Structured Exercise Appears Feasible and Safe in Survivors of Aortic Dissection, Suggests Study
USA: Survivors of aortic dissection remain at lifelong risk for adverse cardiovascular events, with outcomes strongly influenced by blood pressure control and physical activity.
Researchers have found in a pilot study that survivors of Type A and Type B thoracic aortic dissection who participated in a structured exercise program experienced no deaths, repeat aortic surgeries, or recurrent dissections compared with usual care. Although these findings suggest that structured exercise is feasible and may be safe in this population, larger prospective studies are needed to determine its long-term effects on cardiovascular outcomes.
The findings were published in Circulation: Cardiovascular Quality and Outcomes by Dipika Bhatia from the John P. and Kathrine G. McGovern Medical School at the University of Texas Health Science Center at Houston and colleagues.
Survivors of aortic dissection often limit physical activity due to concerns that exercise may trigger another life-threatening aortic event. However, evidence on the safety of structured exercise in this high-risk population remains limited. To address this gap, researchers conducted a multicenter randomized controlled pilot trial to evaluate the safety and feasibility of a moderate-intensity, home-based guided exercise program.
The researchers enrolled adults at least three months after a Type A or Type B thoracic aortic dissection from three US academic medical centers between December 2022 and October 2024. Participants were randomly assigned to either a guided home-based exercise program with virtual follow-up or usual care consisting of standard exercise counseling and routine clinical visits.
The primary outcomes were safety and patient-reported health status. Researchers evaluated deaths, recurrent dissections, repeat aortic procedures, exercise-induced hypertension, symptoms, injuries, and other medical events, and assessed quality of life using the PROMIS-29 Profile. Secondary outcomes included ambulatory and exercise blood pressure and adherence to the exercise program.
The trial revealed the following findings:
- The trial randomized 93 participants with a mean age of 56 years.
- Women accounted for 30% of the study population.
- Approximately 67% of participants had a previous Type A thoracic aortic dissection.
- Forty-four participants were assigned to the guided exercise group, while 49 received usual care.
- Sixteen participants were lost to follow-up, and 65 completed all study milestones.
- No deaths, recurrent aortic dissections, or repeat aortic surgeries occurred in either group during the study.
- Exertional hypertension occurred in 39% of participants in the guided exercise group during supervised training, but was effectively managed by modifying exercise intensity.
- No significant changes were observed in ambulatory blood pressure between the guided exercise and usual care groups.
- Patient-reported health and quality-of-life scores (PROMIS-29) were similar between the two groups throughout the study.
The researchers concluded that a structured, moderate-intensity home-based exercise program is feasible and is not associated with an increased risk of adverse aortic events in survivors of thoracic aortic dissection. They emphasized that larger, long-term randomized trials are needed to determine its effects on cardiovascular outcomes and overall health.
Reference:
https://doi.org/10.1161/CIRCOUTCOMES.126.013292
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