Exercise recommendations in patient with BAV: new perspectives

This month we recommend a study of great interest and relevance in which the authors lift taboos on the practice of exercise in patients with bicuspid aortic valve (BAV), the most common congenital cardiac defect affecting 1% to 2% of the general population.

The long-term impact of exercise on aortic dimensions and valvular function in patients with BAV, is not clear. Traditionally, it has been considered that the increased blood pressure during exercise could accelerate valve deterioration and aortic dilatation.As a result, current exercise recommendations for patients with BAV are based on expert consensus and are rather conservative due to limited scientific evidence on the risks versus the benefits of exercise in patients with BAV.

The authors examined in a cross-sectional study the independent associations of lifelong exposure (30±17years) to exercise volume, intensity, and exercise type on disease characteristics in a large cohort of 407 patients with a BAV.

As a results and conclusions, authors found no deleterious associations between exercise volumes, exercise intensity, or sport type and valve dysfunction or aortic dilatation.In contrast, predominantly performing vigorous-intensity exercise and exercise in mixed sports was associated with a lower prevalence of moderate-to-severe aortic valve stenosis. Based on these findings, and although longer series of similar studies are warranted, the authors recommend promoting exercise in patients with BAV.  

It is without any doubt a study of great interest for our daily clinical practice. Until now, a cautious exercise practice has been recommended in patients with BAV and ascending aortic dilation; however, the benefits of sports practice on cardiovascular risk are well known. We greatly appreciate the existence of studies and initiatives such as this one that can help modify the current restrictive recommendations allowing us to be more permissive with patients with BAV, who are in many cases young and active.