Exercise - Straight Answers?

[Rush20]

Hi gang. It's close to 9 months post-op and I feel great. My frustration lies in the lack of straight answers from my PCP, Cardiologist and Internet research on the subject of exercise.

I had my aortic valve replaced last year with a St. Jude Mechanical. I'm 40 years old and have always led an active lifestyle. I have been lifting/biking and playing competitive sports since I was 12. I also tried to eat well and I have never smoked. I was completely taken by surprise last year when after a routine physical, my failing bicuspid aortic valve was discovered. Needless to say, I feel blessed that I have been given a second chance. My valve failed due to a bacterial infection from a dental procedure the year before.

My frustration lies in the amount of mis-information I receive pertaining to aorobic and anaorobic exercise. Per the recommendation of my cardiologist, I purchased a heart monitor to "monitor" my heart rate specifically during exercise. I immediately noticed that my heart rate rapidly peaks and then returns to normal level during weight lifting sessions. At rest or pre-exercise I average 65-70 bpm. My heart rate increases to an average of 80 bpm during recovery of weight training and then peaks up to 120-150 depending on the exercise. My target maximum is 180 (220-40/age = 180).

Upon completion of my 12-week rehab, my cardiologist said I should not go higher than 155 or 160. During aorbic exercise (treadmill, road biking, walking/running), my BPM gradually increases from 70-160.

My frustration lies in whether or not this type of activity (especially weight lifting) actually wears down the artificial heart valve. Logic would dictate that more beats means more valve openings/closings, therefore more wear on the valve. However, both forms of exercise obviously benefit the heart.

My operating surgeon told me my arteries, chambers and heart in general were "beautiful" (his words, not mine). He indicated that about 6-12 months post-operation, I would really feel the benefits of the new valve. At first, I didn't believe him because I felt pretty good pre-surgery. Now, I realize the truth of his statement. Although I had always been physically active, I was never very good at endurance sports, therefore my focus was on baseball and football. This was probably due to my bicuspid valve. Since surgery, my endurance is a lot better, however I'm very nervous in attempting to push myself into a new level of fitness in fear of damaging the valve. I read horror stories about valve stitches becoming loose or the valve not opening or closing correctly etc. I know this is more in my head, however I can't stop the thoughts or images of these events happening.

Another voice inside of me is whispering that maybe I should just stop lifting, stop playing softball, stop biking and simply "retire" to golf and walking/running. As mentioned, I'm a 40 year old who like to pretend I'm a 25 year old and I'm really struggling with this.

Does anyone have any advise or good internet links on this subject to share?

HAPPY MOTHERS DAY to all!

 

[Mary]

I think after reading the various posts from members who exercise a lot. I should be able to do anything aerobic that I want to do.
However, I don't know about weight lifting. I have been told by my cardiologist to absolutely do none, nor am I to do anything that would be classified as isometric exercise. I haven't had my valve replaced yet, so I don't know what will be advised afterwards.
What does your doctor say?
Mary

 

[tobagotwo]

Before surgery, almost all of the problems that require valve replacement or repair would cause a surgeon or cardiologist to say no lifting, very limited exercise, etc. This is to avoid damaging the heart further before a repair can be completed. After successful surgery, things change considerably.

As far as the mechanical valve getting loose: There have been instances where older mechanical valve types, which tended to "hammer" harder, could damage the tissue that they were mounted to over time. However, it didn't happen to most people. It seemed more likely to happen with people who had other heart issues as well, especially if they had had other work done near the point where the valve was attached. Again, it didn't happen to most of them, either. It was a small, but real statistic. I have never read that weight lifting or aerobics was listed as a cause.

The newer valves do not have the hard impact that the older versions did. Partly because of that, they are also less likely to become damaged, which was a very small part-of-a-percentage to begin with.

