Dr. Maciej Malinski is on the medical staff at Sherman Hospital. He has been kind enough to answer some frequently asked questions related to maintaining a healthy heart. Look for additional heart information from Dr. Malinski in the coming weeks.
Q: Dr. Malinski,
What are your thoughts on moderate to high intensity cardio exercise and beginning to intermediate yoga practice for a person with a 4.1 cm aortic aneurysm? It seems there is no research to support the restrictions that I have been given, which are: no heavy weight training, keep target heart rate 115-120. This is very difficult for an active person like myself.
A: A diagnosis of Abdominal Aortic Aneurysm (AAA) creates significant disease-related anxiety in patients who understand they have a life-threatening illness that carries a small chance of sudden death in the months or years prior to eligibility for surgical repair. Aneurysms occur with greatest frequency in the distal aorta. Sedentary style of life creates hemodynamic (blood flow) conditions predisposing aorta to degenerative changes (increased peripheral resistance, increased wall shear stress, and reduced flow). Basically, this means that NOT exercising makes it far more likely that you will develop dangerous heart conditions down the road.
There is some evidence that these high-risk sedentary hemodynamic conditions are completely obliterated with moderate levels of exercise. So, how much exercise is necessary? Unfortunately, there is currently no protocol to help doctors craft an exercise plan for people diagnosed with AAA. Generally, moderate levels of exercise are beneficial, and patients with mild AAA are encouraged to engage in exercise programs. As for weight training, doctors typically advise against it, just as yours did. I usually tell my patients not to engage in heavy weight lifting programs, but to take advantage of aerobic exercises and light-to-moderate weight lifting.
Let’s not forget that there are also other strategies proven to limit AAA expansion, one strategy being blood pressure (BP) control. In the past, beta-blockers were the first line of therapy, but now we have lots of evidence for angiotensin-converting enzyme (ACE) inhibitors being a better choice as a first line of medication. The second line of therapy with cholesterol lowering medications (statins) is beneficial.
In summary, I would not put too many restrictions on aerobic exercise. As far as target heart rate is concerned, there is no medical evidence to guide you with any restrictions. Heavy weight lifting is where you’d need to be careful. Were you my patient, I’d likely advise to stay away from heavy weight training. The advice also depends on the size of AAA and the rate of expansion. I would advise you to see a cardiovascular specialist who would review your imaging studies of AAA, and give you very specific advice on the exercise program that would be best for you.
Do you have a question for Dr. Malinski? To submit your question, either post it in the comments section below or email firstname.lastname@example.org with the subject line “Question for Dr. Malinski.” For more information on heart health, click here to visit Sherman’s Heart and Vascular Center.
This post is published by Sherman Health to provide general health information. It is not intended to provide personal medical advice, which should be obtained directly from your physician.