Do the generic restrictions against weightlifting with a thoracic aortic aneurysm change when the routine is done the “super slow” way?

In the super slow method of lifting weights, the positive or concentric portion of the lift takes 10 seconds, up to 14, and the negative/eccentric or release takes five to 10 seconds.

The blood pressure increase won’t be as sharp and sudden, when compared to the traditional protocol of strength training – in which it takes one to two seconds to perform the lift, then one to two seconds for the release.

If you’ve been diagnosed with a thoracic aortic aneurysm, your physician has surely informed you of the associated weightlifting restrictions.

You may have been instructed never again to “lift more than 50 pounds.”

This is crushing to someone whose workout regimen includes lifts well over a hundred pounds.

In fact, there are certain exercises for which the load typically exceeds 100 pounds, such as the standard bench press, incline press, lat pull-down, leg press, leg curl, back squat and deadlift.

How safe is super slow training for people with a thoracic aortic aneurysm?    

“This comes down to blood pressure increases,” says Alexandra Kharazi, MD, a cardiothoracic surgeon with the Sharp HealthCare system in CA.

“Super slow weightlifting is likely to raise blood pressure more gradually, whereas standard tempo weightlifting may cause more sudden increases in blood pressure.

“Sudden increases in blood pressure are very risky for aneurysm rupture or dissection.”

That’s because the thinned-out portion of the aneurysmic interior wall of the aorta can’t efficiently withstand the increased pressure of blood flow – that’s needed to support heavy weightlifting.

A rupture may result, causing severe chest pain. This is an emergency situation, and many people with an aortic dissection die on the way to the hospital.

Graphic of an aortic dissection. Shutterstock/sciencepics

“The mainstay of medical management in patients with aortic aneurysms is blood pressure control (<120) with serial surveillance [of the aneurysm] using CT scans,” continues Dr. Kharazi.

Sometimes, the restriction is worded as: “Don’t lift more than half your body weight.”

What does this mean for super slow training?

After all, a 400 pound person gets to lift 200 pounds, according to this restriction, while a thin but strong individual is penalized due to their light body weight, whatever half that may be.

Furthermore, what does the “don’t lift” actually mean when the patient is told “don’t lift more than 50 pounds?”

For example, picking up a 50 lb. suitcase and holding it straight-armed while walking 30 feet is significantly easier than is hoisting that same suitcase onto a high shelf.

“This is a good point,” says Dr. Kharazi. “An option I recently recommended to a patient who was weightlifting with an aortic aneurysm was to monitor his blood pressure and heart rate during weightlifting sessions to see how these numbers change with exercise.

“This can be applied regardless of body weight. I agree that a one-size-fits-all recommendation doesn’t work here.

“For example, someone who is 400 lbs. but obese with other medical problems, such as high cholesterol and high blood pressure (and not in shape), is much more likely to have an aneurysm rupture while lifting 200 lbs. than is a fit and healthy person lifting greater than 50% their body weight.

“The general guidelines refer to all types of lifting; however, the response varies greatly depending on the person doing the lifting.

“For example, someone who is sedentary and not used to lifting, at any time can have a sudden spike in blood pressure when lifting a suitcase.

“In contrast, a fit person who lifts regularly may not experience a sudden spike.

“In this case, the person lifting the suitcase would be at greater risk of aneurysm rupture.”

Super Slow Training and Blood Pressure

Due to the slow nature of this approach, blood pressure will rise a lot more slowly, posing less threat of dissection to a thoracic aortic aneurysm.

But this doesn’t mean you wouldn’t need to monitor your blood pressure during your workout. You still should, as best as you can make that happen.

However, there’s another point to consider when it comes to the super slow method to lifting weights.

Whatever load you use for standard tempo lifts would need to be much lighter in order to lengthen the positive and negative phases.

If you normally perform eight reps of a 185 pound bench press at conventional speed, you’d have to use a much lighter barbell to spend 10 seconds pushing it upward and then another 5-10 seconds lowering it.

You won’t be able to do this at 185 pounds if this weight is close to your 8 RM.

Your blood pressure will rise more slowly with a prolonged positive or concentric lift of a much lighter weight and a longer negative or release.

The slow nature of super slow, coupled with the lighter resistance, mean less of an impact on your blood pressure – and thus a safer way to strength train with a thoracic aortic aneurysm.

The caveat is that it may take some time to get used to super slow training, especially with big compound moves like barbell presses, the back squat and the deadlift.

Good form must be strictly adhered to for every moment of your prolonged deadlift and back squat rep.

The load for a super slow deadlift and back squat would need to be significantly lighter to allow for eight reps.

Super slow is easier to employ and stick to with weight stack machines, pulley systems or equipment that’s loaded with plates.

Dr. Kharazi has many areas of surgical expertise including the following: aortic aneurysm repair, aortic valve repair and replacement, and CABG. Other areas of focus include arrhythmia, bloodless medicine, lung cancer and resection, septal defect repair and thoracic surgery.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


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