starting strength gym
Page 2 of 2 FirstFirst 12
Results 11 to 14 of 14

Thread: Heavy Lifting and Heart Health

  1. #11
    Join Date
    Aug 2013
    Location
    Lakeland, FL
    Posts
    3,112

    Default

    • starting strength seminar april 2024
    • starting strength seminar jume 2024
    • starting strength seminar august 2024
    Quote Originally Posted by Jonathon Sullivan View Post
    This post is provided for ejumacational and infotainment porpoises only and does not constitute medical advice for any particular person, patient, disease or condition. Sully is not your doctor and not your coach, and very smart people like marenghi and quad and meshuggah will gladly tell you that he doesn't know what the fuck he's talking about. You should listen to them. Sully is full of shit, and he kills people in the gym all the time. He'll kill you too if you're not careful. Just by reading this post you have put yourself in Grave Danger. And besides, everybody knows you shouldn't be lifting weights anyway, even if you DON'T have a heart condition. What the fuck were you thinking?
    This could be slightly modified to make a very interesting business card.

  2. #12
    Join Date
    Oct 2013
    Posts
    765

    Default

    Quote Originally Posted by Grundsey View Post
    I have a couple of questions. I'm 61, soon to be 62, with some heart issues. I have an irregular heart rate (small pre-beats) that my cardiologist says is A-fib, along with some relatively minor leakage of the aortic valve. My blood pressure is good. I'm on a statin due slightly high cholesterol and carvedilol for the a-fib. My current lifting and also my long term lifting goals are pretty modest in comparison to most of the posters on this board. I am wondering if there is any benefit to getting and using a lifting belt, or whether that would not be a good idea considering my heart condition. A second question is whether anyone knows of any articles relating to the use of a belt for lifters with heart issues.
    Hi Grundsey,

    As Sully said, there aren't any compelling data to support resistance training recommendations here when it comes to your aortic insufficiency ("leaky valve") - especially data looking at real, long-term clinical outcomes, versus just measuring regurgitant fraction during exercise.

    Most of the typical cardiologist recommendations you'll get are based on "physiologic hypothesizing" - in other words, inferring conclusions using basic physiologic/pathophysiologic principles. The thought process goes, "Chronically increased afterload (e.g, from systemic blood pressure) results in a larger regurgitant fraction, and this causes problems over time... therefore, if you Valsalva under load and make your blood pressure increase [acutely], it should do the same thing. Better be safe than sorry and never lift weights."

    Interestingly, this is the exact same reasoning used to argue against resistance training for patients with heart failure, or even the preposterous argument that resistance training thickens your ventricle to the point of causing heart failure... even though we now have plenty of evidence showing resistance training to be 1) extremely beneficial and 2) not harmful in these patients. We similarly used this physiologic hypothesizing in the past to argue that giving beta blockers to patients with heart failure would be extremely harmful... turns out, that's not the case either, and now these medications are are standard therapy for chronic heart failure.

    The point being, inferring conclusions about the potential harms of an acute exercise stressor based on chronic pathophysiology has failed us numerous times. It also tends to significantly overestimate the risk of harm, while completely disregarding the known benefit.

    But in the absence of data, it's not surprising that people who 1) have no experience with training, and assume you're walking into the gym on day 1 to take 405 lbs out of the rack, and 2) have liability concerns, tend to err on the side of caution. Hell, even with data in numerous disease states they say the same things. We had two questions this week about people who said their doctors recommended against strength training - one individual with PCOS "because it will raise testosterone" and one with Crohn's disease "because it will cause digestive stress"... both of which are 100%, complete, utter bullshit (-- had to borrow Sully's bold/italics combo to convey my frustration on the matter).

    However, when it comes to your situation it's still relevant to know what you mean by "relatively minor leakage" of the aortic valve (how much?), and why you have it (primary valvular issue vs. dilation of the whole aortic root?). We see "trace regurgitation" of one or more valves on just about everyone's echocardiogram, and this is of essentially no real significance. But if you had severe chronic aortic insufficiency with "wide-open" valves and a massive regurgitant fraction things get a bit hairier as you'd be considered for surgery at that point. This doesn't sound like the case, given your description and lack of symptoms or heart failure (though Carvedilol is an unusual choice for Atrial fibrillation).

