12. Returning to Exercise


The information in this module is based on a scientific report on SCAD, and contains general observations, but does not constitute individualized advice for SCAD patients.

The question of exercise after SCAD is an important one to many SCAD patients.  Many of us were quite physically active before our SCAD, and would like to resume at least some of the activities we enjoyed.  But we know that intense physical exercise is implicated in about a quarter of SCAD cases.  However, there are also cardiovascular risks associated with inactivity.  SCAD patients must work with their doctors to balance the risk of overdoing physical activity with the risk of a sedentary lifestyle. This module reports on some of the current recommendations around physical activity that were published by the American Heart Association in 2018.

Although more long-term research is needed, here are some of the current recommendations around post-SCAD exercise:

  1. Attend cardiac rehabilitation. This recommendation is widely regarded as an important first step in resuming exercise and gaining psychological confidence in your post-SCAD body.
  2. Blood pressure and heart rate recommendations in at least one cardiac rehabilitation facility is no higher than 130/80 and heart rate no higher than 50-70% of heart rate reserve.   However, your doctor may have different recommendations for you.
  3. Weight training.  Low resistance and high repetitions are better than the other way around.
  4. Activities to avoid:
    1. Prolonged high-intensity activity
    2. Highly competitive or contact sports
    3. Activities performed to exhaustion (e.g. racing, boot camp)
    4. Abrupt increases in activity without first warming up
    5. Exercises in extreme temperatures (e.g. hot yoga, cold water swimming)
    6. Performing the Valsalva maneuver.  This happens when you hold your breath and bear down, as if having a bowel movement.  Valsalva maneuvers can result in dangerous increases in heart rate and blood pressure.

Many SCAD patients feel afraid to return to exercise, especially if their event occurred during or after intense exercise. Cardiac rehabilitation is the best way to conquer this fear because qualified medical personnel create an individually tailored exercise program for each patient. Return to exercise is gentle and gradual. By the time a person finishes cardiac rehab, she has had the chance to “relearn” her body’s response to exercise and feels much more confident about exercising safely on her own.




Hayes SN, Kim ESH, Saw J, et al; on behalf of the American Heart Association Council on Peripheral Vascular Disease; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Functional Genomics and Translational Biology; and Stroke Council. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 2018;137:e523-e557. doi:10.1161/CIR.0000000000000564.

Returning to Exercise Checklist

Before returning to exercise, check with your doctor on guidelines for physical activity.

Check off items that you would like to talk to your doctor about.