Key result
Appropriately managed exercise appears unlikely to cause fatal hemodynamic changes in older severe AS patients.
Why the study?
Older patients with severe aortic stenosis may be ineligible for TAVI or surgery, requiring symptom-based rehabilitation, but no studies have examined exercise safety in this group.
Is exercise safe for older patients with severe aortic stenosis undergoing conservative management?
Is exercise safe for older patients with severe aortic stenosis undergoing conservative management?
Exercise under appropriate management is unlikely to cause fatal hemodynamic changes in older patients with severe aortic stenosis, suggesting that symptom-based rehabilitation may be safely considered for those undergoing conservative management.
Answers are grounded in this paper and cite their sources.
Supports supervised exercise in conservative severe AS; leaves open RCTs of structured interventions.
The incidence of aortic stenosis (AS) increases with age and is a serious problem in an aging society. In recent years, transcatheter aortic valve implantation (TAVI) has been performed widely; however, older patients may be ineligible for TAVI or surgical treatment because of medical ineligibility. Symptom-based rehabilitation is required for these patients to maintain and improve their physical function and ability to perform activities of daily living. No studies have examined exercise safety for older patients with severe AS who are ineligible for TAVI or surgery. We summarized the safety of exercise for older patients with severe AS, collecting 7 studies on maximal exercise stress tests and 16 studies on preoperative physical examinations. From this review, it may be unlikely that exercise under appropriate management can cause hemodynamic changes, leading to death. However, there were no studies on exercise intervention for older patients with AS who are chosen for conservative management. The optimal exercise intensity for symptomatic older patients with AS undergoing conservative management and the effects of continuous exercise intervention require future study.
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Nashimoto et al. (2022) conducted a review in Severe aortic stenosis. Exercise was evaluated on Safety of exercise (hemodynamic changes leading to death). Exercise under appropriate management is unlikely to cause hemodynamic changes leading to death in older patients with severe aortic stenosis, based on a review of 23 studies.
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