Progressive Exercise Training After Aortic Dissection in a Recreational Athlete

Figures

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  Figure 1. Computed Tomography Imaging of a 56-Year-Old Man With Aortic Dissection (A) Initial presentation shows an extensive thoracic and abdominal AD originating in the ascending aorta, sparing the aortic root, coronary arteries, and major branches, with super mesenteric artery perfused by the false lumen. (B) Postsurgical repair with a 32-mm Hemashield graft in the ascending aorta, aortic valve resuspension, and aortic arch reconstruction, leaving residual descending AD unrepaired. (C) Sixteen months after surgery, follow-up imaging shows stable graft position and unchanged residual descending AD.

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  Figure 2. Progressive Exercise Training Plan for Post-Aortic Dissection Rehabilitation The plan outlines initial (left) and updated (right) aerobic and resistance training regimens, including frequency, intensity, time (including warm-up [WU] and cool-down [CD]), type, and progression, with specific parameters for heart rate (HR), blood pressure (BP), and rating of perceived exertion (RPE) to promote safety.

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  Figure 3. Supervised Exercise Treadmill Test Systolic blood pressure (SBP) (red circles), diastolic blood pressure (DBP) (blue circles), and heart rate (HR) (green circles) responses to a bespoke supervised treadmill exercise protocol in a patient after surgical repair of aortic dissection. White bars signify each interval, with the maximum speed and total interval time noted for each. Red dotted lines show the set parameters for SBP (≤150 mm Hg) and HR (<120 beats/min). After 3 minutes of brisk walking (3 mph, 0% grade), the patient performed 4 × 3-minute intervals at 4.5 mph, 0% grade. Two minutes of rest was allowed between each interval. There was a progressive rise in SBP and HR with progressive exercise intervals. Conversely, DBP did not change from resting values as exercise progressed. Peak SBP was ≤155 mm Hg and peak HR ≤120 beats/min.

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  Visual Summary. Case Summary, Serial Imaging, and Procedural Steps of Return to Exercise 1 RM = 1-repetition maximum; BMI = body mass index; BP = blood pressure; CD = cool-down; CT = computed tomography; DBP = diastolic blood pressure; HR = heart rate; RPE = rating of perceived exertion; SBP = systolic blood pressure; WU = warm-up.