{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:38:59Z","timestamp":1792647539074,"version":"4.5.0"},"reference-count":100,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,20]]},"abstract":"<jats:p xml:lang=\"en\">Exercise is widely recognized for its cardiovascular benefits; however, its safety and role in patients with thoracic aortic aneurysms (TAAs) remains complex due to its distinctive biomechanical vulnerabilities. Fundamentally different from abdominal aortic aneurysms, TAAs develop from distinct pathophysiological processes that affect their hemodynamic responses to stressors and influence their risk of adverse aortic events. Exercise induces acute hemodynamic changes, including increased stroke volume, systolic and pulse pressures, and transient aortic stiffening. These changes impose mechanical stress on the aortic wall, potentially accelerating aneurysm progression or triggering adverse aortic events. Although moderate aerobic exercise generally appears safe with potential cardiovascular benefits, evidence supporting safe practices in TAAs is limited. Current guidelines frequently extrapolate from abdominal aortic aneurysm data, which overlook the specificities of the thoracic aorta. This review underscores the urgent need for comprehensive research, using advanced imaging, biomarker profiling, and real\u2010time hemodynamic monitoring to understand how different exercise modalities and intensities affect TAAs. Well\u2010designed prospective studies are crucial to improve risk stratification, optimize antihypertensive strategies, develop personalized exercise prescriptions, and provide evidence\u2010informed guidance to patients. Perioperative strategies like prehabilitation and structured postoperative rehabilitation show promise but lack rigorous evaluation. Ultimately, this work advocates a paradigm shift from conservative inactivity toward informed, individualized physical activity regimens tailored to each patient's risk profile. This approach aims to maximize cardiovascular benefits while minimizing adverse aortic events, thereby improving overall health and quality of life in patients with TAAs.<\/jats:p>","DOI":"10.1161\/jaha.125.046671","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:18:01Z","timestamp":1792149481000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Exercise and Thoracic Aortic Aneurysms: A Paradigm Shift Toward Informed, Personalized Activity Guidelines"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2326-8336","authenticated-orcid":false,"given":"Habib","family":"Jabagi","sequence":"first","affiliation":[{"name":"The Valley Hospital","place":["Ridgewood, USA"]},{"name":"Mt. Sinai Hospital, Icahn School of Medicine","place":["New York, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9242-4897","authenticated-orcid":false,"given":"Giuseppe","family":"Imperatore","sequence":"additional","affiliation":[{"name":"Scuola Superiore Sant'Anna","place":["Pisa, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Nantsios","sequence":"additional","affiliation":[{"name":"Washington University","place":["St. Louis, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-3115","authenticated-orcid":false,"given":"Louise Y.","family":"Sun","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine","place":["Stanford, USA"]},{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Lewis","sequence":"additional","affiliation":[{"name":"The Valley Hospital","place":["Ridgewood, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munir","family":"Boodhwani","sequence":"additional","affiliation":[{"name":"University of Ottawa Heart Institute","place":["Ottawa, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Mir","sequence":"additional","affiliation":[{"name":"University of Ottawa Heart Institute","place":["Ottawa, Canada"]},{"name":"University of Ottawa Heart Institute","place":["Ottawa, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7840-801X","authenticated-orcid":false,"given":"Hiroo","family":"Takayama","sequence":"additional","affiliation":[{"name":"Columbia University","place":["New York, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7639-2416","authenticated-orcid":false,"given":"Himanshu","family":"Patel","sequence":"additional","affiliation":[{"name":"University of Michigan","place":["Ann Arbor, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Burns","sequence":"additional","affiliation":[{"name":"The Valley Hospital","place":["Ridgewood, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan B.","family":"Grau","sequence":"additional","affiliation":[{"name":"The Valley Hospital","place":["Ridgewood, USA"]},{"name":"University of Ottawa Heart Institute","place":["Ottawa, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.051351"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000048890.59383.8D"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000075572.40158.77"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1159\/000381281"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fspor.2022.888534"},{"key":"e_1_3_1_7_2","volume-title":"Cardiac Surgery in the Adult, 5e","author":"Cohn LH","year":"2018","unstructured":"Cohn LH, Adams DH. Cardiac Surgery in the Adult, 5e. China: McGraw Hill; 2018."},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001513"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.185214"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1159\/000094530"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001106"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2014.02.018"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae179"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000154569.08857.7A"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.017468"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajpc.2022.100378"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.08.025"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/1274034"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.carpath.2016.03.002"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.31083\/j.rcm2406178"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf556"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmbbm.2023.105922"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.03.435"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.17021"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40560-018-0287-7"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2017.00687"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.114.304936"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1111\/micc.12101"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.fluid.39.050905.110128"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2020.110065"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00877747"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.02.048"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-022-00763-0"},{"key":"e_1_3_1_34_2","unstructured":"https:\/\/marfan.org\/blog\/to\u2010know\u2010or\u2010not\u2010to\u2010know\u2010genetic\u2010testing\u2010and\u2010marfan\u2010syndrome\/#:~:text=Lack%20of%20any%20genetic%20mutation with%20clear%2Dcut%20Marfan%20syndrome. Accessed September 12 2025."