BAV & Resistance Training

[Odie]

I’m a 50 year-old BAV male 3-½ months post-op for AV repair. Prior to surgery weight-lifting and cycling were my primary forms of exercise, which I did regularly 5-to-6 days per week.
My goal is to regain my pre-surgery level of physical fitness… and then exceed it.
I’m very pleased with my recovery progress thus far. I was able to start cardiac-rehab two weeks after surgery and have already completed the entire program. With the help of a supportive cardiac-rehab staff I have worked up to spinning for an hour at near pre-surgery levels and have made substantial progress with a wide range of resistance exercises (including push-ups, pull-ups, bench-press, squats, rows, curls, dips, push-downs, etc.). With regards to resistance training, my desire is to weekly increase poundage until I’m back to my pre-surgery levels.
Last week I saw my cardiologist, a Doctor who I respect and adore. While she is very pleased with my progress, she is not at all enthusiastic about having me increase the amount of weight I’m lifting beyond the current levels. Her blunt instructions are to only lift only “light” weights from here on out. The cardiac-rehab staff had advised me to lift as much weight as I wanted so long as I could do so with proper form and while continuously breathing -- thereby avoiding valsalva.
Given the zipper-club includes body-builders and professional athletes among its ranks I’m wondering how well the topic of BAV-repair and weight lifting has been studied. Can anyone point me towards respected research in this area?

I’m not opposed to changing my goals, but I’d prefer to do using fact-based decision making rather than what I fear is an abundance of caution.

 

[Guest]

Hi, Odie. I too have had my ascending aorta replacement/repair, kept my natural valve in 2007. I was not allowed to carry anything over 20lbs, and I was not comfortable with carrying anything heavy either. I felt the pressure in my chest, so I stayed away from weights. I swam daily, hiked, walked, danced, tread mill and bike....but no weights. So sorry to say, but I would not recommend taking the chance especially if your doc says not to. 7 years later, I have been diagnosed with stenosis and require a valve replacement, so I am taking it super easy until it is done. I am hoping to be able to be back even stronger with the new valve. Be careful and take care of yourself! All the best,
Lilly

 

[Odie]

Thanks Lilly. Sorry to hear about your stenosis and upcoming valve replacement. You are wise to take it easy for now. I like your attitude about bouncing back stronger with the new valve.

I know the advice I'm getting from my doc is consistent with what many of us on this forum hear from our doctors. That's actually one thing that makes me question the facts behind the broadly handed-out recommendation to lift-light weights. I have low blood pressure, no stenosis and no signs of aortic degradation. Does lifting heavy weights really pose the same level of risk to me as someone with stenosis and a higher blood pressure? If not, then how different are the risk profiles? Similarly, if I shouldn't lift heavy due to risk of aortic dissection then why should someone who has had their ascending aorta replaced be cautioned too?

 

[Agian]

They're good questions, Odie, and I look forward to reading the replies. I am under the impression that it is the spike in BP when lifting that might harm the aorta. If you have a bicuspid valve the ascending aorta tends to be a bit 'softer' than normal, and therefore more prone to stretching. I wouldn't have thought it would be an ongoing issue for someone with a Dacron graft. Gymguy lifts tons.

 

[knotguilty]

Odie, I know exactly how you feel. I love being in the gym, lifting and running. It is what I would rather do than anything else. But, I have been warned by my PCP and my cardiologist not to go heavy, use more reps, and to breath. They have the experience and I don't think they are warning me just for the heck of it. It all has to do with the pressure you build within your heart. In my mind, depending on your fitness level and build, your light weight is someone elses heavy. Even when you use lighter weights and higher reps, it still gets hard if you go to failure. For me, I listen to the doctor and I use more reps with a little lighter weight until that gets too easy and then I increase the weight. You need to be more careful and methodical in your goals. I think you will be surprised at how good a work out you can get with lighter weights and more reps. I know for me, I am not getting any younger and I realize I am not going to attain the fitness level I would like to be at or where I was when I was in my mid forties. But I am happy with my progress and happy just to be in shape. (And happy to be alive)

 

[ski girl]

Interesting! I have the world's most cautious cardiologist, and he has NEVER given me any weight restrictions. I too had a BAV repair (two, actually). My surgeon has also never given me restrictions - his final words were 'go forth and sin no more'.

