Marfan Syndrome Exercise Recommendations

Marfan syndrome is a common inherited disorder of the connective tissue. About 1 person in 5,000 to 10,000 is born with Marfan syndrome. This condition commonly affects the skeletal system, heart, blood vessels, and eyes.

People with Marfan syndrome, especially those who have significant involvement of the cardiovascular system, may have to limit their physical activity—but most can still remain active and participate in at least some competitive sports.

athlete blood vessels
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Potential Risk of Athletic Activities

People with Marfan syndrome are usually quite tall and thin, and their arms and legs are longer than normal. They also often have long fingers (a condition doctors call arachnodactyly), an abnormal chest shape (pectus carinatum or pectus excavatum), and dislocation of the lens of the eye.

The most life-threatening complications of Marfan syndrome are related to the heart and blood vessels; in particular, aneurysm of the aorta.

An aneurysm is a dilation (ballooning-out) of the wall of the blood vessel. This dilation greatly weakens the wall of the aorta and makes it prone to sudden rupture (dissection). Aortic dissection is a medical emergency and can lead to sudden death in people with Marfan syndrome.

This condition is more likely to occur during times when the cardiovascular system is being significantly stressed. Vigorous exercise, in particular, can precipitate aortic dissection in a person with Marfan syndrome. For this reason, young people who have Marfan syndrome must often limit their participation in athletic activities.

It is never easy for young people to hear that their physical activity has to be limited. Fortunately, most people who have Marfan syndrome can stay active, but with restrictions.

It is important for these young athletes to be aware of the kinds of activities they should avoid and those they can continue to enjoy.

General Exercise Recommendations

Formal recommendations on engaging in a competitive athletic activity for athletes with Marfan syndrome were published in 2005 by the Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities. These recommendations were updated in 2015.

Notably, the Bethesda Conference specifically addressed people who are engaging in organized, competitive athletics. In particular, it laid out guidelines for schools and other organizations with such programs. It did not specifically address the recreational athlete.

However, the recommendations can still provide guidance for recreational athletes and their physicians.

Activities to Consider

In general, if no more than one of the following applies to someone with Marfan syndrome, they can participate in non-contact competitive sports that do not create significant stress on the cardiovascular system:

  • Aortic root dilation
  • Significant mitral regurgitation
  • Other serious cardiac abnormalities
  • Family history of aortic dissection or sudden death with a minimally dilated aorta

They can enjoy what is called “low and moderate static” sport activities—that is, those activities that usually do not require "bursts" of intense exercise. Examples of appropriate activities include:

  • Golf
  • Bowling
  • Hiking
  • Cricket
  • Archery
  • Curling

If a person with Marfan syndrome has had a surgical correction of the aorta and is cleared by their surgeon, sporting activities should generally be limited to low-intensity exercises such as walking, bowling, golf, or yoga.

Some people with Marfan syndrome may be individually cleared by their doctors to do more than low-intensity exercises, but that is done on a case-by-case basis.

Activities to Avoid

Anyone with Marfan syndrome should avoid:

  • Sports that are likely to cause the body to collide with something, such as other players, the turf, or other objects
  • Isometric exercises such as weight training, which increases the stress on the wall of the heart and blood vessels
  • High-resistance activities that activate the Valsalva maneuver (breath-holding)

Monitoring and Activity Adjustments

Periodic echocardiograms (every six to 12 months) can be used to guide an appropriate level of physical activity for those with Marfan syndrome.

These are done to look for dilation of the root of the aorta and for mitral regurgitation. Either, if present, increases the risk of aortic dissection and other cardiovascular emergencies.

In such cases, approved activities will likely need to be rethought.

People with Marfan syndrome have a lifelong increased risk for serious cardiovascular events and require regular medical follow-up.

A Word From Verywell

Exercise restrictions are advised for anyone with Marfan syndrome. However, the degree of restriction will vary from person to person, and most are able to (and are encouraged to) enjoy active lifestyles with appropriate precautions.

Some degree of exercise is important for everyone, so if you have Marfan syndrome, you should work with your doctor to design an exercise program that will optimize your health without putting you at undue risk.

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Article Sources
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  1. Braverman AC, Harris KM, Kovacs RJ, Maron BJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 7: Aortic diseases, including Marfan syndrome. Circulation. 2015;132(22):e303-e309. doi: 10.1161/CIR.0000000000000243

  2. Marfan Foundation. Familial Thoracic Aortic Aneurysm and Dissection. Published September 20, 2013.

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