Exercise in Patients With SCAD and Fibromuscular Dysplasia

Tweet MS, Olin JW, Bonikowske AR, Adlam D, Hayes SN.
Physical Activity and Exercise in Patients With Spontaneous Coronary Artery Dissection and Fibromuscular Dysplasia. Eur Heart J 2021;Jun 7:[Epub ahead of print].

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

  1. The safety of physical activity and exercise in patients with SCAD or FMD is unknown.
  2. The hypothesis suggests that the increase in cardiac contractility and heart rate during exercise will lead to increased focal shear stress and strain at high-risk segments of vulnerable arteries.
  3. Patients with SCAD or FMD are often young and otherwise healthy. Restrictions on physical activity are often based on an abundance of caution rather than clinical evidence.
  4. Exercise restrictions have impacts on cardiovascular disease and atherosclerosis, mental health, and physiological fitness.
  5. Cardiac rehabilitation programs for patients with SCAD have shown physical and mental benefits.
  6. The authors recommend aerobic training for their patients with SCAD, including 30-40 minutes of moderate-intensity physical activity 5-7 days/week, similar to the general population.
  7. There is no evidence to prove that exercising with heavy loads is harmful, provided that proper technique is followed to prevent straining or Valsalva.
  8. Current recommendations for patients with FMD are to avoid resistance training during the first 8-12 weeks after acute carotid or vertebral artery dissections.
  9. The authors do not recommend any restrictions on sexual activity. Hemodynamic studies have shown that sexual activity is below the threshold for concern and comparable to 3-5 metabolic equivalents.
  10. Current recommendations are based on opinion. Cardiac rehabilitation programs are safe and useful, but future research is needed to define optimal fitness and strength training thresholds in this population.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Prevention, Sports and Exercise Cardiology, Vascular Medicine, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, Exercise, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology

Keywords: Atherosclerosis, Cardiac Rehabilitation, Coronary Vessel Anomalies, Dissection, Exercise, Fibromuscular Dysplasia, Heart Rate, Mental Health, Primary Prevention, Resistance Training, Sinus of Valsalva, Vascular Diseases, Vertebral Artery Dissection, Women

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