I think the research on people being active, and I mean *really* active, not just walking around the mall, post-op is lacking because so few of us really push ourselves after surgery. Personally I expected to be BETTER when I was fixed!! Otherwise, I wasn't fixed very well. TheGymGuy is absolutely smashing it with weights and doing just fine - I'd be asking your cardio for the scientific research behind what she's saying, as it may just be caution on her part due to lack of evidence.

 

[ski girl]

Interesting! I have the world's most cautious cardiologist, and he has NEVER given me any weight restrictions. I too had a BAV repair (two, actually). My surgeon has also never given me restrictions - his final words were 'go forth and sin no more'.

I think the research on people being active, and I mean *really* active, not just walking around the mall, post-op is lacking because so few of us really push ourselves after surgery. Personally I expected to be BETTER when I was fixed!! Otherwise, I wasn't fixed very well. TheGymGuy is absolutely smashing it with weights and doing just fine - I'd be asking your cardio for the scientific research behind what she's saying, as it may just be caution on her part due to lack of evidence.

 

[mcsf]

I am almost seven month post AVR. It is my second AVR. I had it repaired when I was younger with a Ross. My cardiologist now and after my Ross stresses not to lift heavy -- don't max out. Her reason is heavy lifting elevates your BP way to much. That said I know there are some power lifters on the site so people are doing it.

 

[bocco]

Odie,

I am 58 with an AVR and aortic root graft and I push weights pretty heavy every morning. I don't push quite as much as I used to but it's mostly just due to age. When I was 50 I was bench pressing 300lb on a good. Lately I'm happy with 250lb.

Ease into the chest work until your sure your all healed up. I started by working mostly back muscles and legs and going really light on everything else. I built everything else up gradually just avoiding any pain.

Good luck

Gary

 

[tom in MO]

Odie, You have had a repair, not a replacement. Not sure how much the advice we who have had replacements will be relevant to yourself with a repair. With my valve replaced by a mechanical, I was told to do anything but exercise that involve holding your breath. I asked because some of the exercises I do are considered "isometric" and these are contraindicated for some heart patients. Per my cardiologist and rehabilitation therapist, isometric exercises are OK after valve replacement surgery as long as I breathe through them all.

 

[epstns]

Not wanting to be a wet blanket, but remember Arnold. He had aortic valve replacement, and as the story tells it, he went back to the gym, lifted heavy too soon, and "damaged" his new valve. He required a second replacement soon after the initial one.

That said, it is up to you. It is your body - not your doctor's. I, too, used to lift (but only moderate weights - bench pressing my body weight plus 10% or so). As my stenosis progressed, I was told to stay with lighter weights and high reps. Since surgery, I've stayed with that. I'm older now (almost 67) and have stayed in relatively good shape. I'll never have the muscle bulk I would have had as a younger man, but I still have decent definition. It all depends on your goals. If you want to build big, or if you're into competition, then you have to decide if it is worth the risk. If all you want is to maintain good muscular definition, body shape and weight, then the conventional advice of lower weight and higher reps can work.

 

[Heart2.0]

I was told to not hold my breath and to not get into the 150 pulse range.
I am female , 53 yrs old. BAV and ascending stem replaced 12/13/13 .I am slow to recover for reasons unknown
This is my 4 month in a cardio rehab level 3 gym . I now go 5 days a week. I am almost at the 10 months mark after surgery.
I have increased my weights from 3 lbs to 12 and work outs from 25 minutes twice a week to 75-90 minutes 5 days a week.
I have improved greatly after a bizarre Afib event as I am now taking a low dose beta blocker.
Which I love! I now feel human and hopeful about recovery and am not constantly freaked out about
random extra beats , flutters and what ever!
I really don't think there is a lot of information about working out athletically after replacements.
And certainly nothing on women.
I plan to keep my pulse monitor on ( polar strap one) and just keep increasingly weights slowly.
I do intervals of both speed and of incline. And on days I am dragging? I just walk on a tread mill
( it's hot here )
It is very hard to get information. I am going to pay a hefty price to go to a specialty gym in a few
months to work with an exercise physiologist as they specifically work with cardiac patients there
I suspect that will be one of the few places I will see and hear positive outcomes for people like me.
I will pay for the training and the specific experience and relevant encouragement . All of which are not available
In any of the three facilities I have attended ,no matter how well meaning.
I wish you good luck and this is worth a second opinion to me.
Other university hospitals have programs Baylor, Cincinnati and contacting them might be helpful?

