Exercise guide
An abdominal aortic aneurysm (AAA) is a swelling of the main artery in your tummy, usually found at screening. Most never cause problems, and the NHS screening programme says you can carry on with your sports and hobbies. In trials of up to 3 years, exercise didn't make aneurysms grow faster, and it builds the fitness that helps if you ever need an operation.
This guide covers how much exercise to do, lifting and blood pressure, what to leave out, getting fit before repair, and recovery after keyhole repair (EVAR, endovascular aneurysm repair) or open surgery. It also covers aneurysms in the chest and Marfan syndrome briefly, and the signs of a burst aneurysm that mean calling 999. Your vascular team's advice comes first.
An AAA is a swelling of the aorta in your tummy to 3 cm or more. Men in England are offered a scan in the year they turn 65. A small aneurysm (3.0 to 4.4 cm) is scanned every year, a medium one (4.5 to 5.4 cm) every 3 months, and a large one (5.5 cm or more) is seen by a vascular specialist, usually within 2 weeks.
The screening programme tells people with an aneurysm of any size: "You do not need to make any other changes to your lifestyle. You can continue with any sports or hobbies." The European vascular surgeons say restricting exercise isn't indicated with an aneurysm under 7 cm.
In trials of up to 3 years, exercise didn't speed up growth, and serious problems were rare (about 0.8% across 7 trials). It builds fitness, but it doesn't shrink an aneurysm.
US and European heart guidelines advise against intense straining exercise, such as very heavy weightlifting with a held breath, with significant aortic disease. The European vascular surgeons say holding back from heavy weightlifting may be advisable with a large aneurysm. No trial has tested lifting with an aneurysm.
In people with an aneurysm, a heart attack or stroke is a far bigger risk than the aneurysm bursting. Staying active, blood pressure treatment and stopping smoking lower that risk, and help if you ever need an operation.
After open surgery, avoid heavy lifting and strenuous sport for 6 to 8 weeks while your tummy muscles heal. After EVAR, NHS hospitals advise anything from 4 weeks to 3 months without heavy lifting, depending on the hospital and the operation, so do as your vascular team advises.
The aorta carries blood from your heart through your chest and tummy; in the tummy it's normally about 2 cm wide, the width of a garden hose. An AAA is a swelling of it to 3 cm or more. Most aneurysms don't cause any problems, but they can be serious because there's a risk they could burst (rupture).
What the screening programme does for each size, and roughly how many men screened have one:
Mostly men over 65, people who smoke or used to, and people with high blood pressure, high cholesterol, a close relative with an aneurysm, other artery disease or COPD (chronic obstructive pulmonary disease). Women get them up to four times less often, but their aneurysms are about four times as likely to burst.
Men in England are invited for a 10 to 15-minute ultrasound scan in the year they turn 65, and screening is recommended for anyone assigned male at birth. If you're not eligible but think you're at higher risk, talk to a GP; NICE (the National Institute for Health and Care Excellence) suggests considering a scan for women aged 70 and over with risk factors. Brothers, sisters and children of someone with an AAA can ask about a scan 5 years before they reach the age it was found.
Small aneurysms grow about 2.2 mm a year on average, faster in people who smoke. In the NHS programme, the risk of an aneurysm under 5.5 cm bursting is about 0.4% a year. About 85 in 100 people with a burst aneurysm die, which is why the scans matter.
Small and medium aneurysms are watched with scans, alongside stopping smoking and treating blood pressure and cholesterol. Repair is considered for an aneurysm that causes symptoms, has grown more than 1 cm in a year, or reaches 5.5 cm. Open repair replaces the swollen section through a cut in your tummy, with about 7 to 10 days in hospital. EVAR places a stent-graft inside the aorta through the groins, with 1 to 3 days in hospital and regular scans for life.
In people with an aneurysm, the 10-year risk of dying from a heart attack or stroke is about 15 times the risk of a sudden aortic emergency, even after repair. That's why statins, blood pressure treatment, stopping smoking and exercise are part of the plan.