},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1207059"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.0000168053.34306.d4"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.54.5.595"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvt040"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivw053"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.12.017"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-95008-8"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.483628"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(99)70317-4"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.1080\/030919099294177"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-017-0733-9"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.1055\/a-2558-4266"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.00552"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.005959"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2014-305648"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.3.193"},{"key":"e_1_3_1_51_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22481"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.1.150"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1985.58.3.785"},{"key":"e_1_3_1_54_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht151"},{"key":"e_1_3_1_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.10.061"},{"key":"e_1_3_1_56_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.14515"},{"key":"e_1_3_1_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.09.063"},{"key":"e_1_3_1_58_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.28.6.1071"},{"key":"e_1_3_1_59_2","first-page":"631","article-title":"Hemodynamic determinants of aortic dissection propagation by 2D computational modeling: implications for endovascular stent\u2010grafting","volume":"53","author":"Chitsaz S","year":"2012","unstructured":"Chitsaz S, Azadani AN, Matthews PB, Chuter TA, Tseng EE, Ge L. Hemodynamic determinants of aortic dissection propagation by 2D computational modeling: implications for endovascular stent\u2010grafting. J Cardiovasc Surg. 2012;53:631\u2013640.","journal-title":"J Cardiovasc Surg"},{"key":"e_1_3_1_60_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40292-025-00710-3"},{"key":"e_1_3_1_61_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmatsci.2024.101363"},{"key":"e_1_3_1_62_2","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000521"},{"key":"e_1_3_1_63_2","doi-asserted-by":"publisher","DOI":"10.31083\/j.rcm2507266"},{"key":"e_1_3_1_64_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157704"},{"key":"e_1_3_1_65_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10020291"},{"key":"e_1_3_1_66_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0110034"},{"key":"e_1_3_1_67_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.0054"},{"key":"e_1_3_1_68_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.16249"},{"key":"e_1_3_1_69_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2005.02.052"},{"key":"e_1_3_1_70_2","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3182a088b8"},{"key":"e_1_3_1_71_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.118.005263"},{"key":"e_1_3_1_72_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu281"},{"key":"e_1_3_1_73_2","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000446"},{"key":"e_1_3_1_74_2","doi-asserted-by":"publisher","DOI":"10.1080\/14017431.2016.1257149"},{"key":"e_1_3_1_75_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31829b5b44"},{"key":"e_1_3_1_76_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-023-02180-x"},{"key":"e_1_3_1_77_2","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqx063"},{"key":"e_1_3_1_78_2","unstructured":"https:\/\/www.cdc.gov\/physical\u2010activity\u2010basics\/measuring\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/physicalactivity\/basics\/measuring\/exertion.htm.Accessed September 15 2025."},{"key":"e_1_3_1_79_2","unstructured":"https:\/\/blog.nasm.org\/rate\u2010of\u2010perceived\u2010exertion. Accessed September 15 2025."},{"key":"e_1_3_1_80_2","doi-asserted-by":"publisher","DOI":"10.1080\/02640414.2012.710757"},{"key":"e_1_3_1_81_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.07.069"},{"key":"e_1_3_1_82_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-76306-9"},{"key":"e_1_3_1_83_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.007959"},{"key":"e_1_3_1_84_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.006438"},{"key":"e_1_3_1_85_2","unstructured":"https:\/\/www.massgeneral.org\/news\/press\u2010release\/study\u2010finds\u2010long\u2010term\u2010endurance\u2010exercise\u2010is\u2010associated\u2010with\u2010enlarged\u2010aorta. Accessed October 2 2025."},{"key":"e_1_3_1_86_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2022.1410"},{"key":"e_1_3_1_87_2","unstructured":"https:\/\/clinicaltrials.gov\/study\/NCT04197648. Accessed October 5 2025."},{"key":"e_1_3_1_88_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2025.01.020"},{"key":"e_1_3_1_89_2","unstructured":"https:\/\/www.aats.org\/resources\/surgical\u2010outcomes\u2010and\u2010quality\u20107904#:~:text=Octogenarians%20undergoing%20aortic%20surgery%20have a%20good%20quality%20of%20life. Accessed October 10 2025."},{"key":"e_1_3_1_90_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaf288"},{"key":"e_1_3_1_91_2","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13697"},{"key":"e_1_3_1_92_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2020.00075"},{"key":"e_1_3_1_93_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeac090"},{"key":"e_1_3_1_94_2","doi-asserted-by":"publisher","DOI":"10.2463\/mrms.rev.2021-0046"},{"key":"e_1_3_1_95_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocmr.2025.101865"},{"key":"e_1_3_1_96_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12687-021-00545-0"},{"key":"e_1_3_1_97_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2022.07.013"},{"key":"e_1_3_1_98_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19052819"},{"key":"e_1_3_1_99_2","doi-asserted-by":"publisher","DOI":"10.70252\/CTWV5704"},{"key":"e_1_3_1_100_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcdd10120480"},{"key":"e_1_3_1_101_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00132.2017"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.046671","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T04:55:05Z","timestamp":1792644905000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.046671"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":100,"journal-issue":{"issue":"20","published-print":{"date-parts":[[2026,10,20]]}},"alternative-id":["10.1161\/JAHA.125.046671"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.046671","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"assertion":[{"value":"2025-09-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e046671"}}