Skip to main content
SpringerLink
Log in

Exercise in Specific Diseases: Abdominal Aortic Aneurysm

  • Chapter
  • First Online:
Textbook of Sports and Exercise Cardiology

Abstract

An abdominal aortic aneurysm (AAA) is a localized dilation caused by weakening of the vessel wall, most often in the infrarenal area. With the ageing of the population and better detection and screening methods, the prevalence of AAAs has increased markedly in recent years. Today, AAAs account for an increasing burden on health care costs in the Western world. AAA is the 13th leading cause of death in the US and is the third leading cause of sudden death in men >60 years of age, accounting for roughly 4–5% of sudden deaths. AAAs are usually asymptomatic and are often not discovered until they rupture or cause symptoms due to localized pressure on adjacent tissues. Until recently, these patients were generally discouraged from participating in rehabilitation programs because of a lack of data on the impact of exercise on the aneurysm, and whether exercise could be performed safely. However, recent randomized trials have documented that patients with AAA who participate in rehabilitation programs achieve functional benefits that are similar to post-MI patients, and that moderate exercise is not associated with higher safety risks. In fact, given the evolution of cardiac rehabilitation from traditional exercise-based programs to comprehensive secondary prevention and chronic disease management, AAA patients would be ideal candidates for intervention since AAA is a disease strongly associated with cardiometabolic risk. This chapter reviews the available evidence on exercise testing and training in AAA, along with the potential for exercise therapy to reduce AAA risk and limit AAA progression.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873–926.

    PubMed  Google Scholar 

  2. Brewster DC, Cronenwett JL, Hallett JW Jr, Johnston KW, Krupski WC, Matsumura JS, et al. Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. 2003;37(5):1106–17.

    PubMed  Google Scholar 

  3. Nordon IM, Hinchliffe RJ, Loftus IM, Thompson MM. Pathophysiology and epidemiology of abdominal aortic aneurysms. Nat Rev Cardiol. 2011;8(2):92–102.

    PubMed  Google Scholar 

  4. Derubertis BG, Trocciola SM, Ryer EJ, Pieracci FM, McKinsey JF, Faries PL, et al. Abdominal aortic aneurysm in women: prevalence, risk factors, and implications for screening. J Vasc Surg. 2007;46(4):630–5.

    PubMed  Google Scholar 

  5. Iribarren C, Darbinian JA, Go AS, Fireman BH, Lee CD, Grey DP. Traditional and novel risk factors for clinically diagnosed abdominal aortic aneurysm: the Kaiser multiphasic health checkup cohort study. Ann Epidemiol. 2007;17(9):669–78.

    PubMed  Google Scholar 

  6. Golledge J, Muller J, Daugherty A, Norman P. Abdominal aortic aneurysm: pathogenesis and implications for management. Arterioscler Thromb Vasc Biol. 2006;26(12):2605–13.

    CAS  PubMed  Google Scholar 

  7. Kent KC. Clinical practice. Abdominal aortic aneurysms. N Engl J Med. 2014;371(22):2101–8.

    CAS  PubMed  Google Scholar 

  8. Aneurysm Outreach Inc. 2018. https://www.crowdrise.com/aaaneurysmoutreach.

  9. U. S. Preventive Services Task Force. Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med. 2005;142(3):198–202.

    Google Scholar 

  10. LeFevre ML, U. S. Preventive Services Task Force. Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(4):281–90.

    PubMed  Google Scholar 

  11. Preventive services: abdominal aortic aneurysm screening. 2008. http://www.medicare.gov/Health/AAA.asp.

  12. Mastracci TM, Cina CS, Canadian Society for Vascular Surgery. Screening for abdominal aortic aneurysm in Canada: review and position statement of the Canadian Society for Vascular Surgery. J Vasc Surg. 2007;45(6):1268–76.

    PubMed  Google Scholar 

  13. Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011;41(Suppl 1):S1–S58.

    PubMed  Google Scholar 

  14. Cowan JA Jr, Dimick JB, Henke PK, Rectenwald J, Stanley JC, Upchurch GR Jr. Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003. Ann N Y Acad Sci. 2006;1085:1–10.

    PubMed  Google Scholar 

  15. Aggarwal S, Qamar A, Sharma V, Sharma A. Abdominal aortic aneurysm: a comprehensive review. Exp Clin Cardiol. 2011;16(1):11–5.

    PubMed  PubMed Central  Google Scholar 

  16. Sidloff D, Stather P, Dattani N, Bown M, Thompson J, Sayers R, et al. Aneurysm global epidemiology study: public health measures can further reduce abdominal aortic aneurysm mortality. Circulation. 2014;129(7):747–53.