In the largest trial, 140 people with small aneurysms trained for up to 3 years with no training-related problems and no faster growth, and their fitness improved. Across 7 trials (489 people), heart problems during testing and training happened in 0.8%; across 8 trials (588 people), exercise made no difference to aneurysm size. The trials are small, and one review rated the evidence very low certainty.
Peak fitness rose in pooled trials. In a UK trial of 56 people under surveillance, a 24-week community programme, at a gym or at home, added about 2 mL/kg/min to peak oxygen uptake, and the gain held 12 weeks after the programme ended.
The NHS screening programme, the European vascular surgeons and the European and US heart guidelines all encourage regular exercise. The US guideline suggests 30 to 60 minutes of mild to moderate aerobic activity on at least 3 to 4 days a week, once blood pressure is controlled.
No trial has tested lifting with an aneurysm. Very heavy lifts with a held breath push blood pressure very high: in a study of 5 experienced bodybuilders lifting to failure, it averaged 320/250 mmHg on a double leg press. Case reports link weightlifting with tears in the aorta in the chest, mostly where it was already widened; the European vascular surgeons note that no equivalent has been reported for an abdominal aneurysm bursting. Whether heavy lifting raises that risk isn't known.
In cohort studies of 409,732 people, the most active were about 30% less likely to develop an AAA. Studies like this can't prove cause.
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No treatment, including exercise, has been shown to stop an aneurysm growing, but stopping smoking slows it. NICE found too little evidence to recommend any medicine for slowing growth, though the NHS says blood pressure and cholesterol medicines may help stop it getting bigger. Exercise works alongside your medicines and scans, never instead of them.
These are starting points for someone without warning signs. Your vascular team may give you different limits.
30 to 60 minutes of mild to moderate walking, cycling or swimming on at least 3 to 4 days a week (the US aortic guideline's dose), building towards 150 minutes a week (the NHS). Keep to a pace where you can talk. The screening leaflets ask you to stay active every day.
Strength work on 2 days a week. Our editorial reading of the guidelines, matching our heart disease guide: choose a weight you could lift at least 15 times and stop at 8 to 10, breathing out on the effort and never holding your breath. No trial has tested lifting with an aneurysm.
Fine with a small or medium aneurysm: the screening leaflets say you can continue with any sports or hobbies. Avoid straining lifts. In one study of tears of the aorta in the chest during sport, golf was the sport most often involved, which the European sports guideline puts down to golfers often being older with high blood pressure; it isn't evidence against golf with an abdominal aneurysm.
Keep walking and doing light activity. The European vascular surgeons say restraint from vigorous sport such as heavy weightlifting may be advisable with a large aneurysm, while the screening leaflet says you don't need to change your lifestyle, so ask your vascular team before heavy lifting or vigorous sport.
The guidelines differ in emphasis. They agree that moderate exercise is good for you, and that very heavy, breath-held efforts are where any caution sits.
For small, medium and large aneurysms: "You do not need to make any other changes to your lifestyle. You can continue with any sports or hobbies." It sets no lifting limit.
Restricting exercise or sex isn't indicated with an aneurysm under 7 cm, there are no data suggesting exercise is harmful, and it isn't advisable to discourage it. They add that restraint from vigorous sport such as heavy weightlifting may be advisable with a large aneurysm, and that no well-founded advice on specific sports exists.
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The US guideline advises people with significant aortic disease to avoid intense isometric (straining) exercise such as heavy weightlifting or anything that needs a held breath, sudden bursts of exertion, and collision sports. It says light weightlifting is considered safe, but that experts don't agree about medium-intensity work. The European heart guideline advises limiting isometric exercise in aortic disease.
Moderate weights you could lift at least 15 times, stopping at 8 to 10 and breathing out on the effort; no maximal lifts, lifting to failure or long straining holds; and a word with your vascular team before anything heavier. This is our editorial reading of the guidelines; no trial has tested lifting with an aneurysm.
In a study of 5 experienced bodybuilders lifting to failure, blood pressure averaged 320/250 mmHg on a double leg press and 255/190 mmHg on single-arm curls, partly from holding their breath. Whether peaks like these raise the risk of an abdominal aneurysm bursting isn't known.