    We have no data to suggest that our style of strength training will cause "trace" AI to progress to severe AI. That concern is entirely based on the "physiologic hypothesis" and acute measurements of regurgitant fraction during exercise, not long-term trials following patients over time. Some people's AI progresses, other's doesn't, and I'm quite sure that if you happened to be strength training and the degree of leak progressed, your Cardiologist would be quick to blame the training. But we just don't know. If the leakage is in fact minor (what we would call "trace regurgitation") I would personally be comfortable training with a belt, because I perceive the benefits to outweigh the risks (admittedly, based on experience and without objective data). Beyond that, things get a bit more complicated and I cannot provide any recommendations on the matter.

    P.S. Having "small pre-beats" is doesn't sound like a typical description of atrial fibrillation, but potentially more like PACs or PVCs... so I'm not sure of your actual diagnosis there. Are you on anticoagulation?

    P.P.S Standard disclaimer, as Sully said. I am not your doctor, this is for educational purposes, it is not medical advice for anyone or anything, and you should always and forever obey your Cardiologist in all facets of your life.
    Last edited by Austin Baraki; 07-08-2017 at 03:33 PM.

  3. #13
    Join Date
    Apr 2016
    Location
    New Mexico
    Posts
    9

    Default

    Drs. Sully and Baraki,
    Thanks for the very-detailed responses. To Dr. S: Yes, I am currently lifting, but not heavy. I have been using Valsalva, but only with a fairly small-to-moderate air intake, not huge. I did get a 4” belt and have been using it – it “feels” good, especially on squats (I had some pretty severe chronic lower back pain when I was in my 40’s).
    Some background: I had a total hip replacement (posterior approach THR) 9 months ago. 6 weeks after that surgery, I fractured the greater trochanter while making a quick instinctive move to catch a falling cell phone. The bone was allowed to heal without further surgery and without any mechanical fixation. I spent the better part of the next month in bed, and then weeks after that with just toe-touch weight bearing. The lower body atrophy was pretty bad. I’ve been lifting lightly for several months now, with very, very slow increases in weight for squats and dead lift, and a little more normal weight increases for bench and press. I still have a little discomfort and pain during some (not all) sets of squats, which just reinforces my decision to take it very slow and easy on the weight increases.
    The heart issue came up while I was in the hospital after the THR. I had a heart monitor on due to the arrhythmia that my family doctor had previously identified in an EKG. (he wasn’t too concerned about it, nor was the cardiologist that he had review the EKG at that time (not my current cardiologist)) While in the hospital after the hip replacement surgery, it was found that I had one late-night episode of rapid or racing heartbeat. I think it was due to me doing upper body isometrics at 3:20 am, which is just about exactly the same time reported on the heart monitor. The hospital doctor was skeptical of my theory. They did a chemical induced stress test before letting me out of the hospital and also a separate imaging test (maybe ultra-sound?). These are the two tests my current cardiologist used for my diagnosis. The doctor at the hospital saw a small spot on my lower heart that he said possibly indicated an old myocardial infarction. My cardiologist thought that it was more likely some type of reflected image off the diaphragm rather than an indication of a prior heart attack.
    After my first visit to see the cardiologist after the THR and heart episode, I asked her if lifting weights was ok and she said yes it was. At my follow-up visit months later, I asked if high-intensity training was ok and if there were any restrictions on my exercising, and she said this was also ok and no exercise restrictions.
    To Dr B: I don’t know exactly how much leakage, although she did tell me I had some other lesser and very minor leakages in one or more other valves (can’t remember whether one or multiple). I did get the impression the AI was significant, but not yet a big problem, and I am on a yearly follow-up with her. She did say it was a valve problem and no mention was made of dilation of the aortic root. As to anticoagulants, they put me on 2 daily baby aspirin in the hospital after the hip surgery, and my cardiologist has kept me on one per day since. FWIW, I feel good, no dizziness, loss of breath or any other symptoms that I would interpret to be heart related. I have led an athletically active life, have normal to lower than normal blood pressure and a resting heart rate below 50 (not counting the pre-beats).
    As a consulting engineer, I know about lawyers (ugh!) and lawsuits, so I understand any reticence to getting too specific, but any tidbits of info or further thoughts either of you may have would be greatly appreciated. One last thing: I read somewhere that the posterior approach THR causes the hip joint capsule to be not as strong after surgery compared to if the anterior approach had been used, and might therefore be more susceptible to rupture and hip dislocation under high loading. Not sure if the writer meant just initially or permanently. Any info on this would be appreciated. Ok, I lied, one more thing: I have been holding back a couple of inches on the full SS recommended ROM depth on squats and dead lifts. Any experience on whether I need to continue with this conservative approach? My orthopedic surgeon told me to avoid deep squats, but I think he meant more the ATG type.
    P.S. Dr S, I am the wiseacre that posted side-by-side pictures of you and Steve Bannon a few months back. I thought it was kind of funny, in a kind of warped sort of way, but I didn’t get the impression that the board much agreed.