    PubMed  Google Scholar 

  17. Blanchard JF, Armenian HK, Friesen PP. Risk factors for abdominal aortic aneurysm: results of a case-control study. Am J Epidemiol. 2000;151(6):575–83.

    CAS  PubMed  Google Scholar 

  18. Lee AJ, Fowkes FG, Carson MN, Leng GC, Allan PL. Smoking, atherosclerosis and risk of abdominal aortic aneurysm. Eur Heart J. 1997;18(4):671–6.

    CAS  PubMed  Google Scholar 

  19. Tornwall ME, Virtamo J, Haukka JK, Albanes D, Huttunen JK. Life-style factors and risk for abdominal aortic aneurysm in a cohort of Finnish male smokers. Epidemiology. 2001;12(1):94–100.

    CAS  PubMed  Google Scholar 

  20. Golledge J, Clancy P, Jamrozik K, Norman PE. Obesity, adipokines, and abdominal aortic aneurysm: health in men study. Circulation. 2007;116(20):2275–9.

    CAS  PubMed  Google Scholar 

  21. Lindblad B, Borner G, Gottsater A. Factors associated with development of large abdominal aortic aneurysm in middle-aged men. Eur J Vasc Endovasc Surg. 2005;30(4):346–52.

    CAS  PubMed  Google Scholar 

  22. Hamburg NM, McMackin CJ, Huang AL, Shenouda SM, Widlansky ME, Schulz E, et al. Physical inactivity rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers. Arterioscler Thromb Vasc Biol. 2007;27(12):2650–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Mobius-Winkler S, Linke A, Adams V, Schuler G, Erbs S. How to improve endothelial repair mechanisms: the lifestyle approach. Expert Rev Cardiovasc Ther. 2010;8(4):573–80.

    PubMed  Google Scholar 

  24. Dalman RL, Tedesco MM, Myers J, Taylor CA. AAA disease: mechanism, stratification, and treatment. Ann N Y Acad Sci. 2006;1085:92–109.

    PubMed  Google Scholar 

  25. Myers JN. Exercise and fitness. In: Perk J, Mathes P, editors. Cardiovascular prevention and rehabilitation. London: Springer; 2007. p. 77–87.

    Google Scholar 

  26. Gielen S, Schuler G, Hambrecht R. Exercise training in coronary artery disease and coronary vasomotion. Circulation. 2001;103(1):E1–6.

    CAS  PubMed  Google Scholar 

  27. Sixt S, Beer S, Bluher M, Korff N, Peschel T, Sonnabend M, et al. Long- but not short-term multifactorial intervention with focus on exercise training improves coronary endothelial dysfunction in diabetes mellitus type 2 and coronary artery disease. Eur Heart J. 2010;31(1):112–9.

    CAS  PubMed  Google Scholar 

  28. Niebauer J, Hambrecht R, Velich T, Hauer K, Marburger C, Kalberer B, et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation. 1997;96(8):2534–41.

    CAS  PubMed  Google Scholar 

  29. Adams V, Reich B, Uhlemann M, Niebauer J. Molecular effects of exercise training in patients with cardiovascular disease: focus on skeletal muscle, endothelium, and myocardium. Am J Physiol Heart Circ Physiol. 2017;313(1):H72–88.

    PubMed  Google Scholar 

  30. Niebauer J, Cooke JP. Cardiovascular effects of exercise: role of endothelial shear stress. J Am Coll Cardiol. 1996;28(7):1652–60.

    CAS  PubMed  Google Scholar 

  31. Tang BT, Cheng CP, Draney MT, Wilson NM, Tsao PS, Herfkens RJ, et al. Abdominal aortic hemodynamics in young healthy adults at rest and during lower limb exercise: quantification using image-based computer modeling. Am J Physiol Heart Circ Physiol. 2006;291(2):H668–76.

    CAS  PubMed  Google Scholar 

  32. Taylor CA, Hughes TJ, Zarins CK. Effect of exercise on hemodynamic conditions in the abdominal aorta. J Vasc Surg. 1999;29(6):1077–89.

    CAS  PubMed  Google Scholar 

  33. Les AS, Shadden SC, Figueroa CA, Park JM, Tedesco MM, Herfkens RJ, et al. Quantification of hemodynamics in abdominal aortic aneurysms during rest and exercise using magnetic resonance imaging and computational fluid dynamics. Ann Biomed Eng. 2010;38(4):1288–313.

    PubMed  PubMed Central  Google Scholar 

  34. Pyeritz RE. Aneurysms and Marfan syndrome. In: Durstine JL, Moore G, editors. ACSM’s exercise management for persons with chronic diseases and disabilities. 1st ed. Champaign, IL: Human Kinetics; 1997.

    Google Scholar 

  35. Kertai MD, Bax JJ, Boersma E, Van Urk H, Poldermans D. The prognostic value of dobutamine stress echocardiography in patients with abdominal aortic aneurysm and concomitant coronary artery disease. J Cardiovasc Surg. 2003;44(3):423–30.

    CAS  Google Scholar 

  36. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)—summary of recommendations. J Vasc Interv Radiol. 2006;17(9):1383–97; quiz 98.

    PubMed  Google Scholar 

  37. Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ, Bittner VA, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128(8):873–934.

    PubMed  Google Scholar 

  38. Best PJ, Tajik AJ, Gibbons RJ, Pellikka PA. The safety of treadmill exercise stress testing in patients with abdominal aortic aneurysms. Ann Intern Med. 1998;129(8):628–31.

    CAS  PubMed  Google Scholar 

  39. Puls A, Thadani U. Rupture of abdominal aortic aneurysm during exercise. Gated blood pool studies. Am J Med. 1986;81(5):887–9.

    CAS  PubMed  Google Scholar 

  40. Myers J, Powell A, Smith K, Fonda H, Dalman RL, Stanford AAA SCCOR Investigators. Cardiopulmonary exercise testing in small abdominal aortic aneurysm: profile, safety, and mortality estimates. Eur J Cardiovasc Prev Rehabil. 2011;18(3):459–66.

    PubMed  Google Scholar 

  41. Wasserman Hansen JE, Sue DY, Stringer WW, Whipp BJ. Principles of exercise testing and interpretation. 5th ed. Philadelphia: Lippincott, Williams and Wilkins; 2012.

    Google Scholar 

  42. Morris CK, Myers J, Kawaguchi T, Ueshima K, Hideg A, Froelicher VF. Nomogram based on metabolic equivalents and age for assessing aerobic capacity in men. J Am Coll Cardiol. 1993;22:175–82.

    CAS  PubMed  Google Scholar 

  43. Yang JC, Wesley RC Jr, Froelicher VF. Ventricular tachycardia during routine treadmill testing. Risk and prognosis. Arch Intern Med. 1991;151(2):349–53.

    CAS  PubMed  Google Scholar 

  44. Beckerman J, Wu T, Jones S, Froelicher VF. Exercise test-induced arrhythmias. Prog Cardiovasc Dis. 2005;47(4):285–305.

    PubMed  Google Scholar 

  45. Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA 3rd, et al. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation. 2007;115(17):2358–68.

    PubMed  Google Scholar 

  46. Carlisle J, Swart M. Mid-term survival after abdominal aortic aneurysm surgery predicted by cardiopulmonary exercise testing. Br J Surg. 2007;94(8):966–9.

    CAS  PubMed  Google Scholar 

  47. Smith TB, Stonell C, Purkayastha S, Paraskevas P. Cardiopulmonary exercise testing as a risk assessment method in non cardio-pulmonary surgery: a systematic review. Anaesthesia. 2009;64(8):883–93.

    CAS  PubMed  Google Scholar 

  48. Lee JT, Chaloner EJ, Hollingsworth SJ. The role of cardiopulmonary fitness and its genetic influences on surgical outcomes. Br J Surg. 2006;93(2):147–57.

    CAS  PubMed  Google Scholar 

  49. Rose GA, Davies RG, Appadurai IR, Lewis WG, Cho JS, Lewis MH, et al. Cardiorespiratory fitness is impaired and predicts mid-term postoperative survival in patients with abdominal aortic aneurysm disease. Exp Physiol. 2018;103(11):1505–12.

    CAS  PubMed  Google Scholar 

  50. Brown LC, Thompson SG, Greenhalgh RM, Powell JT, UK Small Aneurysm Trial Participants. Fit patients with small abdominal aortic aneurysms (AAAs) do not benefit from early intervention. J Vasc Surg. 2008;48(6):1375–81.

    PubMed  Google Scholar 

  51. Singh K, Bonaa KH, Jacobsen BK, Bjork L, Solberg S. Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study: the Tromso study. Am J Epidemiol. 2001;154(3):236–44.

    CAS  PubMed  Google Scholar 

  52. EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005;365(9478):2187–92.

    Google Scholar 

  53. Brown LC, Greenhalgh RM, Howell S, Powell JT, Thompson SG. Patient fitness and survival after abdominal aortic aneurysm repair in patients from the UK EVAR trials. Br J Surg. 2007;94(6):709–16.

    CAS  PubMed  Google Scholar 

  54. Kothmann E, Batterham AM, Owen SJ, Turley AJ, Cheesman M, Parry A, Danjoux G. Effect of short-term exercise training on aerobic fitness in patients with abdominal aortic aneurysms: a pilot study. Br J Anaesth. 2009;103:505–10.

