Table 3.

Key principles, components, and recommendations to be considered for developing an individualized exercise prescription for patients recovering from a spontaneous coronary artery dissection or aortic dissection

Foundational principles of exercise prescription: F.I.T.T.—V.P.

Frequency: Number of weekly sessions/bouts: ≥ 3 days weekly is minimum; preferred is all days. Intensity: Aerobic/cardio exercise: Optimal: determine heart rate and/or work-rates by referencing VT1 and VT2 landmarks identified on cardiopulmonary exercise testing. Percentage of V̇O2 reserve, heart rate reserve, and/or work-rate. Strength/resistance: low loads/weights. Always avoid loads/weight that require sustained and/or forceful engagement of Valsalva manoeuver. Breath holding should always be avoided. Avoid lifting to local muscle fatigue and/or whole body exhaustion. Avoid isometric exercises (e.g. body planks). Avoid explosive/plyometric movements. Rating of perceived exertion (RPE, Borg scale 6–20): Applicable to any form of exercise, but should not be used independently of objective training zones, such as heart rate, during aerobic/cardio exercise bouts. Time (not including time required for warm up and cool down periods): Total number of weekly minutes: ≥ 150; long-term goal is to achieve 300 min weekly. Total number of minutes per training day. Continuous minutes are preferred if physical conditioning allows. Avoid exercising to exhaustion. Bout duration within a training day (e.g. deconditioned individual). Multiple bouts may be needed within a chosen training day if unable to sustain continuous exercise of medium-sized length, e.g. 20 min. Two-to-three 10 min bouts interspersed with rest periods as needed. Very low-intensity warm up and active cool down periods. Each lasting at least 8–10 min in length (more time is encouraged, as needed). Should be performed with all aerobic exercise sessions. The warm up should be performed using the intended training mode. Type: Aerobic/cardio activities: highest priority. Strength/resistance activities: if interested and time allows, up to 1–2 days weekly. Flexibility: static and/or dynamic types (no breath holding), 2–3 days weekly. Coordination/balance. Cross-fit and/or other high-intensity training exercise regimens should always be avoided. Volume: Computing kcal/week or METS-minutes/weekly is not practical and often inaccurate for estimating volume. Volume is trackable as documentation occurs for weekly session: duration, intensity, and frequency. Progression: Progression should be individualized to each patient. As tolerated and based on initial physical conditioning, risk level, and familiarity with exercise, training progressions are commonly considered in the order of session: duration, intensity, and weekly frequency. Only one feature should be progressed at a time. Cardio exercise session duration may be increased 1–5 min every 2–3 weeks until achieving the plan goal. Cardio exercise session intensity may be increased up to 5% every 2–3 weeks until achieving the plan goal.

V̇O₂, oxygen uptake; heart rate reserve (= HR_rest + [HR_peak − HR_rest] · X%); VT1, first ventilatory threshold/lactate threshold; VT2, second ventilatory threshold/respiratory compensation point.