 

[Paleowoman]

I had my bicuspid aortic valve replaced last January, now nine months post op. I was lifting heavy weights before surgery, though with restrictions. I started resuming weight lifting at about three months with no restrictions. I use a high intensity super slow technique of lifting which means breathing throughout since it's 10 secs lift, 10 secs lower ! I currently am lifting, for example, 40 pounds (18 kilos) chest press, 16 pounds (7.5 kilos) bicep curls each arm, using free weights (I have my own set plus weight lifting bench). I was lifting heavier before surgery and am finding it tricky to get as fit as I was then, but as I say, I have no restrictions. (I get a bit of pain along the sternum from time to time - discussion about this in another thread). At cardiac rehab, I got a severe ankle injury a couple of weeks into that so the cardiac rehab nurse gave me upper body weight lifting exercises to do with an EZ bar which I continue to do - these are different exercises to the high intensity super slow ones as they are much faster, and more aerobic than anaerobic, breathing throughout again - the weight for these specific cardiac rehab exercise is 15 pounds (7 kilos). I do the cardiac rehab exercise programme twice a week and the proper weight lifting programme twice a week. I wear a heart rate monitor to keep an eye on my heart rate goals set by the cardiac nurse. I stress I was much fitter before surgery - this all takes time !

 

[Odie]

Thanks for keeping this thread alive. In the absence of medical research on this topic personal experiences are always very helpful. Thanks for sharing.

Heart 2.0, I think you'll find your investment in specialized training will pay off quickly. Many people hire trainers for motivation. That's a great reason however I think the real value is the knowledge gained through working with a good trainer. When I first started lifting weights I joined a specialty gym and worked with a very experienced trainer. I love lifting weights and all forms of cardio so I'm fortunate in that I'm always motivated to exercise. Once I understood the correct form for a wide range of exercises I preferred to workout on own. But I still go to that same specialty gym to have access to such knowledgeable trainers when I want it.

Paleogirl, Don't give up hope. I'm impressed with the weight you are lifting now! For now I'm sticking with high reps and mixing the intensity (speed) between workouts. I'm being very careful with breathing -- as should everyone (incl. non-heart patients). Each week I've tweaked the weight or reps up higher... so I'm pleased with my progress. Unless I find some solid research I don't expect to get back to my pre-surgery max-lifts.

Speaking of research. I recently ran across this: "Weight lifting and aortic dissection: more evidence for a connection." http://www.ncbi.nlm.nih.gov/pubmed/16847387

Also, this week I spoke with one of the nurses from cardiac rehab. (I finished the program a few weeks ago). He has contacts at the Mayo clinic who he thinks might have better access to the kind data I'm interested in seeing. He has offered to reach out to them.

 

[Paleowoman]

Also, this week I spoke with one of the nurses from cardiac rehab. (I finished the program a few weeks ago). He has contacts at the Mayo clinic who he thinks might have better access to the kind data I'm interested in seeing. He has offered to reach out to them.

Hi Odie - if you find anything of interest it would be great if you could post about it if you are able.

 

[Odie]

Absolutely, Anne, I'll share anything I can.

 

[AZ Don]

This is a topic of interest for me. Much of what I have found is that any restrictions seem to be based on the potential for developing an aortic aneurysm. I have a bicuspid aortic valve and had an aortic aneurysm (now replaced with a graft). My Cardiologist told me: “We have to assume that your arteries were formed with material that is weaker than that in a typical person”. So it seems that my risk for a subsequent aneurysm is higher than for those w/o a bicuspid valve or connective tissue disorder. There is not consensus on this among Dr's. Dr Svensson of the Cleveland Clinic, possibly the leading Cardiologist in the country for valve related issues, since 2010 has been suggesting the risk of an issue (repeat aneurysm) is very small and that "exercise is not an issue". See my thread on this topic with references, here: http://www.valvereplacement.org/foru...neurysm-repair

The situation is much different for those with an active aortic aneurysm, the risks of exercise can be very real depending on the specific situation. See my thread on this topic with references here: http://www.valvereplacement.org/foru...ortic-aneurysm.

