Starting Strength with Heart Conditions

[Mikeinchicago]

Hi Coaches,

I originally posted this question in another thread but it didn't get a response there so I thought I'd try to post it here. I really hope it is ok that I'm posting this again as a new thread.

I have been doing the Starting Strength novice program for about eight weeks now with advice from my cardiologist to “not overdo it” and would really be extremely grateful to get input from people like you (especially Dr. Sullivan) who are actually knowledgeable about strength training. I understand and accept the usual disclaimers (you are not a doctor/you are not my doctor, you have not reviewed my medical records, etc.)

I am a 35 year old male. I was born with a ventricular septal defect that was repaired with two surgeries during my infancy. I currently have a tricuspid valve leak that causes tricuspid regurgitation and a slight enlargement of my right ventricle. I also have had a history of paroxysmal supraventricular tachycardias that have had to be corrected via catheter ablations .

My doctor has encouraged me to do cardiovascular exercise like walking and running. I am not currently experiencing any arrhythmias and the only symptom of my valve leak is a decrease in cardiovascular endurance. That said, I run about 2 miles, three times a week and I find that my ability to run/climb stairs is better than most sedentary people.

When I ask my doctor about strength training, he will say something along the lines of, “Well, the cardio is what I really want you to do, but I guess you can lift weights too as long as you don’t overdo it.” In the past, I took that to mean that I should keep the weights light and the repetitions high, but that never got me anywhere. I recently discovered Starting Strength, read the book, and started the program.

Can anybody offer me any guidance regarding doing heavy barbell lifting with my conditions?

[Michael Wolf]

Beyond wishing your cardiologist would give more useful and specific advice than "don't overdo it," this one is beyond my area of expertise. Input from Sully should be helpful. Paging Dr. Sullivan.

[Brian Harlin]

Hi Mike,
Can you share your experience so far over the last two months that you have been running the novice progression? I am interested to hear this as my wife also has PSVT, (and possibly POTS, though she has never had a tilt table test). She has never had ablation, and doesn't really want to.

Have you been running the program, as written? I would assume that deadlifting and power cleans would be most likely to trigger an event. Have you had any events since you began, during, after lifting? How do you feel during and after lifting?

Thanks for sharing

[Mikeinchicago]

Hi Rumblefish,

I've been running the program mostly as written. I waited until week 5 to introduce the cleans because I was new to barbell work and I wanted to make sure I had my form down on the first four lifts before introducing a new one. Also, I've de-loaded on the squats a couple times to correct form issues. Like you, I have been the most nervous about deadlifting. That said, I haven't suffered any tachycardia events since I started. I haven't had any events at all since my last ablation in 2011, in the gym or otherwise. As far as how I feel during lifting, I don't notice any cardiac symptoms during or after lifting except that I experience the same shortness of breath after my deadlift work set that I do from climbing several flights of stairs. I don't know if this is normal for lifters without underlying cardiac conditions, or if it's because of my compromised cardiovascular endurance. I had never experienced shortness of breath from weightlifting before, but then again, I had never lifted heavy before. I haven't let it stop me because it feels like the exact same shortness of breath that I get from the steady state cardio that my doctor specifically advises me to do.

You didn't really give me any details about your wife's condition and why she doesn't want to have an ablation, but for what it's worth, I've benefited greatly from the procedure and procedure itself wasn't so bad. Send me a PM if you want to ask any questions about it.

[Paul1]

I don't think these kids of defects should really be adversely affected by strength training. The tricuspid valve sits between the right atrium and right ventricle, and regurgitation through this valve will NOT be especially affected by the tension / weight created by lifting heavy weights (as would be the aortic or mitral valve). Your VSD may have contributed to your enlarged RV (because of L to R shunting through the defect), but if that has been repaired then I'd assume it's a nonissue. Finally, if you've had SVT ablated and you no longer have episodes of tachycardia, then the epinephrine surge that happens with exercise won't be likely to drive you into SVT. I'd imagine you're on a beta blocker (something like metoprolol or atenolol or carvedilol) which will decrease the heart's responsiveness to epinephrine and lower the arrhythmia risk.

Your risk of arrhythmias is going to be higher than that of the general population -- between your past history and the fact that you have structural heart disease, that's just going to be a fact. At the same time, if it's well controlled, your best service to yourself is staying fit.

And I don't think running is any LESS risky than weight training. Running 2 miles is going to give EVERYONE a sinus tachycardia for the 20 or whatever minutes you run -- running makes you tachycardic. Sinus tachycardia is normal, but the processes that produce a sinus tachycardia can also trigger tachyarrhythmias. The duration of this stimulus will be much much longer with running than with lifting.

[Mikeinchicago]

Thank you so much for your response, Paul! That was very helpful. Regarding the VSD, I should have mentioned in the original post that, in my late 20's, my doctors found evidence of an extremely small remaining VSD that they guess formed as I grew after my original surgeries. They said it is much too small to warrant any intervention. I forgot to mention it because it is never discussed during my doctors visits. For the record, you're right, I am on a beta-blocker. My medications are another thing I should have mentioned in the original post. I take 25mg of metoprolol and 10mg of lisinopril daily.

[Mikeinchicago]

I forgot to ask, Paul, do you have any advice for me for anything further I could do to lower my risk of any potential adverse effects from strength training?

[Jonathon Sullivan]

Agree with Paul. I hope he's wrong about you being on the beta blocker, though, and that your ablation has been adequate for rate control without pharmacotherapy. Beta blockers are not the lifter's best friend.

Transient shortness of breath after a heavy workset is normal. By "transient" I mean "a minute or two."

You can lower lower your risk of potential adverse effects by doing the exercises properly as described in the book; following the program; adding weight rationally; hydrating well; eating properly; telling your doctor you're going to lift heavy and fuck hard and eat well and live your life but otherwise following up with him regularly; and by not dropping the weights on your feet, head, spouse or cat.

Seriously. If the program hasn't killed you yet, it's not gonna.

Carry on.

[Mikeinchicago]

Thank you so much for your response, Dr. Sullivan. You had me laughing out loud imagining telling my doctor those things. I was wondering if you could expand on this:

I hope he's wrong about you being on the beta blocker, though, and that your ablation has been adequate for rate control without pharmacotherapy. Beta blockers are not the lifter's best friend.

I am on a beta blocker, metoprolol 25 mg/day (also, FWIW, lisinopril 10mg/day). Do you mean that they hamper performance for a lifter, or something worse?

[Jonathon Sullivan]

Beta blockers can dampen reflex tachycardia, and reflex tachycardia can be helpful under a heavy squat. They have other side effects as well. It may very well be that you need the AV nodal blocking effect of a BB, but if you've been ablated, you may not. If your doc has you on it for hypertension (rather than for arrhythmia), you may want to ask him to consider switching out metoprolol for a less cardioactive agent. Up to him, and you. It hasn't been a problem yet, apparently, so maybe you want to let sleeping dogs lie.

All of this is strictly hypothetical, of course.... It's not as if this post represented medical advice for any specific patient or condition.