Exercise-based cardiac rehabilitation after aortic dissection: a systematic review of exercise prescription and blood pressure–guided management

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-guided 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.