Exercise and stress with Aortic Aneurysm

[ottagal]

Thanks for the great discussion and information, everyone!

In addition to AZ Don's link, I also found another link from the European Heart Journal (2005) for your reading enjoyment and for comparitive reasons.
It is entitled: Recommendations for competitive sports participation in
athletes with cardiovascular disease: A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology

http://eurheartj.oxfordjournals.org/content/26/14/1422.full.pdf

 

[ElectLive]

I've posted the official US consensus guidelines (Thoracic Aorta Disease) a few times before, but probably makes sense to now do so here as well: http://circ.ahajournals.org/content/121/13/e266.full.pdf. See page 80 (e344).

An excerpt of the same:

"The prescription of exercise represents a dilemma in the management of patients with thoracic aortic disease. Because it is thought that the sudden increases in dP/dt and systemic blood pressure associated with physical and mental stress may be a trigger for AoD in many patients, the concept of avoiding such stresses makes sense. However, maintaining a regular routine of aerobic exercise has day-to-day benefitsin helping patients achieve an ideal blood pressure, heart rate, and body weight. Moreover, many patients simply enjoy engaging in sports such as tennis, basketball, golf, bike riding, etc. and wish to continue in such activities if at all possible. There are no outcomes data, and scant data of any variety for that matter, to indicate how much exercise is safe or beneficial for patients with thoracic aortic disease. However, aerobic exercise, sometimes referred to as dynamic exercise, is associated with only a modest increase in mean arterial pressure and AoD rarely occurs during aerobic exercise.

Consequently, most experts believe that aerobic exercise, particularly when heart rate and blood pressure are well controlled with medications, is beneficial overall. Nevertheless,if patients wish to engage in vigorous aerobic exercise, such as running or basketball, one might consider performing a symptom-limited stress test to ensure that the patient does not have a hypertensive response to exercise. Conversely, with isometric exercise, there is a significant increase in mean arterial pressure. When the Valsalva maneuver is used for the lifting of heavy weights, there is a superimposed increase in intrathoracic pressure, followed by a dramatic increase in systemic arterial pressure with systolic pressures reaching 300 mm Hg or greater. As a result, most experts believe that heavy weight lifting or competitive athletics involving isometric exercise may trigger AoD and/or rupture and that such activities should be avoided. Working with patients on an individualized basis to streamline these goals based on insufficient data can be challenging. For patients who are very much interested in maintaining some sort of weight lifting program, choosing sets of repetitive light weights appears to make more sense than permitting heavy weight lifting. For example, instead of bench-pressing 200 pounds, one might recommend selecting much lighter weights in repetitive sets to minimize the hemodynamic consequences. Patients often ask exactly howmuch weight is permissible to lift. Unfortunately, it is not possible to provide a blanket answer to that question, as it all depends on the patient’s size, muscular strength, physical fitness, and how the weight is actually lifted. Rather than try to define a numerical limit, it may be useful to explain that patients can lift whatever weight they can comfortably lift without having to “bear down” or perform the Valsalva maneuver.

In addition to the physiologic stress of exercise, certain sports, recreational activities, or sudden stress or trauma to the thorax can potentially precipitate aortic rupture and/or dissection. Thoracic stress or trauma can occur during competitive football, ice hockey, or soccer or may result from a skiing accident, a fall while water skiing, etc. Therefore, experts often advise patients with thoracic aortic disease to avoid these types of sports. Furthermore, rapid chest rotational movement while straining or breath holding (Valsalva maneuver) may be a common denominator in many patients who develop aortic dissection (ie, basketball, tennis, golf, baseball bat swing, chopping wood with an ax, shoveling snow, and rapidly lifting heavy objects).​

 

[ottagal]

I've posted the official US consensus guidelines (Thoracic Aorta Disease) a few times before, but probably makes sense to now do so here as well: http://circ.ahajournals.org/content/121/13/e266.full.pdf. See page 80 (e344).

Thanks Elective! You are always a wealth of information.

I have to wonder if 'holding a plank' during yoga is a contraindication.

 

[Rachel]

I have to wonder if 'holding a plank' during yoga is a contraindication.

I have the exact same question - I've asked my cardio about this but she didn't know what I was talking about (and I didn't demo it for her)

 

[AZ Don]

I have to wonder if 'holding a plank' during yoga is a contraindication.

I have to think it would be. In a plank you are holding roughly 2/3 your bodyweight and the general guidelines on lifting is 50% of bodyweight. Still, what's heavy to one person may not be to another. Here's an article that touches on that:
http://voices.yahoo.com/aortic-aneurysm-safe-weight-lifting-techniques-10202915.html?cat=70

The article suggests using a weight you can lift at least 15-20 reps.

 

[TheGymGuy]

This is very good discussion. I have read the Article that EL posted before as well. What is interesting is that they refer to patients with Thoracic Aorta Disease, but there is not a mention of indications for patients form whom the weak parts of aorta were fixed/replaced/etc.