  4. #14
    Join Date
    Dec 2015
    Location
    Chattanooga, TN
    Posts
    17

    Default

    starting strength coach development program
    Long time lurker but first time poster.

    Firstly, I want to drop a sincere thank you to Stef, the authors, and commenters here. I can't say how much I appreciate the quality of the articles and this site. I wanted to pose a scenario maybe, that is, to put it as Dr. Fiegenbaum likes to say, nuanced.

    Earlier this year I went to a cardiologist after having a couple of episodes of palpitations, tachycardia, and dyspnea. I wore a Halter monitor and also did an echocardiogram. The Dr. did say he thinks I probably have SVTs, and also said there was a finding of slight pulmonary regurgitation on the echo. I was told that neither finding was remarkable enough to warrant intervention with medicine. I am firefighter/EMR, so I wanted to be thorough and get the problem checked out. When I asked the doc whether or not he thought it was safe for me to continue my activity as a firefighter, his response was that he didn't care what I did as long as I wasn't symptomatic and failing to follow up. He advised if I had another episode of tachycardia that I should actually initiate Valsalva or gag myself in order to stimulate a vagal response and bring the heart rate down. SO....

    I went to Disney World with my wife and rode every roller coaster I could get my butt into, which was cathartic and helped shake off the "there's something wrong with me" feeling. For two weeks we walked an average of 8-9 miles a day. It was a blast honestly. But I digress...

    I participated in SCBA survival drills one evening at the fire department during our weekly training. This involves specialized tactics for conserving air in a Mayday situation i.e. being separated or trapped away from help inside a burning structure, past point-of-no-return with available air supply, etc. Of course it is a highly physical activity, and involved taking a deep breath, holding it for an extended period of time, and then letting it out slowly, and then "feeding" yourself individual breaths of air from your air cylinder. We also did a skip-breathing technique. While holding my breath at one point I did notice my HR was elevated, but we had also been working so I didn't think much of it. I finished training with no problem, and went home.

    My HR never did really come down after I got home and had awhile to chill out, so I initiated valsalva, and I'd get a temporary drop in HR on exhalation lasting for a few seconds, but then the rhythm would pick up again. I tried it repeatedly and no dice, so then I resorted to gagging myself brushing my teeth. This did finally get some result. I was otherwise asymptomatic. That night after I laid down in bed, I experienced a sudden and sharp, pressure-like pain in my chest. I immediately grabbed my phone to call 911 but I noticed that it largely went away when I sat up. I also noticed that the pain completely resolved upon exhalation, and would hurt again on inhalation, and the bigger the breath the more pain and pressure I felt. I got up and sat on the couch and monitored myself for awhile. HR had come back down to normal, blood pressure was normal, and Sp02 was normal. I tried to sleep but the discomfort kept me up for most of the night. Onset was at about 10PM, and by 11AM the symptoms had completely resolved.

    Insert obligatory I-searched-Google-for-my-symptoms story here. What came back was a spontaneous pneumomediastinum. Could this be correct? I haven't had this happen again since even with more SCBA training.

    I have, unfortunately, been pretty sedentary for a large portion of my life, however I am making changes. I am reading the book for the second time now and about to get down to business starting the LP. I finally have a rack, plates, a bar, and I'm ready to get to work. I'd be lying to say there aren't some reservations in the back of my mind about using valsalva so much if indeed I did have the pneumomediastinum, but my gut tells me it may have just been a one time response to so much work that night involving air, abnormal breathing techniques, and then my intentional and multiple attempts at valsalva and then gagging.

    At any rate, thanks again to everyone here and to the authors. This is one of the best articles I have ever read and I am looking forward to reading and learning more around here.

Page 2 of 2 FirstFirst 12

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •