Resistance training: A safe non-pharmacological approach to improve cardiovascular function in patients with Marfan syndrome

Abstract Background Marfan syndrome (MFS) carries a high risk of aortic dilation and dissection, yet the cardiovascular impact of specific exercise modalities remains uncertain. Methods and Results Forty-five adults with MFS were randomised to 12 weeks of endurance (END), resistance (RES) or combined endurance–resistance (COMB) training (15 per group). Primary outcomes were resting and exercise systolic blood pressure (SBP), augmentation index normalised to 75 beats·min -1 (AIx@75), pulse-wave velocity (PWV), aortic root diameter, left-ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Compared with END, RES reduced resting SBP by –11 mm Hg versus –5 mm Hg and lowered AIx@75 by –29 % versus –9 % (interaction P < 0.05). PWV declined by –1.71 m·s -1 (RES) and –1.24 m·s -1 (COMB) versus –0.37 m·s -1 (END; P < 0.001). LVEF rose by +4.4 % (RES) and +3.2 % (COMB) compared with +1.6 % (END), paralleled by similar GLS improvements. Muscle strength increased in RES (+21 %) and COMB (+18 %) but not END (+3 %). No group showed a significant change in aortic root diameter, and no adverse events occurred. Conclusions In adults with MFS, a 3-month programme incorporating resistance exercise— alone or combined with endurance—confers larger reductions in blood pressure and arterial stiffness and enhances ventricular function without short-term aortic enlargement. These findings support the safe inclusion of resistance training in exercise prescriptions for MFS, with continued surveillance to confirm long-term safety. Clinical Trial Registration URL: https://clinicaltrials.gov ; Unique identifier: NCT04553094 . Clinical perspective What’s new ? Safe integration of resistance training : Patients with Marfan syndrome who followed a resistance or combined (endurance + resistance) program showed greater improvements in vascular and cardiac parameters than those assigned to purely endurance training. Significant reduction in blood pressure and improvement in Augmentation Index normalized to a heart rate of 75 beats per minute (bpm) AIx@75 : The Resistance and Combined groups experienced a drop in resting blood pressure (≈ 8 to 10% corresponding to –11 to –13 mmHg) and a much more pronounced decrease in AIx@75 (–25 to –30 mmHg) compared to the Endurance group (–9 mmHg),). Improved myocardial function : Myocardial strain and left ventricular ejection fraction (LVEF) tended to increase more in the groups performing resistance-type training (approximately +8% for strain and +7% for LVEF), without negatively impacting the diameter of the Valsalva sinuses. What are the clinical implications? Improved cardiovascular health : The significant reduction in blood pressure during exercise and the improvement in AIx@75 reflect a decrease in hemodynamic stress at the aortic root, which could help reduce the risk of aortic complications such as aneurysm or dissection. Expansion of exercise-based therapeutic options : These results suggest that a supervised training program incorporating resistance exercises is more beneficial for improving vascular and cardiac function in Marfan patients than endurance training and can be safely provided. Need for rigorous echocardiographic follow-up : Despite the absence of any worsening in Valsalva sinus diameter, regular echocardiography remains essential to monitor the evolution of cardiovascular parameters and to determine optimal exercise loads in these high-risk patients.