Science Wednesday: Weight Lifting, Blood Pressure Spikes and Dissection

The following is updated from August 2023. In our 2024 survey, nine percent of Aortic Athletes identified weightlifting as their primary exercise activity. We have all heard cautions from medical providers that heavy weight lifting is not recommended for people with a diseased aorta. Sometimes this message gets telescoped down to avoiding the Valsalva maneuver (taking a deep breath and holding it while lifting heavy weights). But are there other weight-lifting techniques that can also spike BP? On the other hand, are there lifting techniques that can reduce the risk of BP spikes? And what is the scientific data on BP spikes when lifting with or without aortic disease? Trigger alert: the following discussion includes descriptions of weight lifters who dissected. In one study, when healthy male athletes did a heavy leg press workout, their average systolic blood pressure (the higher number) was 200. When they did the same workout using the Valsalva maneuver, their systolic blood pressure surged to over 300. Aortic Athletes’ friend Dr. Siddharth Prakash of the University of Texas recommends lighter weights with higher reps, gradually increasing weights over time, no grunting or breath holding, and no lifting to exhaustion. He also suggests that people who are just starting improve their form with the help of a trainer. Another factor is aneurysm size and stability. Those with larger aneurysms need to adjust to lower weights than those with dilations. And recommendations may change depending on whether or not an aneurysm is growing and whether the person has a family history or known syndrome. As usual, it’s nuanced and comes down to our individual situation, which is why reviewing your lifting program with your cardiologist is important.

So what does the science around blood pressure spikes and weight lifting show?

In 2002, a team of Yale researchers first reported that some weightlifters may be at risk of rupturing the aorta. Well-known Yale University cardiovascular surgeon and researcher John Elefteriades, MD, said:
“We had seen a couple of patients in a row who had been weight lifting when (an aortic dissection) occurred.”
He found other cases:
“I noticed that two or three of them were young people who otherwise wouldn’t have been expected to have an aortic dissection and were lifting weights at the time.”
Their study found that systolic pressure during heavy weight lifting can rise to highs of 280 and even 300. Dr. Elefteriades said:
“If your aorta is weak due to your genetics and if it is mildly enlarged, weight lifting might be what puts you over the brink.”
Other studies found that the highest blood pressure recorded (345/245) was during squats. A sampling of more recent case studies includes:
  • A 27-year-old who was weightlifting at a gymnasium when he experienced weakness, shortness of breath, and dizziness before dying. An autopsy determined that the cause of death was a ruptured ascending aorta at the root. His mother had died at 39 years old of a dissection, and the man had had surgery on both shoulders involving connective tissue.
  • A 37-year-old man with a history of hypertension and long history of weightlifting was admitted to a hospital complaining of knifelike chest pain while lifting, with severe sweating and palpitations. Following cardiac arrest and open heart surgery, the patient died due to complications. The study concluded: “we strongly advise that athletes with one of the predisposing factors for aortic dissection eschew intense physical exertion.”
  • A 45-year-old weightlifter went to an emergency room after having a “popping” sensation in his chest while weightlifting with an 80-lb (36.3 kg) dumbbell at a gym. His symptoms included a sensation of electric shock from his chest to his legs and a loss of vision. A CT revealed a dissection from the aortic root to the abdomen. He underwent emergency repair with aortic root replacement and survived.
These studies conclude that weight-lifting-related acute aortic dissection appears to be a real phenomenon, with increasing evidence for the association of extreme exertion with this catastrophic aortic event. There is one clinical study involving some weight lifting, the recent post-aortic dissection exercise study led by Dr. Prakash which included (amongst other exercises) two sets of bicep curls with lighter weights and high repetitions, stopping prior to failure. The study lasted one year and many Aortic Athletes participated. It included other safety checks such as ensuring stability of any aneurysm with regular exams, blood pressure during exercise that did not exceed 160 systolic, maintaining blood pressure below 120 systolic at rest, and observing good exercise form. The results, which are soon to be published, are encouraging in that none of the approximately one hundred participants experienced dissection. Dr. Prakash hopes to obtain funding to expand the study to include people in watch and wait.

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