    CAS  PubMed  Google Scholar 

  55. Myers JN, White JJ, Narasimhan B, Dalman RL. Effects of exercise training in patients with abdominal aortic aneurysm: preliminary results from a randomized trial. J Cardiopulm Rehabil Prev. 2010;30(6):374–83.

    PubMed  Google Scholar 

  56. Tew GA, Moss J, Crank H, Mitchell PA, Nawaz S. Endurance exercise training in patients with small abdominal aortic anuerysm: a randomized controlled pilot study. Arch Phys Med Rehabil. 2012;93:2148–53.

    PubMed  Google Scholar 

  57. Myers J, McElrath M, Jaffe A, Smith K, Fonda H, Vu A, et al. A randomized trial of exercise training in abdominal aortic aneurysm disease. Med Sci Sports Exerc. 2014;46(1):2–9.

    PubMed  Google Scholar 

  58. Barakat HM, Shahin Y, Barnes R, Gohil R, Souroullas P, Khan J, McCollum PT, Chetter IC. Supervised exercise program improves aerobic fitness in patients awaiting abdominal aortic aneurysm repair. Ann Vasc Surg. 2014;28:74–9.

    PubMed  Google Scholar 

  59. Nakayama A, Morita H, Nagayama M, Hoshina K, Uemura Y, Tomoike H, Komuro I. Cardiac rehabilitation protects against the expansion of abdominal aortic aneurysm. J Am Heart Assoc. 2018;7(5). https://doi.org/10.1161/JAHA.117.007959; pii: e007959.

  60. Taylor CA, Cheng CP, Espinosa LA, Tang BT, Parker D, Herfkens RJ. In vivo quantification of blood flow and wall shear stress in the human abdominal aorta during lower limb exercise. Ann Biomed Eng. 2002;30(3):402–8.

    PubMed  Google Scholar 

  61. Suh GY, Les AS, Tenforde AS, Shadden SC, Spilker RL, Yeung JJ, et al. Quantification of particle residence time in abdominal aortic aneurysms using magnetic resonance imaging and computational fluid dynamics. Ann Biomed Eng. 2011;39(2):864–83.

    PubMed  Google Scholar 

  62. Gielen S, Schuler G, Adams V. Cardiovascular effects of exercise training: molecular mechanisms. Circulation. 2010;122(12):1221–38.

    PubMed  Google Scholar 

  63. Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA. 1999;282(21):2035–42.

    CAS  PubMed  Google Scholar 

  64. Topper JN, Cai J, Falb D, Gimbrone MA Jr. Identification of vascular endothelial genes differentially responsive to fluid mechanical stimuli: cyclooxygenase-2, manganese superoxide dismutase, and endothelial cell nitric oxide synthase are selectively up-regulated by steady laminar shear stress. Proc Natl Acad Sci U S A. 1996;93(19):10417–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  65. Topper JN, Gimbrone MA Jr. Blood flow and vascular gene expression: fluid shear stress as a modulator of endothelial phenotype. Mol Med Today. 1999;5(1):40–6.

    CAS  PubMed  Google Scholar 

  66. Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg. 2009;50(4 Suppl):S2–49.

    PubMed  Google Scholar 

  67. Fonda H, Myers J. Aneurysms. In: Durstine JL, Moore G, editors. ACSM’s Exercise Management for Persons with chronic diseases and disabilities. 4th ed. Champaign: Human Kinetics; 2016.

    Google Scholar 

  68. Ades PA, Balady GJ, Berra K. Transforming exercise-based cardiac rehabilitation programs into secondary prevention centers: a national imperative. J Cardpulm Rehabil. 2001;21(5):263–72.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, USA

    Jonathan Myers

  2. Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Authors
  1. Jonathan Myers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Josef Niebauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    The incidence of abdominal aortic aneurysm has increased markedly in recent years. Which factors account for this increase?

  2. 2.

    AAAs occur most commonly in whom?

  3. 3.

    Do patients with AAA respond to exercise training like other cardiac patients or differently?

1.2 Answers

  1. 1.

    This increase is owed—among others—to the aging of the population, better detection methods, public outreach programs, and guideline-directed inclusion of AAA ultrasound screening for particular at-risk populations.

  2. 2.

    It occurs most commonly in men between the ages of 65 and 75 years with a history of smoking.

  3. 3.

    Responses to exercise programs are similar in AAA patients to those observed in post-MI patients and other groups referred for cardiac rehabilitation.

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Myers, J., Niebauer, J. (2020). Exercise in Specific Diseases: Abdominal Aortic Aneurysm. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_51

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-35374-2_51

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-35373-5

  • Online ISBN: 978-3-030-35374-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation