Marfan Syndrome Exercise Recommendations

Marfan syndrome is the most common inherited disorder of the connective tissue. About in person in 10,000 to 20,000 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.

The Potential Risk Of Athletic Activities in People with Marfan Syndrome

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 curvature of the spine ( kyphoscoliosis), 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, to 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 (a condition doctors call 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 athletic activities they should avoid, and those they can continue to enjoy.

General Exercise Recommendations For Young Athletes With Marfan Syndrome

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.

Here is a summary of the recommendations on athletic activity in people who have Marfan syndrome.

Athletes who have Marfan syndrome should have echocardiograms every six to 12 months to look for dilation of the root of the aorta and for mitral regurgitation. Either dilation of the aorta or mitral regurgitation, if present, increases the risk of aortic dissection and other cardiovascular emergencies.

Athletes who have Marfan syndrome should have echocardiograms every six to 12 months to look for dilation of the root of the aorta and for mitral regurgitation. Either dilation of the aorta or mitral regurgitation, if present, increases the risk of aortic dissection and other cardiovascular emergencies.

In general, if there is no aortic root dilation, significant mitral regurgitation, or any other serious cardiac abnormalities, and if there is no family history of aortic dissection or sudden death, people with Marfan syndrome can participate in non-contact competitive sports that do not create significant stress on the cardiovascular system. They can partake in what is called “low and moderate dynamic” sport activities—that is, those activities that usually do not require "bursts" of extremely high-intensity exercise. Examples of appropriate activities include golf, bowling, hiking, doubles tennis, swimming laps, skating, and table tennis.

If a person with Marfan syndrome has a dilated aortic root, mitral regurgitation, or a family history of aortic dissection or sudden death, sporting activities should generally be limited to low dynamic exercises such as walking, bowling, golf, or yoga.

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. They should also avoid isometric exercises such as weight training, which increases the stress on the wall of the heart and blood vessels. Patients with Marfan syndrome should also avoid heavy weight-lifting or high-resistance activities that activate the Valsalva maneuver. 

Some people with Marfan syndrome may be individually cleared by their doctors (if their risk is judged to be quite low) to participate in intermediate-risk sports such as basketball, baseball, touch football, and strenuous bicycling.

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 for which athletes with Marfan syndrome may be looking to participate in their programs. It did not specifically address the recreational athlete.

However, the Bethesda recommendations can still provide guidance for recreational athletes and their physicians. In anyone with Marfan syndrome who wishes to engage in sports, periodic echocardiograms can be used to guide an appropriate level of physical activity.

A Word From Verywell

People with Marfan syndrome have a lifelong increased risk for serious cardiovascular events and require regular medical follow-up. 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 settle on an exercise program that will optimize your health, without producing undue risk.

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