Safety and Feasibility of Moderate-Intensity Home-Based Guided Exercise in Aortic Dissection Survivors in the United States: A Multicenter Randomized Controlled Trial
Dipika Bhatia, Nikhil Erabelli, Kayla House, Yasmin Toy, Michelle S. Lim, Leslie M. Boyer, Kim A. Eagle, Marion K. Hofmann Bowman, Alan C. Braverman, Siddharth K. PrakashBACKGROUND:
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
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.