{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:59:52Z","timestamp":1782867592645,"version":"3.54.5"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004823","name":"Nagoya University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004823","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Heart Vessels"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Survival after acute aortic dissection (AAD) has improved substantially; however, optimal exercise prescription and blood pressure (BP) thresholds during cardiac rehabilitation (CR) remain unclear. Although current guidelines recommend CR after aortic repair, evidence-based BP thresholds are undefined. A systematic search of PubMed and the Cochrane Library identified 88 records. After screening and eligibility assessment, 27 studies were included. Eligible studies investigated exercise-based rehabilitation, early mobilization, or BP-guided exercise management in patients with Stanford type A or B aortic dissection. Data on exercise intensity, BP limits, monitoring strategies, safety outcomes, and functional recovery were extracted and narratively synthesized. Most studies were observational, with only one randomized controlled trial evaluating early goal-directed mobilization. Exercise intensity was typically prescribed as low-to-moderate and frequently constrained by systolic BP thresholds; however, reported upper limits were inconsistent and often not explicitly defined or evidence-justified. Continuous or intermittent BP monitoring was commonly employed in early phases. Across studies, exercise-based cardiac rehabilitation was not clearly associated with increased rates of re-dissection or major adverse events, and early mobilization was associated with improved activities of daily living and shorter functional recovery time. Of the 27 included studies, explicit systolic blood pressure thresholds for exercise were reported in fewer than one-third, and quantitative descriptions of aortic event rates were provided in only a minority, with most studies concluding safety based on qualitative assessments; however, the absence of reported events does not necessarily indicate evidence of safety. Exercise-based cardiac rehabilitation following aortic dissection appears feasible when conducted under BP\u2013guided monitoring, with no clear signal of increased aortic risk reported in the available literature. However, the current evidence remains largely qualitative and heterogeneous, highlighting the need for standardized exercise intensity criteria and prospective studies to establish evidence-based rehabilitation strategies.<\/jats:p>","DOI":"10.1007\/s00380-026-02727-7","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:42:59Z","timestamp":1782866579000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exercise-based cardiac rehabilitation after aortic dissection: a systematic review of exercise prescription and blood pressure\u2013guided management"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4029-3373","authenticated-orcid":false,"given":"Kiyonori","family":"Kobayashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"2727_CR1","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1016\/j.jtcvs.2014.06.053","volume":"148","author":"T Tsukube","year":"2014","unstructured":"Tsukube T, Haraguchi T, Okada Y, Matsukawa R, Kozawa S, Ogawa K, Tsubota H, Oda T (2014) Long-term outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma. J Thorac Cardiovasc Surg 148:1013\u20131018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2727_CR2","doi-asserted-by":"crossref","first-page":"e266","DOI":"10.1161\/CIR.0b013e3181d47d48","volume":"121","author":"LF Hiratzka","year":"2010","unstructured":"Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM (2010) 2010 ACCF\/AHA guideline for the diagnosis and management of patients with thoracic aortic disease. Circulation 121:e266\u2013e369","journal-title":"Circulation"},{"key":"2727_CR3","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1055\/s-0041-1731403","volume":"9","author":"SR Pasadyn","year":"2021","unstructured":"Pasadyn SR, Roselli EE, Artis AS, Pasadyn CL, Phelan D, Blackstone EH (2021) From court to couch: exercise and quality of life after acute type A aortic dissection. Aorta (Stamford) 9:171\u2013179","journal-title":"Aorta (Stamford)"},{"key":"2727_CR4","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1097\/HJR.0b013e32831fd6c8","volume":"16","author":"S Corone","year":"2009","unstructured":"Corone S, Iliou MC, Pierre B, Feige JM, Odjinkem D, Farrokhi T (2009) French registry of cases of type I acute aortic dissection admitted to a cardiac rehabilitation center after surgery. Eur J Cardiovasc Prev Rehabil 16:91\u201395","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"key":"2727_CR5","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1097\/HCR.0000000000000965","volume":"45","author":"KSR Larsen","year":"2025","unstructured":"Larsen KSR, Tang M, Budtz-Lilly JW, S\u00f8rensen L (2025) Evaluation of a rehabilitation program with blood pressure-guided exercise intensity restrictions for patients with thoracic aortic dissection or aneurysm. J Cardiopulm Rehabil Prev 45:404\u2013410","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2727_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2023.102348","volume":"49","author":"A Carbone","year":"2024","unstructured":"Carbone A, Lamberti N, Manfredini R, Trimarchi S, Palladino R, Savri\u00e8 C, Marra AM, Ranieri B, Crisci G, Izzo R, Esposito G, Cittadini A, Manfredini F, Rubenfire M, Bossone E (2024) Cardiac rehabilitation and acute aortic dissection: understanding and addressing the evidence gap: a systematic review. Curr Probl Cardiol 49:102348","journal-title":"Curr Probl Cardiol"},{"key":"2727_CR7","doi-asserted-by":"publisher","first-page":"2931","DOI":"10.3390\/jcm11102931","volume":"11","author":"N Zhou","year":"2022","unstructured":"Zhou N, Mampuya WM, Iliou MC (2022) Is exercise blood pressure putting the brake on exercise rehabilitation after acute type A aortic dissection surgery? J Clin Med 11:2931","journal-title":"J Clin Med"},{"key":"2727_CR8","first-page":"379","volume":"11","author":"M Stiefel","year":"2024","unstructured":"Stiefel M, Brito da Silva H, Schmied CM, Niederseer D (2024) Exercise, sports, and cardiac rehabilitation recommendations in patients with aortic aneurysms and post-aortic repair: a review of the literature. J Cardiovasc Dev Dis 11:379","journal-title":"J Cardiovasc Dev Dis"},{"key":"2727_CR9","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1177\/02692155231169822","volume":"37","author":"Y Lin","year":"2023","unstructured":"Lin Y, Liang T, Zhang X, Peng Y, Li S, Huang X, Chen L (2023) Early goal-directed mobilization in patients with acute type A aortic dissection: a randomized controlled trial. Clin Rehabil 37:1311\u20131321","journal-title":"Clin Rehabil"},{"key":"2727_CR10","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1080\/14017431.2016.1257149","volume":"51","author":"S Fuglsang","year":"2017","unstructured":"Fuglsang S, Heiberg J, Hjortdal VE, Laustsen S (2017) Exercise-based cardiac rehabilitation in surgically treated type A aortic dissection patients. Scand Cardiovasc J 51:99\u2013105","journal-title":"Scand Cardiovasc J"},{"key":"2727_CR11","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1298\/ptr.E10308","volume":"28","author":"Y Ohnishi","year":"2025","unstructured":"Ohnishi Y, Yokote T, Shirado K, Okuno S, Kawamitsu K, Yamauchi K, Nishimura T, Tanaka M, Uchida T, Kawakami S (2025) Effect of number of days to ambulation on postoperative daily activities in patients with type A aortic dissection. 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Heart Vessels 40:72\u201385","journal-title":"Heart Vessels"},{"key":"2727_CR14","doi-asserted-by":"crossref","unstructured":"Isselbacher EM, Preventza O, Hamilton Black J 3rd, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A Jr, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ (2022) 2022 ACC\/AHA guideline for the diagnosis and management of aortic disease. 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