Most people who want to seem to easily outdo what their physicians prescribe for exercise. Whether this is smart, we'll see over time. Probably, like most things in life, many people will get away with it fabulously, and a few will come to grief with it. There are many threads in active lifestyles about people with mechanical valves who do keep up with weights and particularly with running. These people will have tips that they have picked up over time.

Regardless, you have to live. You've got a second chance, and you don't want to lose too much of it to worrying.

Best wishes,

 

[tommy]

Allen,

We have some things in common. Please take a look at my story.
http://www.valvereplacement.com/stories/tom_hosack.htm

I look back sometimes and wonder if I had normal heart, would I have been able to run faster. People said that I ran like I had a piano on my back. I play the piano, but never carried one on my back. I actually had a tryout with the Pittsburgh Pirates. The scout told me to give him a call, if I ever got some speed.

Now I run (still not fast, but farther and with more endurance than as a kid), play softball, and golf. I've done some nautilus lifting. Frankly I use low weights and high reps. I'm more interested in conditioning than body building. The high stress of high weights does concern me, although that is a gut reaction with no concrete foundation. There are others in VR.com that lift. MarkU is one. Hopefully some of them will chime in.

As far as other activities, I encourage you to stay close to the docs and go slow. You know the drill from rehab.

Everybody's condition is different, but if you look throught the posts in "Active Lifestyles", you'll see a lot of activity.

I'll turn 50 this year. I feel like a 25 year old. When people ask me the standard greeting "how ya doin'?", I tell them "never better". They think I'm kidding, but I'm not.

Keep up posted.

 

[Johnny Stephens]

Hi Allen, my surgery was a little over 2 years ago, and I'm 45 years old. I have 2 St. Jude mechanical valves. I was leading a sedentary life before, and was severely out of shape.

I suffered from a rapid heartbeat (resting at 90 bpm +) for over twenty years following chest radiation treatments for Hodgkin's disease. My docs believe that the rapid heart rate was a contributing factor in the poor condition of my NATIVE valves. I'm now on Toprol-XL to keep the heart rate down. Like yours, mine don't want my heart rate going too high (in my case because the normal electrical pathways have been disturbed by radiation and cutting).

Following surgery, I did have some initial exercise prohibitions from my doctors, especially around anything involving "bearing down" or valsalva-type maneuvers. This puts high pressures on the great vessels in and around the heart.

I'm now in a supervised fitness program, and have improved dramatically. I work out (45 reps or more) with weight about *double* what I could even lift before. Some of this even involves "bearing down", but proper breathing techniques reduce the risk of a problem. All my doctors are aware and approve.

RobthatsMe does some serious lifting and may have some input to offer...

Best of luck,
Johnny

 

[McCln]

Johnny

Johnny

There are too many John's in the world. I have a brother named John and a half-brother named John. Had an Uncle John and my dad was named John.
Well, to the point. You know what you can do, exercisewise. You know your limits on all you can. Do not stop doing them. Just what the doctor is saying is take the exercise in moderation, not to stop doing it all. You are still so young and active. Be proud that you can still do all the things you enjoy. Just keep doing it. You are doing great. Take care.

Caroline
09-13-01]
Aortic valve replacement
St. Jude's valve

 

[Rush20]

Thanks everyone. Interesting read Tom. Keep up the good work in conditioning your body.

As to weight lifting, I remember reading about how "the limit" was 40 pounds. Come on! 40 pounds is a lot different to a 40-year old man than a 70-year old woman just for example. Thus my frustration. I remember the cardiac rehab nurses telling me to limit my lifting to 40 pounds after I finished my 12-week session. Although I appreciated their concern I also questioned the amount.

I met with my cardiologist prior to lifting again (last December) and he said just take it slow. I did, and I feel really good. Although I have no plans to ever max out, my lifting is strictly for fitness and calorie burn. It's just the monitoring of my heart that caused my initial concern. Amazing what a heart monitor reveals. I plan to wear one for 24 hours just to see when and how my heart rate increases.

