Exercises for Marfan syndrome — AVOID Valsalva + heavy lift + contact, Bethesda IA-IIA only, aortic surveillance

Loeys 2010 Ghent revised criteria + 2022 ACC/AHA aortic disease management guidelines. Marfan syndrome is an autosomal-dominant connective tissue disorder caused by FBN1 mutations affecting fibrillin-1 microfibrils. The triad: progressive aortic root dilation + dissection risk (the leading cause of premature mortality), ectopia lentis (lens subluxation), and skeletal features (tall stature, arachnodactyly, pectus deformity, scoliosis, joint hypermobility). Treatment is medical (beta-blocker + losartan slow root dilation per COMPARE 2014 trial) + surgical (prophylactic aortic root replacement at 50 mm root diameter; 45 mm in Loeys-Dietz syndrome with TGF-βR mutations). Exercise restrictions are non-negotiable and specific: AVOID Valsalva manoeuvres, AVOID heavy isometric loading (deadlifts, bench press to failure, max-effort lifts), AVOID contact sports (rupture risk from impact), AVOID competition-intensity exercise. Sport eligibility per AHA 2015 + ACC 2020 is restricted to Bethesda class IA-IIA (low-to-moderate DYNAMIC + low STATIC) — walking, light cycling, swimming, doubles tennis with controlled intensity. Annual transthoracic echo + cardiac MRI surveillance. Lens dislocation needs annual ophthalmology exam. Scoliosis may need brace. The Marfan Foundation + ACC/AHA + multi-specialty care.

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity work, wall-push-up for scaled upper-body strength (NOT bench press — risk of overload + Valsalva), scapular-retraction for posture (the long lever arm + chronic scoliosis posture combination), cat-cow for spinal mobility, supine-knee-to-chest for low-back release, diaphragmatic-breathing for parasympathetic regulation + breath control (training to NOT Valsalva is a Marfan skill), standing-march for managed cardio at controlled intensity, ankle-pump for circulation, chin-tuck for cervical posture (compensatory for thoracic curvature). The AI coach also knows the nutrition side — BP control non-negotiable low-sodium <2 g/day + Mediterranean + omega-3 1-3 g/day + cardiology team, AVOID stimulants + caffeine excess >200 mg/day + decongestants (pseudoephedrine) + ADHD stimulants without cardiology approval (all raise BP + HR + aortic stress), AVOID grapefruit + Seville orange (losartan + beta-blocker metabolism), calcium 1000-1200 + vit D + weight-bearing within Bethesda limits for bone density (Le Goff 2002 lower BMD), Mediterranean anti-inflammatory backbone, AVOID alcohol excess + AVOID smoking absolutely (pneumothorax + dissection compound), post-aortic-replacement warfarin + CONSISTENT vit K, pregnancy (especially root >40 mm) pre-conception cardiology + maternal-fetal medicine + Mediterranean + folate + iron + Ca. CRITICAL: Marfan Foundation + National Marfan Foundation + ACC/AHA + Loeys-Dietz Foundation if LDS overlap + cardiology (annual echo + cardiac MRI) + ophthalmology + orthopedics + maternal-fetal medicine + dental. This is NEVER a replacement for cardiology + genetic counselling.