The following are key points to remember from this Viewpoint article on physical activity and exercise in patients with spontaneous coronary artery dissection (SCAD) and fibromuscular dysplasia (FMD):

1. Patients with SCAD and FMD remain at risk of recurrent vascular dissection in the setting of increased mechanical and shear stress of the arteries. Extreme or unusual exercise has been reported as a trigger for SCAD in up to 29% of patients, although causation has not been proven.
2. Exercise in general is associated with positive effects on vascular function, and as such, limiting exercise among patients with SCAD or FMD due to mechanistic risk should be avoided.
3. With limited available data, moderate aerobic training among SCAD patients is recommended for 30-40 minutes 5-7 days/week.
4. Cardiac rehabilitation should be recommended for all patients. In addition, patients should be counseled to remain active using interval training and low resistance weight training.
5. Activity such as endurance aerobic training, muscle building, and yoga with extreme head and neck positions should be done with caution.
6. Patients should use proper breathing and lifting techniques, avoid Valsalva or straining, and avoid high-intensity exercises in extreme environmental conditions.
7. Patients with carotid or vertebral artery dissections should avoid exercises such as push-ups and sit-ups for 8–12 weeks after the acute dissection after which the recommendations would be similar as for SCAD.
8. There are no data currently to support restricting activities such as riding a roller coaster, sky diving, scuba diving, or sexual intercourse.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Exercise

Keywords: Cardiac Rehabilitation, Coronary Vessel Anomalies, Dissection, Exercise, Fibromuscular Dysplasia, Lifting, Muscles, Myocardial Ischemia, Risk Assessment, Secondary Prevention, Vascular Diseases, Vertebral Artery Dissection, Yoga

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