Strenuous Exercise is Risky!

Dr. James Manos (MD)

February 18, 2016

Strenuous exercise, including weightlifting, may increase the risk of fatal rupture of an aortic or a brain aneurysm or aortic dissection!

There are many concerns that strenuous weightlifting may cause aortic dissection or aortic or brain aneurysm rupture, which may be fatal.

Current studies in the pathophysiology and predisposing conditions of acute aortic dissection in the young population (children, adolescents, and young adults) include congenital cardiovascular anomalies, specific heritable disorders of the connective tissue (such as Marfan’s syndrome), cocaine abuse, and weightlifting (5).

Aortic dissection (AD) is an uncommon condition that occurs mainly in the population aged more than 40 years old. It is rare in younger people and is usually associated with trauma, Marfan’s syndrome, or pregnancy. A case of a young weightlifter who died from an AD was reported in a study. The autopsy diagnosed a non-Marfan’s fibrillinopathy. The authors of the study recommend that aortic dissection (AD) should be considered in symptomatic patients with any family history of early cardiac deaths, a history suggestive of a connective tissue disorder (that is, multiple joint surgeries), or people who practice weightlifting (6).

Contrary to aerobic exercises, weight training routinely produces sharp rises in blood pressure to over 300 mmHg! This is a danger for individuals with an unknown aortic aneurysm to whom the deteriorated mechanical properties of the aortic wall resulting from aneurysmal enlargement increase the susceptibility to aortic rupture when the high wall coincident with exertion exceeds the tensile strength of the aortic wall. 

A study demonstrated a causal link between extreme effort, severe emotional stress, and acute type A aortic dissection. People participating in weight training, especially young people, are unaware of the aortic enlargement. Thus, an iSnapShot Echocardiogram screening program has been proposed for persons participating in weight training. Pre-participation cardiac screening is essential for the early detection and prevention of aneurysms. Without an aneurysm, wall tension does not reach dangerous levels, even at extremes of exertion. However, in individuals with known aortic dilatation, the authors recommend a program that limits their lifting to 50% of body weight in the bench press or an equivalent level of perceived exertion for other specific strength exercises (2).

Another study mentioned a case of a 23-year-old male professional bodybuilder who developed squeezing retrosternal chest pain following weightlifting. In the ER (emergency room) examination, his heart rate (HR) was 42 bpm (beats per min), and his blood pressure (BP) was 70/50 mmHg. The electrocardiogram (ECG) showed inferior and right ventricular ST-elevation myocardial infarction. An emergency coronary angiography was done and showed normal left coronaries. However, the right coronary artery angiogram revealed a dissection in the mid-part of the right coronary artery, which was extended to the right ventricular branch (3).

Interesting is also the case of a 28-year-old previously healthy male with a 13-year history of weightlifting. The patient presented to the emergency department (ER) complaining of severe anterior chest pain beginning during a workout. A transthoracic echocardiogram and computerized tomogram diagnosed an ascending aortic dissection. The patient was taken emergently for surgical repair of an incompetent aortic valve and type II aortic dissection. Histopathologic examination of the aorta showed cystic medial degeneration (4).

Studies have demonstrated that repetitive upper- and lower-extremity weight training incorporating a Valsalva maneuver can increase arterial pressure to values as high as 480/350 mmHg. This marked increase in arterial pressure is transmitted to the cerebral vasculature. It increases cerebral arterial transmural pressure and may potentially initiate the rupture of a previously innocuous intracranial aneurysm. Three cases of subarachnoid hemorrhage (SAH) associated with arm (bicep) curls and leg press weight training were reported in a study, raising the possible link between weight training and aneurysmal subarachnoid hemorrhage (SAH) (1).

Weightlifting-related acute aortic dissection is associated with extreme exertion. Moderate aortic dilatation confers vulnerability to exertion-related aortic dissection. Individuals with known aortic dilatation should be cautioned to avoid weightlifting or strenuous exertion. Also, routine echocardiographic screening of individuals engaging in heavy strength training should be considered (7).

Thanks for reading! 

Reference:

1. http://www.ncbi.nlm.nih.gov/pubmed/8925367

2. http://www.ncbi.nlm.nih.gov/pubmed/20924328

3. http://www.ncbi.nlm.nih.gov/pubmed/17913271

4. http://www.ncbi.nlm.nih.gov/pubmed/15758856

5. http://www.ncbi.nlm.nih.gov/pubmed/10696543

6. http://www.ncbi.nlm.nih.gov/pubmed/15788848

7. http://www.ncbi.nlm.nih.gov/pubmed/16847387