 

[Shine_on_Syd]

excercise

excercise

while I have a tissue Aortic valve rather than a mechanical one, your concerns of wearing out your valve are unfounded. You are probably exercising no more than a couple of hours a day, by increasing your cardiovascular ability your are putting much less strain on your valve in the long run. Not to mention relaxation, stress reduction, endorphins and a feeling of well being. I wear a heat monitor all the time when I exercise. I'm 55 and . my cardiologist said my max rate is 140. I regularly push 150 up to 160 and my surgeon says go for it.
I do use cybex and Kaiser resistance machines and don't go to much into heavy free weights. That's where I think you need to be various on too much sudden strain on your valve.

 

[Martin_W_Riley]

Just a quick caution on formulas

Just a quick caution on formulas

People often use the formula 220-age to establish your max heart rate.

This is kind of like saying the average male lives to age 77...

If you are looking for general fitness targets ie 60-80% of max for aerobic workouts, then that's fine.

HOWEVER anyone wishing to push a little beyond should do proper max heart rate and VO2 max tests (to find both your aerobic and anaerobic limits - tests are done in clinic or at some universities with a doctor present).

You may also find that your max heart rate varies by sport as well...

I'll use myself as an example, at 32 my max HR was 205 on the bike and 201 running. Not at all the formula predicted max!

My cardio says that even with a mechanical aortic valve I should be able to do whatever I could do in the past but I still intend to recheck my limits before training seriously or picking out my target heart rate zones.

 

[hensylee]

for the answers, go to the following site and see what Dr Rich has written for this week's article. He's a real cardiologist, btw:

http://heartdisease.about.com/cs/exercise/a/enoughexercise.htm

 

[Marge]

Good article, thanks, hensylee.

Makes me feel quite comfortable about my own daily exercise regimen!

Is the "cardiovascular risk" Dr. Rich keeps talking about the risk of coronary artery disease? I get that impression. There doesn't seem to be too much written about exercise for those of us who have clear arteries and no issues with weight, BMI index, cholesterol, etc. I noticed that at cardiac rehab, although I learned quite a lot of helpful stuff, it was pretty obvious the program was geared to the CAD folks, or those in danger of developing CAD. I can understand that -- CAD is, clearly, THE Great American Disease.

 

[tommy]

Yes, hensylee, thanks for the link.

I agree that most programs are not tailored for valve patients. Even my wonderful and expert surgeon had me on cholesterol meds while I was under his care (1 month). My cardio cut off several meds when I went back to his care.

My cardiac rehab instruction was that 30 minutes of exercise 3x per week was considered "maintenance". If you want to be more fit or lose weight, you would have to do more. I think that is about right, except for two variables. 1. As we age, we need to exercise more or eat less (or both ). 2. People that sit at a desk all day may need more than 90 minutes per week.

Other than Coumadin and antibiotics, as a recovered valve patient (without other issues) I don't think that I am much different that the rest of the population, except that I have gained a lot of knowledge and appreciation of life in the process. After 25 years of being a couch potato and knowing the damage of that lifestyle, I'll try the other one for a while while I can. I am grateful for the second chance to make that decision for myself.

 

[RobThatsMe]

How to Measure Pulse Rate if you are on Beta Blockers

How to Measure Pulse Rate if you are on Beta Blockers

Hi,

Thought I would post this information. It is good knowledge to have if you are working out, or even taking a stress test while on Beta Blockers.

This information was originally posted on WebMD. A response to someone concerned about exercise, an dlow pulse due to medication.

*****

Your heart is getting an adequate workout as long as you raise it 20-30 beats per minute over your resting levels. You can't calculate a target heart rate based on the traditional method of subtacting your age from 220 and
multiplying it by 70-85%, because of the beta-blocker.

In the cardiac rehab setting we usually use 70-85% of the highest heart rate achieved on the pre-exercise stress test, if the medication(s), especially
beta-blockers, were taken before the test. If the medication(s) were held,
the highest heart rate achieved must be further adjusted for these meds;
typically a range of 10-20% more depending on the size and frequency of the beta-blocker dose and the dose(s) of other medications being taken that may also be lowering the heart rate. Sometimes this method of calculation is
ineffective; in this case we often use the simple formula of resting heart
rate plus 20 to 30 beats per minute. This range is decided upon based on
whether or not the person is still ischemic (blockages that are preventing
adequate blood flow to the heart), the amount of heart muscle damage from the heart attack, the ejection fraction and other individual considerations.
In regard to your question about time of day to exercise, in my opinion you
are actually better off to exercise earlier in the day, when your
beta-blocker is having the most efffect on your heart rate. I can't evaluate
this in relation to your condition, because I don't know what the situation
is with your heart's blood flow. In general the effect of the beta-blocker is
to improve blood flow to the heart muscle, so it is better protected from the
potential effects of decreased blood flow and thus you are less likely to
have angina. Hope this is clear and helpful; I will watch for additional
posts from you should you have another question.
Sincerly, Laurie Anderson, RN, BSN


Regards,
Rob

 

[MarkU]

I was a pretty serious weight lifter prior to my AVR, doing 300-320 in the bench press. After my surgery, my cardiologist asked me to cut out max weight lifting and concentrate on higher reps with "moderate" weights. He knew my background and didn't try to arbitrarily define what "moderate" weights were - he left it up to my judgement. I still bench press 200 lbs for three sets x 10 reps.
My cardiologist also asked me to give equal time to aerobic work whenever I was at the gym - he basically said that I could do as much aerobic work as I wanted to.
I now lift 2-3 times per week, swim 1-2 times per week and do a long bike ride on the weekends (I also ride a stationary bike on the days I go to the gym).
One of my objectives is to lose about 20 pounds (less to weight to haul around while running).
As my aerobic conditioning has improved over the past year, I am finding it more difficult to get my pulse rate above 140-145 for any sustained length of time, although I occasionally hit 160 when doing hill work.

MarkU

 

[epstns]

I can only comment from the pre-surgery end of things. Having a (probable) bicuspid aortic valve and moderate aortic stenosis, my cardio has recommended a limit on the weights of 40 lbs., but no limit on reps. His point is to be sure that I don't elevate blood pressure, as others have noted, and that even though he has performed several exams, X-Rays, echo's, etc., he feels that we who have bicuspid valves are at higher risk for aneurisms, and wants to err on the safe side. No quarrel from me. Especially since he basically has not put limits on my running. On this he says, "If it feels good, then it is OK." No heart rate caution, just be sensible. My resting HR is usually in the 50's (I'm 56, and have been a recreational runner/jogger for 25 years) and i bring it up to the high 150's or low 160's during a 4 to 5 mile run. I run at about a 9:00/mile pace, and still feel fine doing that. I do keep a careful log of my exercise, as this will be my first indicator if anything changes.

That said, I'm happy with low weight/high reps to maintain tone, as long as I can still run to my heart's content!

So much road, so little time!

 

[Les]

Thnaks for the Beta-Blocker post, Rob. Being a "Slow Ticker" because of the heavy dose I take twice a day, this information is not only informative, but qualifies "No Need For Speed"...just consistency.

 

[Mark Wagner]

My surgeon told me, I could do anything with this valve. The only thing I was told I could not do, was impact sports. That being because of the weakend sternum. Your 9 months out, and as I have remarked before on threads, my doctor said I would feel a tremendous difference at the one year mark. He was right on.
My advice is take it slow and don't push it that first year. Remember, your heart surgery was to give you quality life. Take that at face value. The only thing that will hold you back is yourself if that is what you choose.

"The miracle isn't that I finished. The miracle is that I had the courage to start."
? John "The Penguin" Bingham

Go for it ... Mark

 

[danielgilboa]

Hi All!

