

Yes, you should also consult your doctors, but I've found it best to go pre-armed with the sort of suggestions I've made.

Your BP is good. I trust you are being monitored well using regular CT scans of your whole aorta, by a specialist aortic centre.

[JulianM]

Hi Rob, your dilation is a little bigger than mine: I'm currently at 4.7 to 4.8, was diagnosed by sports cardiologists at St George's when it was 4.5 to 4.6. My valve is tricuspid and working well: your bicuspid valve and regurgitation puts you in a slightly different category to me, but I suspect it won't make much difference to the advice you'd get

So, the bottom line is that exercise is good but must be moderated. Heavy weight training is very definitely out, especially if it goes isometric (maximum effort with little or no movement) or involves breath holding or other forms of control (so, basically, no grunting). My risk assessment at work says no heavy lifting, but I do work as a lifeguard, have renewed my qualification including fitness tests, and can do the essential physical parts of my job without straining, so it's not a problem.

The guidance I was given on aerobic exercise was to avoid competitive sports and any maximal effort training, to limit myself to 80% of maximum heart rate and not to train close to that level for extended periods. Previously, I'd be above that level for the whole of a half marathon race, or for the 10K run section of a standard triathlon, so this is quite limiting for me - but I can still run, cycle and swim.

There are some published 2015 US professional guidelines from a sports cardiology working party looking at Marfan and related conditions, linked here: pubmed.ncbi.nlm.nih.gov/265...

These are mostly geared towards young professional athletes, but they do give a feel for the thresholds where there's room for debate and perhaps (when you know the aorta is stable) pushing things a bit more - but, unfortunately, we're both well above those limits.

The other consideration is to understand the signs and symptoms of aortic dissection - severe pain with rapid onset is the key one, sometimes felt in different parts of the body (chest, back, shoulders, neck) sometimes shifting and then fading; it's an ambulance call to a hospital for a CT scan and a transfer to a specialist centre for emergency surgery. Definitely worth avoiding, though.

[JulianM in reply to JulianM]

One very useful thing the sports cardiologists did for me was to assess my blood pressure during exercise (on a static bike) at different levels of intensity, which found no evidence of an abnormal blood pressure response. It also showed that hill climbing where I am using my upper body to assist on a very steep slope (pulling on the handlebars, going isometric) is the one time when blood pressure on a bike would go close to 200 systolic. When I'm out on long rides, I'll now walk some hill sections.

I've also tried to check blood pressure on a treadmill run session, with the help of a friend who is a personal trainer and has worked in cardiac rehab; it's technically very hard to do, but might be worth asking around to get help on it. The results, such as they were, were quite reassuring. Careful warm-ups and warm-downs to avoid blood pressure surges are definitely a good idea.

[Robfromwales]

This is so very helpful and thank you.

[LaceyLady]

Yoga, Thai Chi?

[Cliff_G in reply to LaceyLady]

Some yoga is ok, some not, if you find it strenuous. Tai chi pretty good, imho

[LaceyLady in reply to Cliff_G]

Hatha yoga is the more common.I’m currently recuperating from an emergency Femoral Hernia surgery so doing nowt