Physical Activity and Exercise Patterns After Spontaneous Coronary Artery Dissection: Insights From a Large Multinational Registry

Abstract

Objective: The objective of the study was to assess the physical activity (PA) and exercise patterns among participants in a large multinational spontaneous coronary artery dissection (SCAD) registry. Patients and Methods: Participants with SCAD enrolled from March 2011 to November 2019 completed surveys including details regarding PA and exercise habits prior to SCAD, and PA counseling received from their provider after SCAD. Demographics and clinical characteristics were collected by electronic record review. Exercise prescribed to patients after SCAD was categorized according to exercise components: type, intensity, frequency, time/session, and extreme environmental conditions.Results: We included 950 participants; mean ± age was 46.8 ± 9.5 years old at the time of first SCAD; most (96.3%) were women and (77.0%) attended ≥1 cardiac rehabilitation session. Hyperlipidemia (34.3%), hypertension (32.8%), and elevated body weight (overweight = 27.0%; obesity = 20.0%) were the most common comorbidities. Prior to SCAD, 48.5% performed aerobic exercise ≥3 times/week, and only 32.0% performed strength-building exercise regularly. PA counseling details after SCAD in 299/950 participants showed that most (93.3%) patients received some form of counseling including exercise prescription (EXP), non-specific recommendations, and discouraged from any exercise. Limits regarding exercise type and intensity were the most common advice among participants who received EXP.Conclusion: Insights from our study suggest that only 48% of the patients performed some aerobic exercise three or more times per week, and 32.0% performed strength-building exercises, which suggest that most of them may not be as active as assumed. Furthermore, 70% of the SCAD patients have ≥1 cardiovascular risk factors. We suggest guiding patients based on individual assessment, taking into consideration baseline PA habits, treatment, and risk factors. SCAD-tailored PA guidelines are needed for optimal EXP without compromising patient safety.

Spontaneous coronary artery dissection: a systematic review of physical and psychosocial recovery following discharge from hospital

“…Therefore, 28 studies were included in the final review (Supplementary material online, File S1). There were 20 cross-sectional studies, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] 2 case-control studies, 34,35 4 quasi-experimental studies, 8,9,36,37 and 2 qualitative studies. 38,39 Participants in one study were healthcare professionals, 39 while the remainder were SCAD survivors.…”

“…34 Furthermore, in the 14 studies that reported ethnicity, the majority of participants were described as of White/Caucasian/European origin (median = 86.9%, range 43-98%). 8,9,[14][15][16][17][18][19][20][21]28,30,31,35,37,38…”

“…Nine studies provided data for physical activity outcomes (Table 1). 8,9,16,[18][19][20]36,38,39 Only one study examined levels of selfreported physical activity pre-and post-SCAD. This retrospective study reported that only 44.5% (n = 133/299) of SCAD survivors were active prior to SCAD (the study authors defined active as undertaking at least three exercise sessions per week for < _31 min), and 2.5 ± 3.7 years after SCAD this decreased to 36.8% (n = 110/ 299).…”

“…This retrospective study reported that only 44.5% (n = 133/299) of SCAD survivors were active prior to SCAD (the study authors defined active as undertaking at least three exercise sessions per week for < _31 min), and 2.5 ± 3.7 years after SCAD this decreased to 36.8% (n = 110/ 299). 20 There is very limited evidence for improvements in cardiorespiratory fitness following CR. Participants in a 6-month dedicated SCAD CR programme (n = 70) had high cardiorespiratory fitness 40 at baseline (10.1 ± 3.3 metabolic equivalents) (METs), which increased to 11.5 ± 3.5 METS at follow-up (P < 0.001).…”

Levine’s Sign Points to Spontaneous Coronary Artery Dissection in a Healthy Young Male

“…Most cases involve a single vessel, with LAD being the most common one. A survey including details of physical activity and exercise habits before SCAD happened was done on 950 patients from 2011 to 2019 and concluded that 32% of the cases had strength-building exercises before presentation, with more than one cardiovascular risk factor in 70% of the patients [ 6 ]. Another observational cohort study of 750 patients with nonatherosclerotic SCAD in North America reported emotional stress as a risk factor in 50.3% and physical stress in 28.9% (about 10% heavy lifting >50 pounds) [ 7 ].…”