Marfan on the Move

Is physical activity a future therapy for patients with Marfan syndrome?

Introduction

The international recommendations tend to avoid physical activity (PA) for patients with Marfan syndrome (MFS). However, exceptions have recently been made in the most recent recommendations for these patients, suggesting benefits from doing PA at low intensity only. Furthermore, there is no evidence that moderate aerobic or weight training can worsen the disease symptoms and increase mortality of MFS patients. The present review sums up the work carried out in the field of PA and MFS. The review aims to (1) identify the different types of exercise testing and training protocols and (2) discuss the feasibility and potentially beneficial nature of PA as an innovative way to manage MFS patients.

Methods

The scientific literature was reviewed using the following words: Marfan syndrome, training, physical activity, evaluation, weight training, arterial disease, aneurysms, lung damage, aortic dissection, rupture. A total of 345 studies were prospected and 43 studies were included.

Conclusions

A limited number of studies were done in humans, however one demonstrated the feasibility of the management of MFS patients with PA. There were potential beneficial effects of PA on arterial structures, but this review also showed deleterious effects when PA was conducted at high intensities, corresponding to 75–85% of the maximal oxygen uptake. However, these effects have only been reported in animal studies.

Exercise parameters for the chronic type B aortic dissection patient: a literature review and case report

INTRODUCTION

The conservative management of a Stanford type B aortic dissection (TBD) is optimal blood pressure management, cardiac rehabilitation, and progressive return to activities of daily living (ADL) while preventing advancing dissection and aortic dilation. Recent case reports indicate higher levels of activity may be safe; however, the exercise parameters for chronic TBD conditions span a broad range and the research is limited.

CASE PRESENTATION

The clinical presentation and outpatient cardiac and physical rehabilitation program for a 61-year-old male with a chronic TBD from his subclavian artery to common iliac arteries is presented. The exercise protocol was developed and based on the available literature for the management of chronic aortic diseases. Eighteen months after the patient's acute TBD event, he began an exercise protocol designed to address the sport specific functional deficits related to his recreational activities. The program incorporated a variety of exercises from resistance training to cardiovascular exercise and high interval training. The therapeutic goals included restoration of cardiac fitness and improvement of core stability and appendicular strength, ultimately aiming toward a potential to return to recreational sport involving short duration, high intensity activity.

CONCLUSION

In conjunction with the appropriate anti-hypertensive medication treatment, understanding the concepts of aortic hemodynamics as they relate to exercise can serve as a guideline for clinicians in developing an individualized exercise program for their TBD patients. Moreover, these physical training programs may include particular exercise guidelines beyond general recommendations of light to moderate cardiovascular activities.