Safety and Feasibility of Moderate-Intensity Home-Based Guided Exercise in Aortic Dissection Survivors in the United States: A Multicenter Randomized Controlled Trial

BACKGROUND: Survivors of aortic dissection frequently restrict personal physical activity due to concerns about provoking recurrent aortic events. We conducted a multicenter randomized controlled trial to evaluate the safety and feasibility of a moderate-intensity, home-based guided exercise (GE) regimen. METHODS: Between December 2022 and October 2024, adults ≥3 months post-Type A or B thoracic aortic dissection were randomized at 3 US academic medical centers to GE or usual care (UC; standardized exercise counseling and routine clinic visits). GE participants completed individualized training on a 6-exercise circuit and performed 12 months of home exercise with virtual follow-up visits. Coprimary outcomes were safety (aortic events, exertional hypertension, symptoms, injury, or events requiring medical care) and Patient-Reported Outcomes Measurement Information System 29-Item Profile scores. Secondary outcomes included exertional and ambulatory blood pressure and adherence. Continuous outcomes were compared using t or Mann-Whitney U tests; categorical using χ 2 or Fisher tests. RESULTS: Ninety-three participants (mean age, 56 years; 30% women; 67% Type A aortic dissection) were randomized to GE (n=44) or UC (n=49). Sixteen participants (5 GE and 11 UC) were lost to follow-up, and 65 participants completed all trial milestones. There were no deaths, aortic operations, or recurrent dissections in either group. Exertional hypertension during supervised training occurred in 17 (39%) GE participants and was mitigated by exercise modification. There were no significant changes in paired ambulatory blood pressure measurements (25 GE, 28 UC) or Patient-Reported Outcomes Measurement Information System 29-Item Profile scores (30 GE, 35 UC). CONCLUSIONS: In this pilot randomized trial, moderate-intensity home exercise appeared feasible and was not associated with observed excess aortic events compared with usual care. Larger prospective trials are needed to determine long-term effects on cardiovascular outcomes.