Exercise Guidance with Ascending aorta dilation

I fully dissected at age 50. I am now 61. It’s totally normal to feel thrown off after being told you have a 4.7 cm ascending dilation, especially when training has been part of your identity for decades. The hard part isn’t the exercise itself—it’s sorting through all the mixed messages. Here’s the reality most aortic docs agree on: the danger isn’t movement, it’s sudden blood-pressure spikes. Heavy straining, breath-holding, grinding reps, and long isometric holds can all send your pressure way up for a split second, and that’s what you’re trying to avoid.

Cardio is generally the easiest part. Swimming, biking, steady treadmill work—these are almost always safe if you keep the effort smooth. A heart rate under about 150 matches what a lot of people in your situation have been told, but honestly the more useful indicator is whether you can breathe normally and stay out of that “I’m pushing hard” zone. Strength work gets trickier, not because you can’t do it, but because you have to approach it differently. Think lighter weights, higher reps, smooth breathing the whole way, and absolutely no bracing or bearing down. If you feel yourself clenching or straining, dial it back. Pushups, rows, TRX work—these can still be fine as long as you keep them moving rather than holding long static positions. Planks are okay in shorter bursts if you keep breathing, but not those minute-long, grind-your-core versions.

The exact pound limit isn’t the point. Whether it’s 50 pounds, half your body weight, or some other number, what really matters is staying in a range where you never feel forced to strain. If you can do a set of 12–15 reps smoothly, with zero urge to hold your breath, you’re in the zone. You don’t have to give up being active. You just have to shift from “training hard” to “training smart,” and once you settle into that mindset, it gets a lot less confusing. Peace.

Agree with everything @moonboy explained. Your question is very common in this forum, there are cardiologists in the US that specialize in aortic diseases and have done their research in exercise and its effects on aneurysms. There’s a group in Facebook dedicated to the topic, someone mentioned it in a previous post, where they share info from those cardiologists, will try to find the name. One of those experts is Dr Siddharth Prakash (UT Health in Houston) there are a couple of videos of him talking about the subject that have been posted in this forum.

Being in good physical shape will pay dividends when and if you ever need surgery. I had mine at 54 yo, it was 5.2cm and found after an MTB accident, I exercised all my life and was in great shape, my surgery went very smoothly and recovery was fast, I’m 60 now and exercise intensely. Have learned to limit weights to what I can comfortably handle while breathing through every single rep, never hold my breath (as Moonboy said), even though it is repaired I need to keep my BP in check to prevent new ones

That’s the main goal keeping you BP always in control.

I will repost the video and will look for the FB group name

Take care!

I fully dissected at age 50. I am now 61. It’s totally normal to feel thrown off after being told you have a 4.7 cm ascending dilation, especially when training has been part of your identity for decades. The hard part isn’t the exercise itself—it’s sorting through all the mixed messages. Here’s the reality most aortic docs agree on: the danger isn’t movement, it’s sudden blood-pressure spikes. Heavy straining, breath-holding, grinding reps, and long isometric holds can all send your pressure way up for a split second, and that’s what you’re trying to avoid.

Cardio is generally the easiest part. Swimming, biking, steady treadmill work—these are almost always safe if you keep the effort smooth. A heart rate under about 150 matches what a lot of people in your situation have been told, but honestly the more useful indicator is whether you can breathe normally and stay out of that “I’m pushing hard” zone. Strength work gets trickier, not because you can’t do it, but because you have to approach it differently. Think lighter weights, higher reps, smooth breathing the whole way, and absolutely no bracing or bearing down. If you feel yourself clenching or straining, dial it back. Pushups, rows, TRX work—these can still be fine as long as you keep them moving rather than holding long static positions. Planks are okay in shorter bursts if you keep breathing, but not those minute-long, grind-your-core versions.

The exact pound limit isn’t the point. Whether it’s 50 pounds, half your body weight, or some other number, what really matters is staying in a range where you never feel forced to strain. If you can do a set of 12–15 reps smoothly, with zero urge to hold your breath, you’re in the zone. You don’t have to give up being active. You just have to shift from “training hard” to “training smart,” and once you settle into that mindset, it gets a lot less confusing. Peace.

@moonboy
Thanks for the quick response and confirming that BP spikes are what I should avoid. Is there a watch that you can monitor BP during exercise? I would be curious to see if my BP can be kept in acceptable ranges with my exercise adjustments. I tried the 50 pound limit in my keg workout last week and it was beyond easy. This is an adjustment, trying to figure out what works. Thanks! JZ

@houston13
Thanks for getting that info. Appreciated greatly.

@moonboy
Thanks for the quick response and confirming that BP spikes are what I should avoid. Is there a watch that you can monitor BP during exercise? I would be curious to see if my BP can be kept in acceptable ranges with my exercise adjustments. I tried the 50 pound limit in my keg workout last week and it was beyond easy. This is an adjustment, trying to figure out what works. Thanks! JZ

@moonboy
Thanks for the quick response and confirming that BP spikes are what I should avoid. Is there a watch that you can monitor BP during exercise? I would be curious to see if my BP can be kept in acceptable ranges with my exercise adjustments. I tried the 50 pound limit in my keg workout last week and it was beyond easy. This is an adjustment, trying to figure out what works. Thanks! JZ