Exercise and Thoracic Aortic Aneurysms: A Paradigm Shift Toward Informed, Personalized Activity Guidelines
8 affiliations
- 1The Valley Hospital
- 2Mt. Sinai Hospital, Icahn School of Medicine
- 3Scuola Superiore Sant'Anna
- 4Washington University
- 5Stanford University School of Medicine
- 6University of Ottawa Heart Institute
- 7Columbia University
- 8University of Michigan
Abstract
Exercise is widely recognized for its cardiovascular benefits; however, its safety and role in patients with thoracic aortic aneurysms (TAAs) remains complex due to its distinctive biomechanical vulnerabilities. Fundamentally different from abdominal aortic aneurysms, TAAs develop from distinct pathophysiological processes that affect their hemodynamic responses to stressors and influence their risk of adverse aortic events. Exercise induces acute hemodynamic changes, including increased stroke volume, systolic and pulse pressures, and transient aortic stiffening. These changes impose mechanical stress on the aortic wall, potentially accelerating aneurysm progression or triggering adverse aortic events. Although moderate aerobic exercise generally appears safe with potential cardiovascular benefits, evidence supporting safe practices in TAAs is limited. Current guidelines frequently extrapolate from abdominal aortic aneurysm data, which overlook the specificities of the thoracic aorta. This review underscores the urgent need for comprehensive research, using advanced imaging, biomarker profiling, and real-time hemodynamic monitoring to understand how different exercise modalities and intensities affect TAAs. Well-designed prospective studies are crucial to improve risk stratification, optimize antihypertensive strategies, develop personalized exercise prescriptions, and provide evidence-informed guidance to patients. Perioperative strategies like prehabilitation and structured postoperative rehabilitation show promise but lack rigorous evaluation. Ultimately, this work advocates a paradigm shift from conservative inactivity toward informed, individualized physical activity regimens tailored to each patient's risk profile. This approach aims to maximize cardiovascular benefits while minimizing adverse aortic events, thereby improving overall health and quality of life in patients with TAAs.
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BibTeX
@article{jabagi2026exercise,
title = {{Exercise and Thoracic Aortic Aneurysms: A Paradigm Shift Toward Informed, Personalized Activity Guidelines}},
author = {Habib Jabagi and Giuseppe Imperatore and Alex Nantsios and Louise Y. Sun and Alexandra Lewis and Munir Boodhwani and Hassan Mir and Hiroo Takayama and Himanshu Patel and Paul Burns and Juan B. Grau},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.125.046671},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.125.046671},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Exercise and Thoracic Aortic Aneurysms: A Paradigm Shift Toward Informed, Personalized Activity Guidelines
AU - Habib Jabagi
AU - Giuseppe Imperatore
AU - Alex Nantsios
AU - Louise Y. Sun
AU - Alexandra Lewis
AU - Munir Boodhwani
AU - Hassan Mir
AU - Hiroo Takayama
AU - Himanshu Patel
AU - Paul Burns
AU - Juan B. Grau
PY - 2026
DA - 2026/10/20
JO - Journal of the American Heart Association
DO - 10.1161/jaha.125.046671
UR - https://www.ahajournals.org/doi/10.1161/JAHA.125.046671
AB - Exercise is widely recognized for its cardiovascular benefits; however, its safety and role in patients with thoracic aortic aneurysms (TAAs) remains complex due to its distinctive biomechanical vulnerabilities. Fundamentally different from abdominal aortic aneurysms, TAAs develop from distinct pathophysiological processes that affect their hemodynamic responses to stressors and influence their risk of adverse aortic events. Exercise induces acute hemodynamic changes, including increased stroke volume, systolic and pulse pressures, and transient aortic stiffening. These changes impose mechanical stress on the aortic wall, potentially accelerating aneurysm progression or triggering adverse aortic events. Although moderate aerobic exercise generally appears safe with potential cardiovascular benefits, evidence supporting safe practices in TAAs is limited. Current guidelines frequently extrapolate from abdominal aortic aneurysm data, which overlook the specificities of the thoracic aorta. This review underscores the urgent need for comprehensive research, using advanced imaging, biomarker profiling, and real-time hemodynamic monitoring to understand how different exercise modalities and intensities affect TAAs. Well-designed prospective studies are crucial to improve risk stratification, optimize antihypertensive strategies, develop personalized exercise prescriptions, and provide evidence-informed guidance to patients. Perioperative strategies like prehabilitation and structured postoperative rehabilitation show promise but lack rigorous evaluation. Ultimately, this work advocates a paradigm shift from conservative inactivity toward informed, individualized physical activity regimens tailored to each patient's risk profile. This approach aims to maximize cardiovascular benefits while minimizing adverse aortic events, thereby improving overall health and quality of life in patients with TAAs.
SN - 2047-9980
ER -