I have spoken with my cardiologist and my Surgeon, two people that I trust a good amount. Both were able to reason that once the weak/broken parts are replaced, all sorts of sports things will be safe to perform. Including valsalva maneuver which my sport requires for every single exercise. The reasoning was also that we monitor things on yearly basis with high-tech equipment and tests, i.e. we can do Cardiac MRIs and CT Scans. I prefer not to do CT Scans, and luckily was involved in an NIH study which allows me to get yearly Cardiac MRIs with contrast. I am a good lab rat, but also benefit from these scans as we can see my heart, valves and all of aorta very clearly.

I have been training as rigorously as ever, and this only applies to me as a test subject for the moment, but things look just fine for now with all the valsalva, high intensity training, etc.

Just my 2cents. My real hope is that we have other athletes who went/go through similar repairs that have years of training on them that can add to the group of lab rats like myself for larger sample size to the experiment to show that exercising (the rigorous kind) is ok.

 

[Rachel]

Yes, Gym Guy I thought about that too after I posted - where are the studies of the "fixed" people????

Oh....that's right, they're on this forum

Rachel

 

[ElectLive]

There are really two conversations to be had, and this thread is touching on both. Pre and Post surgery do not necessarily mean the same thing. Of course, we also have to be a little careful how we define "fixed". For those with BAV, replacing the valve and grafting the aneurysm doesn't cure the underlying disease. It does, though, solve the active problems. As Don mentioned earlier, Cleveland Clinic is pretty consistent on this (just check out their aorta related webchats)...they have very firm cautions pre-surgey then pretty much open everything up post-surgery for those whom it really matters, for those without active disease. Many of the professional athletes who have gone there are now evidence. What they do seem to insist upon, though, is more proactive measures...such as yearly MRI. Should aorta issues develop elsewhere (low risk, but it does certainly happen in some) then hopefully it will be discovered early, and caution can return as needed.

No one wants to just survive, we all want to live, in every aspect of the word. We should be fully open with our doctors about our aspirations, and hope we are treated as persons as much as patients. Caution can take many forms beyond mere restrictions...things such as exercise stress tests, more frequent monitoring, etc.

 

[AZ Don]

Good discussion. I have started a new thread specifically to discuss exercise post aneurysm repair:
http://www.valvereplacement.org/forums/showthread.php?41721-Exercise-Post-Aneurysm-Repair

I've posted what little specific information I could find on this subject. The net of it is that everything in life carries some risks, exercising post aneurysm repair is no different, but it does appear the risks are small and as gymguy mentions, mitigated somewhat by regular follow-ups. Still, since April when I've started following this subject, I've come across at least two people that had a 2nd aneurysm.

 

[canon4me]

AZ Don, very good subject! I am now 12 days out from a AVR and Aortoplasty done at Cleveland Clinic by Marc Gillinov, MD. He was pretty optimistic about me resuming weightlifting activities. However, with that being said....cardiologists at Cleveland Clinic were not. My aneurysm had been previously measured at 4.5 for over 15 years using an echocardiogram. On one occasion at Mayo, using a 64 slice CAT scan as my cancer recheck, they measured my aneurysm at 4.3 cm. when Cleveland gets ready to do AVR and aneurysm repair, they always do a high resolution CAT scan on the heart itself. They told me it was at 4.3 cm. the surgeon said at 4.3 cm it technically is not an aneurysm but an enlargement ord the aorta. The surgeon, during the Aortoplasty, folded over a piece of the aorta and sutured it reducing the volume of the aorta.

Anyway, since I have bicuspid aortic valve before surgery, which is a connective tissue disease, the cardiologist at Cleveland said despite the repair, anywhere else along my ascending aorta or descending aorta all the way down into my abdominal aorta, I am at risk for another aneurysm or dissection and his advice would be no gut-wrenching poundages and that toning would be ok, even slightly heavier than toning as long as I never held my breath on the exertion phase of the lift. I am 57 years of age and have lifted weights since age 14, always non-competitively, but nonetheless have loved it and the benefits one gets from lifting. I am going to listen to the cardiologist and not my surgeon fixing my chest. I've got about 4 complete York Olympic milled 400# sets that I will probably be selling except for my original set I purchased at age 17. I have a hip sled and squat machine and that will probably go to. Don't know for sure. I've got a multi exercise machine for the wife that I may move to. I've never been a gambler, especially with my own life and this time I choose life over risky behavior. At 57 years old I realize I am no longer 18 and I have nothing to prove and I intend on staying fit as a fiddle, but just not carrying the mass I did as a youngster in my early 20's. I am enjoying my life too much with my wife on our prairie now to throw a wrench into the mix.

