Cardiac Rehab, valsalva and me

[mbdonner]

I'm 30 days out from an MI and a stent. Started cardiac rehab, which is 10 minutes at a time on three different machines (so as to exercise the entire body!). They say it should be "slightly hard" which means still able to have a conversation with the very nice people who work there and are taking my blood pressure as I exercise.

Asking the exercise physiologists monitoring me (presumably to call 911 should I drop dead) about weightlifting, they all agree that I can now start using an empty bar, progress up just a teeny bit, that's all good.

Question: Their consensus is that the valsalva will kill me because of increased BP so avoid it, based on the guidelines of the ACSM. I'm looking for some research to support this. I have done some Google Scholar kanoodling but haven’t found much. CJ Gotcher and Austin Baraki wrote a nice piece here on valsalva and the risk of dropping dead or your head exploding, but it doesn't really speak to the post MI situation.

Any current resources and or references would be appreciated.

[Mark Rippetoe]

The Valsalva & Stroke | Jonathon Sullivan

[Jonathon Sullivan]

If they've cleared you for exercise with a barbell, they've cleared you for increased myocardial demand. The MI just means that you lost some cardiac tissue, but unless you had a massive MI or one that involved the valves, a ventricular aneurysm, or resulted in heart failure (in every which case you have big problems) your hemodynamics are essentially unchanged, and the articles by Gotcher/Baraki and Sullivan still apply. After all, if valsava were capable of producing ischemia even in the presence of a fixed stenotic lesion, everybody with undiagnosed coronary artery disease would drop dead every time they sneezed or took a shit.

Nobody here can prudently give you advice to the contrary of Holy ACSM Writ, even if it isn't evidence based. And everybody here, if they found themselves in your situation, would just train.

You pays your money and you takes your chances.

This post is for educational and infotainment purposes only and does not constitute medical advice for any particular person, patient, disease or condition. I am not your doctor, or anybody else's. I have no more business giving you medical advice than, say, an exercise physiologist. Based on ACSM, you should never, ever, valsalva again. Don't poop. Don't sneeze. Don't have an orgasm. Breathe in, breathe out. Always look eye.

[mbdonner]

So I'm a month into "rehab." I have been doing 30 minutes of cardio three times a week, and have not dropped dead yet. Started lifting again. Back on (or starting for the first time) NLP. I did the valsalva, and guess what? Still not dead. I’ll keep you posted.

[mbdonner]

Making big jumps on linear progression. Still doing 30 minutes of cardio on various machines at the rehab facility. Ordered a couple of T-Shirts from Greysteel and Jonathan Sullivan and Barbell Medicine hoping to influence the other almost dead people doing the rehab. My fellow cardiac patients all look weak, old and bent over. I think it is appalling that the cardiac rehabilitation folks don't see the need for these folks to do some lifting. During the "cool down" there is some resistance training with dumbbells. Most people are using 2.5-10 pounds. People are commenting because I'm using the heaviest. They weigh 20 lbs. The nurses seem worried and keep checking my blood pressure while I'm exercising. I hope I don't die from all the fitness.

[mbdonner]

An update. I have continued to lift and am following the NLP. I do the valsalva, and have not died. My squat is up to 265 and Deadlift 300. Looking back on my logs, I'm 20 pounds under my best 3x5 squat (I write it wrong, that's 3 sets of 5 reps) and just under the best deadlift I’ve had in 18 months. The restricted blood flow and subsequent exhaustion and problems with recovery was definitely taking it's toll. Things seem to be progressing nicely. Turned 63 yesterday, and pulling that 300 felt great.

[danomite!]

An update. I have continued to lift and am following the NLP. I do the valsalva, and have not died. My squat is up to 265 and Deadlift 300. Looking back on my logs, I'm 20 pounds under my best 3x5 squat (I write it wrong, that's 3 sets of 5 reps) and just under the best deadlift I’ve had in 18 months. The restricted blood flow and subsequent exhaustion and problems with recovery was definitely taking it's toll. Things seem to be progressing nicely. Turned 63 yesterday, and pulling that 300 felt great.

Happy birthday and awesome progress! Thanks for sharing your experience.