Your GP or team sets it. European heart guidelines aim for below 140/90, and 120/80 if you can manage it without side effects. Take your medicines as prescribed; regular aerobic exercise helps lower blood pressure, and if your home readings are 180/100 or higher, speak to your GP before doing more, as our blood pressure guide explains.
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Our editorial suggestion, matching our heart disease guide's rule and the US guideline's "light weightlifting". No trial has tested lifting with an aneurysm.
See the movement on the 3D figure: Sit to stand from a chair
At a pace where you can talk, on most days. The recumbent bike and elliptical move pages start at 10 to 20 minutes, building towards 30.
2 days a week, breathing out on the effort, with weights you could lift at least 15 times (our suggestion). The band row move page gives 3 sets of 10 to 15.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoWall push-upBeginner · A wall
3D demoBand rowBeginner · A band + An anchor point
3D demoLow step-upBeginner · A step
3D demoGlute bridgeBeginner · No equipment
3D demoSlow calf raiseBeginner · A wall
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weightLeave these out, or ask your vascular team first:
Add sit-ups and heavy core work to the list until your team clears them: the muscles under your wound take 6 to 8 weeks to heal, and being careful lowers the risk of a hernia.
In a trial of 124 people, 6 weeks of supervised exercise before repair cut heart, lung and kidney complications from 42% to 23% and shortened the hospital stay by a day. Five years later, fewer of those who went to the classes had died (4 against 16), but the difference wasn't clear when everyone was counted as randomised.
A Cochrane review of 4 trials (232 people) found exercise before repair may reduce heart and kidney complications, with low certainty, and was uncertain about everything else. NICE found too little evidence to recommend it, but suggests a fitness test (cardiopulmonary exercise testing) can help decisions about surgery.
In a supervised programme before repair of large aneurysms, high-intensity cycling intervals 3 times a week for 4 weeks were feasible, with blood pressure kept below 180 mmHg and heart rate below 95% of maximum; there was 1 adverse event in 27 people. This was in hospital, with staff watching.
Ask whether your hospital runs a fitness programme; otherwise keep walking daily at a pace where you can talk. Your assessment before surgery may include a fitness test on an exercise bike.
These are what NHS leaflets usually say. If your vascular team's advice differs, follow theirs.
You'll usually walk the next day and go home within 1 to 3 days, then build up with short walks and rest for the first few weeks. NHS hospitals advise anything from 4 weeks to 3 months without heavy lifting, depending on the hospital and the operation, so do as your vascular team advises. Full recovery usually takes 2 weeks to 2 months (Leeds) or 3 to 6 weeks (Guy's and St Thomas').
Hospitals word this differently. Birmingham says you may resume gentle sports such as golf or crown green bowling when you feel comfortable. Norfolk and Norwich says not to undertake strenuous activities or sports such as golf during the several weeks of recovery. Guy's and St Thomas' says avoid strenuous exercise for the first few days, then build up gradually.
Norfolk and Norwich's plan: week 1, walk gently around the house and garden; week 2, a 7 to 15-minute walk in the morning and afternoon; week 3, 15 to 20 minutes twice a day. Birmingham uses the slower plan below after both operations.
Expect a day or two in a high dependency unit and about 7 to 10 days in hospital. The muscles under your wound take up to 6 to 8 weeks to heal, so avoid heavy lifting, strenuous activity and sport (Norfolk and Norwich names golf) in that time, and vacuuming, mowing and carrying shopping for the first 4 to 6 weeks (Birmingham), to lower the risk of a hernia. Feeling tired for at least 4 to 6 weeks (Norfolk and Norwich) or 6 to 12 weeks (Birmingham) is normal, and it can take up to 6 months to feel yourself again (Cambridge).
The leaflets agree that too much activity causes pain rather than damage. Cambridge says if an activity causes pain, stop it for another 1 to 2 weeks and then try again, and Norfolk and Norwich says moving around won't damage the graft or your wound.
After EVAR you'll have regular scans for life, because leaks around the graft can appear months or years later. After open repair there's usually one clinic check at about 6 to 8 weeks, and then your GP takes over.