 

[RobThatsMe]

Hi all,

I had an ascending aortic dissection at age 49. I was one of the lucky ones who made it to the hospital. Even then, they told my wife to say her goodbyes, that I only had a 3 to 6% chance of surviving the emergency surgery. The stats indicate that if an aneurysm or dissection occurs, most don't make it to the hospital, and of those that do, only about half survive the emergency surgery.

Prior to my incident, I was a weight lifter/body builder for years. I was in great shape. After my surgery, I was after answers, and my vascular surgeon told me that I had a congenital tissue disorder, and that even if I did find out more info on this, it would not change the past or fix the on-going underlying condition. I could still however, workout in moderation, much lighter weights, and higher reps.

10 yrs later, my body was rejecting my valve, by building up panus tissue preventing it from functioning. While undergoing the pre-surgery testing for my valve replacement, the tests revealed a new issue, an aneurysm in my arch..Hummm. Long story shorter, All went well, 13.5 hrs in surgery, 30 days in the hospital post surgery, and all is well. Today, I am 63, and continue to stay in good condition to fight the next health issue.

My point is this, Each person has unique issues. There is no "all in" one answer. Dissections, and Aneurysms are called the "Silent" killers for a reason. Follow your doctors' guidelines, and determine if the reason for your surgery can pose on-going health risks. Don't tempt your fate with vanity over life, or trying to prove that you are still as you were prior to your incident.
Aneurysms, and Dissections are a whole different beast than many other heart related issues. Many have VR surgery for other issues, and many can go back to life as normal, but again, one shoe does not fit all.

Just my 2 cents worth, from one still going strong, but not as strong as I once was. But then again, 13 yrs later, I am still enjoying life with my wife.

Rob

 

[AZ Don]

Canon, thanks for mentioning. Surprising that the Cleveland Cardiologists are saying something different than the surgeons.

Rob, quite a story, thanks for sharing.

 

[Rachel]

Rob,

You're an inspiration - wise words!!!

 

[MtBiker]

My cardologist and my surgeon both said to continue being active before surgery. I decided on my own to scale back my four or five two or three hour rides a week. I didn't so much reduce the time as the intensity. Nevertheless when the surgeon got my chest cracked three months after the echo that diagnosed my 5.0 cm aneurysm (bav) it was significantly more advanced than he expected and he had to do a hemiarch repair rather than just replacing the ascending aorta.

The lesson I came away with was that I should have had the surgery sooner after the echo though it was hard enough to get on the surgical calendar as it was.

 

[Capt.Jim]

I have a small farm and I'm a commercial fisherman, having aorta and aortic valve replacement in October. I've worked hard all my life and even though the cardiologist said I shouldn't lift over 50lbs 15 yrs ago I've had to keep working to take care of my family, I haven't had a day off since 1971 when I got leave from the military and I still work 12 to 16 hrs. a day. I'm sixty years old weigh 205 , 5'10", don't smoke, drink a bit, never run or work out, I feel fine, a bit tired after a long hard day but I'm OK in the morning. My question is will I be able to keep going after surgery? I have to work another twenty years to help get everyone through college and I don't know what to expect. I guess I'm just worried, I didn't give this much thought until they said I needed surgery, By the way my great grandfather lived to 102 and taught me how to plow with horses, I still do.

 

[Agian]

From what I understand, the lifting restrictions (if any) are related to the risk associated with increasing your blood pressure and placing strain on your currently dilated aorta. When the aorta is fixed, those restrictions are no longer relevant. Although many would choose to be a little cautious post-op, this would still be less so than pre-op. I'm pre-op as well, and as I see it, I expect to feel more comfortable lifting 'heavy', after the operation. My ascending aorta is currently 4.1 cm.

 

[AZ Don]

As Agian says, the risks of exercise are primarily associated with an aortic aneurysm. After that is repaired, the risks of exercise are less clear. Some Dr's say no limitations and others say heavy lifting and strenuous exercise should still be avoided. If you can it would be wise to limit the heavy lifting prior to surgery and post-op you should plan to avoid heavy lifting for at least 8-12 weeks. The sternum has to heal and I understand heavy lifting can cause complications. Some people have returned to very active lifestyles after surgery. Jeff Green returned to the NBA after surgery, and TheGymGuy from this forum returned to competitive power lifting. I'm just over 3 months post-op now and I am taking it a little easy because I can, but I feel capable of doing anything I want to.

 

[pellicle]

as I understand it, yes! And probably you may feel better too.

Not having the surgery increasingly becomes a much greater risk than anything that is likely from the surgery.

 

[Agian]

Did this Jeff Green guy have a valve replacement?

 

[AZ Don]

Did this Jeff Green guy have a valve replacement?

I don't think so. I read that he had a root repair though, and typically the aortic valve is re-implanted inside the aortic root graft. So if his operation was valve sparing then he has his original valve but it is almost as if it was re-installed.