Table 4.

Individualized exercise testing and exercise prescription recommendations for stable patients recovering from a spontaneous coronary artery dissection or aortic dissection

Exercise training type(s)	Clinical exercise testing	Main exercise prescription features
Aerobic training:	Maximal effort CPET is the optimal clinical exercise test	Exercise training should be performed while on optimal rate-limiting and anti-pressor medications.
Continuous minutes ≥150 min/weekly spread over ≥3 days of week Eventual progression up to ≥300 min/weekly spread over all days of the week, as tolerated	Upright cycle ergometry using a ‘ramp-slope’ work-rate increase is preferred as the default.
		Training intensities should correspond to exercise BP <150/<90 mmHg. Avoid intensities causing >10 mmHg rise in DBP above rest.
Examples to consider:	Exercise stress testing is acceptable when CPET is unavailable.
Treadmill Cycle ergometer Semi-recumbent if hypotension is a risk Elliptical (minimize upper body involvement) Stepper
		A dedicated period of ≥8–10 min for both warm up and active cool down are required.
		Prescribe an initial low intensity phase (Min: 4 weeks, longer as needed):
	All measurements should be acquired while patient is on optimal rate-limiting and anti-pressor medications:	HR or Watts <VT1 ≤40% V̇O2reserve ≤40% HRR RPE: 10–11 Time: up to 20–25 min Continuous or split into 2–3 ≤ 10 min bouts with rest taken, as needed
Examples to avoid:	Peak exercise:
Rowing Cross-country skiing Hiking with weighted backpack High-intensity interval training	V̇O2 HR SBP/DBP Watts or speed/grade
Maintain an active lifestyle on non-scheduled training days.	VT1 and VT2 domains	If exercise BP remains controlled, progress to moderate intensity phase, as tolerated:
Minimize sedentary time	V̇O2 HR SBP/DBP Watts or speed/grade	HR or Watts ≥VT1 and <VT2 ≤70% V̇O2reserve ≤70% HRR RPE: 12–14 Time: up to 30–45 min Continuous or split into 2–3 ≤ 15 min bouts with rest taken, as needed Exercise <60 min Do not perform to exhaustion
Lifting and intensity precautions should always be followed, for example:	CPET data should be recorded throughout testing and reviewed while interpreting both submaximal and peak response data.
Leisure activities Household chores Yard work/gardening
	Where appropriate, other CPET data and variables in addition to those listed above should be considered when developing the exercise prescription.
Strength, resistance, and other types of training
Do not consider initiating until at least 6–8 weeks of aerobic training have been completed, BP remains well controlled, and patient endorses confidence in aerobic training Performed after aerobic training Up to 1–2 × weekly, non-consecutive days Performed after aerobic training if on same day Functional training should be emphasized	Lower body strength Knee/hip extensor and flexor/abductor and adductor Balance Sit-to-stand Body weight squat Upper body strength Seated chest press Seated shoulder press Seated single-arm row Seated dumbbell curls Standing tricep pushdown Core Crunches on back Avoid full sit-ups Avoid weighted ball twists Avoid straight legged raises Avoid hanging leg raises	Low intensity: Up to 3–5 exercises, non-timed circuit style RPE: < 13 Repetitions: weight that can be lifted with perfect technique and without Valsalva strain at least 15–18 × for >1 set Sets: up to 2 ≥2–3 min rest between sets Do not use HR zones to guide intensity Do not lift to the point of complete muscle fatigue Total time and volume of training should not elicit feelings of whole body exhaustion
Modalities to consider:
Body weight Free weights Weight machines Resistance bands
Examples to avoid:
Isometric exercises Explosive and power movements, plyometrics, agility drills, etc. Cross-fit, obstacle course, and P90 × styles of training

CPET, cardiopulmonary exercise testing; DBP, diastolic blood pressure; HR, heart rate; HRR, heart rate reserve (= HR_rest + [HR_peak − HR_rest] · X%); RPE, rating of perceived exertion, 6–20 scale; SBP, systolic blood pressure; V̇O_2peak, peak exercise oxygen uptake; VT1, first ventilatory threshold/lactate threshold; VT2, second ventilatory threshold/respiratory compensation point.