In my own exercise I now avoid lifting heavy weights, though I did not lift particularly heavy prior to finding out I had heart issues.

Regarding super slow, from: http://online.wsj.com/public/resourc...uments/hb2.htm

The latest trend in resistance training is called slow lifting, in which the participant takes 10 seconds to raise a light to moderate amount of weight and 10 seconds to lower it. Proponents tout it as a safer and more effective alternative to both regular lifting and aerobic exercise. But the authors of two books on slow lifting concede they haven't measured its blood-pressure spikes, which is arguably the most crucial safety issue. The two authors, Adam Zickerman and Michael Eades, say that slow lifting produces smaller spikes than regular lifting. Other doctors and fitness experts disagree. They say that one cause of blood-pressure spikes during weight lifting is the contraction of the effected muscle. During slow lifting, a muscle may be contracted for more than 60 seconds compared with two or three seconds in regular speed lifting. For anyone concerned about stroke, aneurysm or dissection, or for the vast number of Americans with uncontrolled hypertension, "I would not recommend slow lifting," says Wayne Westcott, a slow-lifting proponent who is director of research at the South Shore YMCA in Quincy, Mass.

How can the authors say that slow lifting produces smaller blood pressure spikes when they concede they haven't measured them?! I consider super slow and isometrics to be similar to lifting heavy in terms of the effect on blood pressure .... at least until someone actually measures it and shows the effects are not the same.

 

[Paleowoman]

I do Super Slow (as I wrote earlier). I'm not worried about the blood pressure spikes as I make sure to breathe well throughout - in fact watching YouTube videos of people lifting superslow, they are often panting loudly ! Super slow is generally regarded as safer as regards getting injuries because when lifting so slowly you are physically unable to lift a weight too heavy for you, whereas with high reps inertia and gravity are helping which can cause injuries. Saying that, I can lift much heavier with superslow because the number of reps is lower, although the 'time under load' is about the same. I don't have any anyeurism issues, just had bicuspid aortic valve, but I believe having an anyeurism definitely means being much more careful weight lifting. I do keep an eye on my blood pressure, though obviously not while lifting (they should probably do a test on someone while doing super slow). My BP has always been good, always on the low side, higher now that I'm post op - cardiologist never seems concerned.

I seriously doubt that many cardiologists or cardiothroacic surgeons really know anything very much about weight lifting. Unless they do it themselves. I have one consultant who knows about weight lifting - he is my rheumatologist and he only knows about it because he has performed in weight lifting competitions. Weight lifting is a personal interest of his.

The book 'Body by Science' by Doug McGuff MD is pretty good at explaining the benefits of superslow, including the cardio benefits. The author also runs a good blog: http://www.bodybyscience.net/home.html/

 

[Paleowoman]

PS - Just to give an example of how little many cardiologists and cardiothoracic surgeons know about weight lifting: at about three months post op my cardiologist said I could resume weight lifting with "no restrictions", but I somehow doubt that he knew how much I was lifting prior to referral for surgery, e.g. 275 pounds (125 kgs) leg press - he was probably thinking a 60 year old woman would be doing those kind of light weights that Hollywood film stars write about in the press ! No way can I resume that leg press weight now, I haven't recovered the fitness yet, but I'm just saying this as I know that generally these docs, unless they do weight lifting themselves, will only know to say "stop weight lifting" at a point prior to surgery and "no restrictions" at a certain point post surgery with no regard to finding out exactly what the patent does !

 

[AZ Don]

My only concern with super slow is the possibility of higher blood pressure during the exercise as speculated in the quote I put above, and I'm concerned with this only because I have had aneurysms (technically the aneurysm in my root and ascending were separate aneurysms). I agree, it would be good if someone would actually measure it. I just looked and couldn't find any references to blood pressure during super slow.