Physical activity and exercise in SCAD and FMD patients

Paper answers questions on exercise after SCAD

A paper summarising the physical activity and exercise considerations for SCAD and FMD patients has been published in the European Heart Journal.

SCAD and Fibromuscular Dysplasia (FMD) are associated conditions. Many patients with SCAD have FMD but there are also many patients who have either one condition or the other. The precise links between these conditions are being studied but are not fully understood.

Following a SCAD, one of the questions many patients ask is what kind of exercise they can do? Some find cardiac rehab doesn’t challenge them enough, especially if they did a lot of exercise pre-SCAD. They also want to understand whether they can return to some of the exercise they previously did, such as running marathons, weight training and more.

It’s not only the patients who want guidance. Healthcare professionals, including cardiac rehab teams, are often unable to advise patients about what is ‘safe’ and what they should avoid.

Exercise has been associated with some SCADs, but it is not yet known if exercise actually causes SCAD. However, this association has led to caution in terms of advising what kind of exercise can be done.

The benefits of exercise, both in terms of physical and mental wellbeing, are well-known and the paper highlights that patients need to balance the theoretical risks of exercise after SCAD or FMD against the disadvantages of not exercising (both physical and mental) with all the known benefits that exercise brings.

The authors say there is a lack of data to help identify specific exercise programmes, however in their experience looking after SCAD and FMD patients, they recommend SCAD patients follow most of the usual advice given to the general public. However, they should avoid extreme exercise, favouring regular repeated activities over exercising to exhaustion and should rest if they become uncomfortable.

Exercise that is recommended for SCAD patients includes:

  • Cardiac rehab
  • Moderate aerobic exercise – 30-40 minutes a day/150 minutes a week
  • Interval training
  • Resistance training using lower resistance and higher repetitions

Patients are advised to be cautious when doing high endurance aerobic training, muscle-building exercises or Yoga poses that involve extreme head and neck positions.

They should avoid abrupt high-intensity exercise, contact sports and extreme head positions. Muscle toning type weights work is reasonable and the authors don’t recommend specific weight limits as some patients may find this too restrictive. Any weight lifting should be completed within a normal regular breathing pattern avoiding the Valsalva manoeuvre (holding your breath and straining during lifting of heavy weights).

The advice, based on expert opinion rather than data or controlled trials, for FMD patients is the same as for SCAD patients, but those with carotid or vertebral dissections should avoid resistance training during the first three months. Anyone with aneurysms should avoid anything that requires straining or Valsalva (eg sit-ups, planks) or anything that quickly increases blood pressure.

Dr David Adlam, who leads the UK SCAD research and is one of the paper’s authors, said: “We are excited to share a first set of published suggestions on how to exercise safely after SCAD and FMD. The main message is that exercise is good for the heart and good for the head and most activities with a few common-sense limitations can be continued safely.”

The paper is a collaboration between SCAD researchers Dr David Adlam, who is leading the UK research in Leicester, Dr Marysia Tweet, Dr Sharonne Hayes and Dr Amanda Bonikowske at the Mayo Clinic, and Dr Jeffrey Olin at the Icahn School of Medicine in New York. Beat SCAD funding has supported this research.

Beat SCAD Walk 2022