Well, I'm actually going to take the side of the medical professionals here. Yes, I do understand what everyone who wants to lift weights is saying, though, you get these blanket orders to not do any heavy lifting, some doctors give actual weights and some don't, and what's the point since everyone has their own individual capabilities anyway. Then, add to that the fact that there is no evidence presented, it seems perfectly overprotective and CYA in nature. Further, the practice guidelines of these medical professionals (Aorta Disease as one example) fully disclose the fact that there are no outcomes data available to indicate in any way what is safe and what is not.
Truth be told, they likely don't know for sure if they are right or wrong, or I guess how right or how wrong. A patient could go to Doctor A and not be satisfied with lifting restrictions, then decide to meet with Doctor B who gives the ok on lifting. Well, obviously Doctor B must be smarter or have more knowledge of the evidence, right?
In my view, likely not. While we hate to admit it as patients, clinical fact and consensus agreement can very often play a more minor role to individual reason and judgment. So, what I think, and surely others could disagree, but what I think, is that more often than not, in situations such as these, cardiologists are not recommending restrictions to cover their "A", but to do their best to cover our "A" instead. They interpret the available information and use their own judgment for what's the most reasonable method to keep an individual patient healthy. Better safe than sorry in other words.
Now, I don't mean to completely let cardiologists off the hook, but here are a few reasons why extreme lifting restrictions could be deemed reasonable:
- Aneurysm grafting is a repair, not a cure. You can replace the bicuspid valve and you can repair the aorta, but the connective tissue disorder still exists. Aneurysms can and do occur elsewhere, even in remote locations (descending). Yes, the overall risk is low (2% at 10 years according to Cleveland Clinic), but there is evidence of additional aneurysm development in previously "fixed" patients.
- While heavy weightlifting is patient dependent (what's heavy for me is not for Gym Guy), for anyone, the Valsalva maneuver is proven to skyrocket intrathoracic pressure and arterial pressure (in the 300s!). This is a potential trigger for aortic dissection/rupture as well as cerebral hemorrage/stroke.
- Elevated blood pressure is proven to thicken and deteriorate vessel walls. Now, primarily this is a more long term issue, relating to hyptertension not elevated blood pressure during weightlifting, but in any case, it is a potential pathway to stroke and aneurysms, and hypertension can be missed with infrequent checkups.
- Mechanical valves are susceptible to clot formation even when properly anticoagulated. This is true also for bioprosthetic valves and deteriorating native bicuspid valves, just not quite as much.
Now, note one specific word choice above: potential trigger. There is evidence showing the impact to the cardiovascular system and related complications that can result, not full studies and outcomes.
To me, the question isn't whether heavy lifting puts one at heightened risk for stroke or further aorta failure, the answer would reasonably seem to be yes on both counts. But the big question is: is the additional risk significant enough to matter? That's where outcomes data would of course come in handy, but unfortunately there are none.
Despite all of this, I'm still a big proponent of returning to normal. I do think there is a difference between everyday normal and clinical normal, though. Sure, we can have a shiny new valve put in with our aorta bulges clamped down with additional reinforcement, and then feel just like our old selves if all goes well. But we are never going to be 100% normal, as risk free as our neighbor next door who was born with perfect valves. So call it 99% normal, I guess. But a bright spot is actually that we're aware about our risk potential. We can do everything else possible to help make up the difference. We can eat healthy, exercise smart, and avoid bad habits (smoking). Stroke and aneurysms are both formed through complex interactions of a wide variety of things, the majority of which we still have control over.
So, at the end of the day, we may in fact be better off than our neighbor next door.
Anyway, I'm rambling obviously, but my basic point is that yes heavy lifting does put us somewhat risk, we'd be crazy not to admit it, but so do a lot of other things too. So we shouldn't just settle for a quick and easy "don't lift heavy weights" recommendation either. We should be thorough and honest with our doctors about our lifestyle, discuss in detail our overall risk profiles and means for improvement, and together with their medical expertise try to make the best decision possible for not only minimizing risk, but maximizing life. It will still be a judgment call in the end, of course, but hopefully the more educated and proactively controlled (frequent monitoring) it is, the more likely we are for proving out our own good outcomes.
