Weightlifter and aortic disease repair surgeon Dr. John Elefteriades talks about squatting with a thoracic aortic aneurysm.

It’s devastating when a strength training enthusiast or bodybuilder learns he or she has a thoracic aortic aneurysm; this means that heavy weightlifting should be avoided.

A favorite with bodybuilders and other weightlifters is the barbell squat.


Kiss Barbell Squats Goodbye?

But does the avoidance of “heavy” or “straining” weightlifting automatically rule out the barbell squat in an athlete with a thoracic aortic aneurysm?

For this article my expert source is John A. Elefteriades, MD, a weightlifter himself, and William W.L. Glenn Professor of Surgery, and Director, Aortic Institute at Yale-New Haven, New Haven, CT.

I’m a former certified personal trainer and was well aware that the general rule that doctors administer to their aortic aneurysm patients is that of avoiding lifting more than half their body weight.

I found this to be a very peculiar rule, because it doesn’t take into account an individual’s fitness level (e.g., strength, especially strength for a particular exercise).

Let’s say I have two clients (let’s make them women) with thoracic aortic aneurysm who were told by their doctors not to lift more than half their body weight. Both clients weigh 200 pounds.

One client can perform barbell squats easily with 200 pounds for 15 reps.

The other client strains and has to loudly grunt to complete eight reps at just 80 pounds—which, according to the half body weight rule, is safe for her to work with.

Though both women weigh the same, their body composition is strikingly different.

The strong client has a lot more muscle than the weak client.

Yet according to the half body weight rule, that strong client suffers with the same restriction as the weak client, even though the strong woman warms up with 200 pounds.

This one-size-fits-all restriction does not make sense.

Dr. Elefteriades tells me, “The half body weight rule is for the average individual.” That would mean my weak client. The average woman would struggle with an 80-pound barbell across her back for a squat.

“There will be a moderate amount of strain,” continues Dr. Elefteriades, “for the amateur bench pressing half his body weight.” The rules that apply to bench pressing also apply to the barbell squat.

He continues, “A trained athlete can lift more to achieve a similar amount of strain. We just advise prorating other exercises to the same perceived strain as with bench pressing 50 percent of body weight.”

This application can get tricky because for some people, benching half their body weight is a breeze, while for others, it requires straining.

So what, then, is the verdict when it comes to thoracic aortic aneurysm and doing barbell squats?

It’s simple: Don’t strain. If that means keep the barbell squat under 100 pounds, then that’s your rule. If it means keep it under 200 pounds, that’s your rule.

Just make sure that you are not straining, struggling, grunting or your face is turning red.

If the tempo of the barbell squat must be slowed down in order for you to complete the reps, it’s too heavy for a thoracic aortic aneurysm.

Formerly the chief of cardiothoracic surgery at Yale University and Yale New-Haven Hospital, Dr. Elefteriades is working on identifying the genetic mutations responsible for thoracic aortic aneurysms. He is the author of over 400 scientific publications on a wide range of cardiac and thoracic topics.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health. 



Top image: Shutterstock/Veronika Zakharova