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

BackgroundMarfan syndrome (MFS) carries a high risk of aortic dilation and dissection, yet the cardiovascular impact of specific exercise modalities remains uncertain. Methods and ResultsForty-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{middle dot}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{middle dot}s-1 (RES) and -1.24 m{middle dot}s-1 (COMB) versus -0.37 m{middle dot}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. ConclusionsIn 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 RegistrationURL: https://clinicaltrials.gov; Unique identifier: NCT04553094. Clinical perspectiveO_ST_ABSWhats new ?C_ST_ABSO_LISafe 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. C_LIO_LISignificant 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 ({approx} 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),). C_LIO_LIImproved 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. C_LI What are the clinical implications?O_LIImproved 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. C_LIO_LIExpansion 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. C_LIO_LINeed 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. C_LI