Exercise and sports participation in patients with thoracic aortic disease: a review

ABSTRACT

Introduction: Current guidelines recommend patients with thoracic aortic disease (TAD) including inherited aortopathies to avoid heavy exercise. However, evidence supporting the negative advice on exercise is scarce. We aimed to provide an up-to-date systematic review of the available evidence on risks and benefits of exercise and sports participation in TAD patients.

Areas covered: A systematic search was performed in Medline, Embase and Web of Science: thoracic aortic aneurysm or thoracic aortic dissection or inheritable aortopathies including Marfan Syndrome (MFS), Loeys-Dietz syndrome, Turner Syndrome, Ehlers-Danlos syndrome, bicuspid aortic valve (BAV) and sports, exercise or athletes. The resulting 1,652 manuscripts were reviewed by two independent observers. Eventually, 26 studies and 12 case-reports were included, reporting on thoracic aortic dimensions in athletes, exercise related acute aortic dissections, and exercise in BAV and MFS patients.

Expert opinion: Blood pressure elevation during exercise may be associated with an increased risk of acute aortic dissection; however, no controlled trials have longitudinally evaluated the effect of exercise on survival or the risk of aortic dissection in TAD patients. Mouse-model studies suggest beneficial effects of exercise in the setting of a dilated aorta in MFS. There is a clear need for prospective research in this field.

KEYWORDS:

• Athletes
• bicuspid aortic valve
• exercise
• heritable thoracic aortic aneurysms and dissection (HTAAD)
• inheritable aortopathies
• Marfan Syndrome
• sports participation
• thoracic aortic dilatation
• thoracic aortic dissection

Article highlights

• Strenuous and isometric exercise might contain a risk of causing acute aortic dissections in patients with TAD. However, the exact relationship between exercise and acute aortic dissections remains unclear.

• A potential positive effect of mild to moderate dynamic exercise training on thoracic aortic dilatation rate and aortic wall structure was reported in mice with MFS.

• There is a gap in knowledge about the positive and negative effects of exercise and sports participation in TAD patients. More research is needed to investigate the exact effects of different types of exercise on thoracic aortic dilatation growth rate and the risk of aortic dissection.

Acknowledgments

The authors would like to acknowledge Gerdien B de Jonge.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Additional information

Funding

This paper was funded by ZonMW (project number: 849200014) and the Dutch Heart Foundation (contract grant number: 2013T093).