The US guideline recommends cardiac rehabilitation after aortic surgery, at light to moderate effort without strenuous lifting. It isn't routine in the UK, and NICE found no trials of exercise after repair, so ask whether a cardiac rehab or community exercise programme is open to you.
Birmingham's leaflet, 3 times a day in the first weeks: brace each knee for 5 seconds, 5 times; bend and straighten each knee 10 times; circle each foot 10 times; march your feet 10 times; and knee rolls. Your physiotherapist teaches the breathing exercises.
3D demoQuad set (static quads)Beginner · No equipment3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoAnkle circlesBeginner · No equipment
3D demoSeated marchBeginner · A bench or box
3D demoHip windshield wipersBeginner · No equipment
3D demoSlow breathing (6 breaths a minute)Beginner · No equipmentAn aneurysm in the chest (a thoracic aneurysm), or a widened aorta with Marfan syndrome, vascular Ehlers-Danlos syndrome or a bicuspid aortic valve, carries a risk of a tear (dissection) rather than a burst, and your heart or aortic team sets your limits. European heart guidelines recommend individual advice and regular moderate aerobic exercise for most people with Marfan syndrome, and say competitive sport isn't suitable. They favour dynamic over static exercise and advise against power sports, and most exercise-related tears in case reports happened during weightlifting. Our hypermobility guide covers vascular Ehlers-Danlos syndrome, and if you have an operation through your breastbone, our heart surgery guide covers the recovery.
Start with the after-repair routine if you've had an operation, as your vascular team allows. The others suit life with a small or medium aneurysm: use moderate weights on the gym machines, breathing out on the effort.
A gentle routine for the first 4 weeks after aortic aneurysm repair: leg circulation exercises in a chair or bed, then a walk that builds week by week.
10 minBeginner7 movesA bench or box, Something with weightA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA 10-minute session for low-energy days: marching, sit-to-stands, wall push-ups, step-ups and bridges, then a short walk. Doing a little counts.
10 minBeginner7 movesA bench or box, A wallA gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.
20 minBeginner11 movesA bench or box, A wallA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA 50-minute gym session for older adults and sarcopenia: 7 machines for the legs, chest and back from the UK prescription, then a short balance finish.
50 minBeginner12 movesCardio machine, A bench or boxA 45-minute home session built like a UK cardiac rehab class: a 15-minute warm-up, 20 minutes of cardio mixed with light strength, and a 10-minute cool-down.
45 minBeginner14 movesA wall, A bench or boxBuild walking towards 150 minutes a week; the seniors' plan adds strength and balance.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA 12-week exercise plan for over-65s: strength and balance three times a week, short balance sessions and daily walks, based on falls-prevention trials.
3 training days40 minBeginnerThis is general information, not a diagnosis: your vascular team knows your aneurysm. A&E means accident and emergency, and GP means general practitioner. In the US, call 911 where this page says 999. For chest pain, use the 999 list in our heart disease guide.
Call 999 if you or someone else:
For severe, lasting pain in your lower back or tummy, the screening leaflets say call an ambulance or go to A&E straight away, and tell them you have an AAA.
In trials of up to 3 years, exercise didn't make aneurysms grow faster, and serious problems were rare, with no ruptures reported. The European vascular surgeons say there are no data suggesting exercise is harmful, and the NHS screening programme says you can carry on with your sports and hobbies.
The screening leaflets for small, medium and large aneurysms say you don't need to change your lifestyle. Everyday lifting, gardening and moderate strength training are part of normal life. The guidelines' caution is about very heavy, breath-held lifting, especially with a large aneurysm, so ask your vascular team about that; whether heavy lifting raises the risk of bursting isn't known.
No treatment, including exercise, has been shown to shrink an aneurysm or stop it growing, so keep going to your scans. Exercise is still worth doing for your heart, blood pressure and fitness.
After EVAR you'll have regular scans for life. After open repair you'll usually have one check about 6 weeks later, and then your GP takes over.
