U.S. — A pilot study led by Dr. Siddharth Prakash, an MD and PhD at the University of Texas Health Science Center at Houston, found that guided exercise is feasible and safe for survivors of thoracic aortic dissection (TAD). The study, conducted at three U.S. academic medical centers from December 2022 to October 2024, challenged previous assumptions about physical activity for these patients.

Researchers screened 477 patients for the study. Ninety-three adults, at least three months post-Type A or B thoracic aortic dissection, were randomized into either a guided exercise group or a usual care group. The guided exercise program included introductory training on a six-exercise circuit, followed by 12 months of moderate-intensity home exercise. The usual care group received standardized exercise counseling and routine clinic visits.

The exercise circuit for the guided group involved wall sits, hand grips, leg raises, treadmill sessions, stationary bike sessions, and bicep curls. Participants had a three-minute rest period between exercises, and each completed the circuit twice. Blood pressure measurements were taken during each exercise and rest period.

The study reported no deaths, aortic operations, or recurrent dissections among participants in either the guided exercise or usual care groups during the study period. Supervised training did lead to exertional hypertension in 39% of cases, defined as systolic blood pressure greater than 180 mm Hg or diastolic blood pressure greater than 100 mm Hg during more than one exercise. This condition was mitigated by modifying the exercise routine.

One participant experienced a right iliac artery dissection after engaging in beach volleyball and cycling, activities outside the recommended exercise routine. This dissection remained stable on follow-up imaging and did not require intervention during the study period. Sixty-five participants completed study assessments, while 17 were lost to follow-up.

Available data from the study did not show changes in paired ambulatory blood pressure measurements or in Patient-Reported Outcomes Measurement Information System 29-Item Profile quality-of-life scores at 12 months. The study missed its target enrollment of 126 patients due to slow recruitment.

Prakash stated, "Our findings challenge long-standing assumptions that TAD survivors should avoid moderate physical activity." He added, "Instead, our data demonstrate that with proper instruction and monitoring, TAD survivors can safely engage in structured exercise without precipitating hypertensive crises or aortic complications." He further noted that the fear of recurrent dissection during physical exertion frequently leads patients to restrict activity, which can limit their cardiometabolic and psychosocial recovery. Prakash also stated, "These findings should be interpreted cautiously. The study was underpowered to detect modest but clinically meaningful differences, and type II error cannot be excluded. Accordingly, these results are best viewed as preliminary evidence supporting the feasibility of this strategy and informing the design of future clinical effectiveness trials."