All of you put together seem to have very valuable information and experience.
I want to make a quality-of-life comment. I believe everybody on this thread feel they enjoy life better by doing their sports. I do too. I think our quality of life is an important argument in the end result of what we choose to do and how we enjoy our life. I am not suggesting to go bang your head against the wall. but streach limits,yes, if you think your doc is being extra protective and you FEEL your body can do better, than yes. Dont forget that if you are physically active you know your body and "hear" it much better. I think our subjective judgement is valid along side the proffesional advice.

I am now (soon) 4 weeks post MVR to a 33mm st jude mechanical. At this stage I am only walking, 45-60 min a day. I look forward to getting back on my bike very soon (maybe this afternoon?!...). I will get back to mountain biking because I love it and it gives me so much in quality of life. Maybe I will return to weight lifting later on.

I year before surgery my cardio scared me out of weights. Then I begun mountain biking and he got shaky about that too. I decided to continue. I had a goodbye ride with my friends just days before op (it was downhill all the way...I couldn't do much more...) Maybe it wore out my valve a bit quicker, but it would need to be replaced anyway, and I enjoyed every minute of riding.

So- we have a life to live, and I think after what we have been through we deserve to enjoy it at least as much as others!

Daniel

 

[Harpoon]

MarkU seemed to have the best suggestions on the lifting part...


I was going to say to lay off the lifting or at least cut way back on it. Strength training puts a very different kind of stress on the heart than aerobic type workouts.

In any other activity. You're doing doing a sustained amount of work for a period of time, running a mile or bicycling or playing tennis. In weight lifting, most people will do a station for so many minutes, bench x number of pounds for x number of reps, then move on to something else. It doesn't work the heart as much as it's working muscles in other parts of your body, however your heart is constantly speeding up and slowing down to adjust for the oxygen demands in different parts of your body and that can cause more stress than it's worth to your heart.

If you've already been doing the lifting for most of your life, you might as well stick with it, moderately at your best judgement of course and STOP if you don't feel right, light-headed or dizzy or tired.

When I was in rehab the nurses said their goal was to get my heart rate up about 30-40 beats per minute above my resting heart rate. I was "scolded" once for having my heart up 50bpm above resting while on a rowing machine once, but I was quite comfortable and having fun with it.

Wish I had a rowing machine at home.... =)


In moderation and what feels most comfortable for you.

We're all different.

 

[BillCobit]

I think we're left to make up our own answers...

I think we're left to make up our own answers...

Side note to Daniel - Be careful on that bike! At 4 weeks out your sternum cannot suffer a crash very well.

Allen - I share your frustration - there just doesn't seem to be a published body of knowledge to guide the heart-patient athlete.

However, I have frequently stumbled across reference to this item:

Bethesda Conference 26
Report Updates Guidelines For Eligibility Of Athletes With CV Abnormalities J Am Coll Cardiol. 1994

I just haven't been able to find it on the web (plenty of offers to purchase a reprint, tho). Next time I'm at the university I'll have to look it up in the med school library & see if it's of any value. Anybody out there read this and have an opinion?

The following was kind of an interesting article,

http://circ.ahajournals.org/cgi/content/full/103/2/327

but since I didn't like what it said, I ignored its advice to me

"The vast majority of athletes with mitral valve prolapse do not have complicating factors and will be able to participate fully in sports. Asymptomatic athletes with mitral valve prolapse and any of the following criteria should be restricted to low-intensity competitive sports (such as golf and bowling): blah blah: (4) moderate to severe mitral regurgitation; blah blah."

Golf and bowling instead of cycling and triathlon? I don't think so!

Here's a link that describes the hemodynamic response to different types of exercise. Pretty easy read - it doesn't provide activity or training guidance, but may help you understand dr. advice, etc.

http://physiotherapy.curtin.edu.au/community/educational_resources/ep552_97/bp.html

I guess since folks like us don't make up significant "market share," we don't inspire/enable significant clinical study...so we just have to read, listen to our bodies, and share our experiences (I love this forum!) & make our own decisions.

Best wishes to all, good luck as you ignore your doctor's cautions and recommendations