Men are more likely to have one, but women can too, and theirs are about four times as likely to burst. NICE suggests considering a scan for women aged 70 and over with risk factors.
The screening leaflets say you can continue with any sports or hobbies, and no study has shown that golf, running or cycling harm people with an abdominal aneurysm. Leave out all-out sprints and collision sport unless your team agrees.
A heart attack or stroke is a far bigger risk than the aneurysm bursting, even after repair, which is one reason staying active matters so much.
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Yes, for most people. The NHS screening programme tells people with small, medium and large aneurysms that they can continue with any sports or hobbies, and the European vascular surgeons say restricting exercise isn't indicated with an aneurysm under 7 cm. In trials lasting up to 3 years, exercise didn't speed up growth and serious problems were rare.
The caution is about very heavy, all-out or breath-held efforts: maximal lifts, long straining holds such as wall sits, all-out sprints and collision sports. US guidelines advise avoiding these with significant aortic disease, and European heart guidelines advise limiting holding (isometric) exercise. Walking, cycling, swimming and moderate strength work are encouraged.
No guideline gives a weight limit, and the NHS screening programme says you can carry on with your sports and hobbies. Our editorial reading of the guidelines, matching our heart disease guide, is a weight you could lift at least 15 times, stopping at 8 to 10 and breathing out on the effort; no trial has tested lifting with an aneurysm. With a large aneurysm, the European vascular surgeons say holding back from heavy weightlifting may be advisable, so ask your vascular team first.
The trials say no. In a trial of 140 people training for up to 3 years, there were no training-related problems and aneurysms grew no faster, and across 8 trials exercise made no difference to aneurysm size. Small aneurysms grow about 2.2 mm a year on average whatever you do, which is why the scans continue.
No treatment, including exercise, has been shown to stop an aneurysm growing, though stopping smoking slows it and the NHS says blood pressure and cholesterol medicines may help. Exercise is still worth doing: it builds fitness, helps blood pressure and lowers the risk of a heart attack or stroke, which are bigger risks than the aneurysm itself.
Your GP or vascular team sets your target. European heart guidelines aim for below 140/90, and 120/80 if you can manage it without side effects. Take your medicines as prescribed and keep active, and if your home readings are 180/100 or higher, speak to your GP before doing more.
Yes: the screening leaflets say you can carry on with any sports or hobbies, and no study has shown that golf, running or cycling harm people with an abdominal aneurysm. Keep to a pace where you can talk, and skip all-out sprints unless your team agrees. After open repair, one hospital says no golf for 6 to 8 weeks; after EVAR, hospitals differ, from "when you feel comfortable" to several weeks.
If your hospital offers a fitness programme, it's worth doing: in a trial of 124 people, 6 weeks of supervised exercise before surgery cut heart, lung and kidney complications from 42% to 23% and shortened the hospital stay by a day. The evidence is low certainty overall, and NICE didn't find enough to recommend it everywhere. Otherwise, keep walking daily at a pace where you can talk.
You'll usually walk the next day and go home within 1 to 3 days, then build up with short walks. NHS hospitals advise anything from 4 weeks to 3 months without heavy lifting, depending on the hospital and the operation, so do as your vascular team advises. Most people feel back to normal within 2 weeks to 2 months, and you'll have regular scans for life.
Expect about 7 to 10 days in hospital, then a walk that builds week by week: around the house in week 1, 3 to 5 minutes twice a day in week 2, and 10 to 20 minutes twice a day by week 4. Avoid heavy lifting, strenuous activity and sport for 6 to 8 weeks while your tummy muscles heal. It can take up to 6 months to feel yourself again.
These are different: the main risk is a tear in the aorta, and exercise limits are stricter and set by your heart or aortic team. Guidelines favour regular moderate aerobic exercise and advise against heavy weightlifting, long straining holds and competitive or collision sports. Our hypermobility guide covers vascular Ehlers-Danlos syndrome.
Yes: the European vascular surgeons say there's no reason to restrict sexual activity with an aneurysm under 7 cm. After repair, NHS leaflets say you can restart when you feel comfortable, which one hospital puts at about 6 weeks after open surgery.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
