Training With Heart Rate Restrictions

Long story, but I was diagnosed with a rare heart defect that affects the right ventricle and can cause dangerous arrythmias. I was diagnosed in October 2017 and I'd been lifting for about 1.5 years then. I was told to stop all exercise except walking. Needless to say, this was a tough adjustment. However, after a recent surgery to address the arrythmias, my doctor has encouraged me to start lifting again. He just said to try to keep my HR under 130. I've been back at it for a couple weeks, starting over with my LP. I've actually been surprised that my HR has been manageable. DL and squat is approaching 300. My last heavy set of 5 on DL my HR shot up quickly. I'm worried this will be a limiting factor as the weight goes up. Also, I have a implanted defibrillator so I've been worried about trying cleans as I don't want to hit my device. It also seems like the explosiveness of the exercise would elevate my HR.

Could I switch to triples on my DL? I imagine this would limit my progress at some point. Also, curious if anyone knows their HR on a heavier set of squats. It's nothing I used to pay attention to in the past so I'm not sure what to expect. I feel like the HR restriction will limit my progress eventually, but I'm just thankful to be able to get back in the gym.

If I were you, I'd take all sets down to doubles or triples and make up the volume with more sets. Take plenty of time between sets, at least 10 minutes. No cleans or snatches, and no conditioning other than your lifts. You will probably have no trouble if you keep your reps down. But I'd like some professional input on my opinion.

Thanks for the reply Mark. Are you talking all sets on all lifts or just deadlift? I squatted 260 3x5 my last workout and with moderate rest periods my HR rate never got over 120. I am on a beta blocker though, which helps.

Thanks for the help.

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Originally Posted by Mark Rippetoe

But I'd like some professional input on my opinion.

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OP, I’m sure that you’re never going to get a definitive medical answer on this one. Mark’s advice seems both conservative and extremely reasonable to me. However, I’m an internist and not a cardiologist.

Here’s my take without knowing your condition specifically: it sounds like you have a cardiomyopathy, probably congenital, that is likely causing certain other issues and that predisposes you to cardiac dysrhythmias hence the AICD in your chest. A heart rate that’s very high, e.g. higher than 130 (even transiently) can increase the irritability of your heart’s conduction system thereby triggering a ventricular dysrhythmia.

I assume your cardiologist has you on a beta-blocker or similar med which should mitigate the risk of activity causing an excessive heart rate.

I have two thoughts here. 1) given the above, you definitely need to do everything in your power while training to keep your heart rate down. Doing more sets with fewer reps and avoiding explosive Olympic lifts seem like reasonable ways of accomplishing this.

2) your AICD may give your physicians the ability to interrogate your heart rate over time. Ask your cardiologist if it’s possible for him to actually monitor your heart rate as well as the morphology of your cardiac impulses (what we call QRS complexes) WHILE you’re lifting. This would be done after the fact, not real time.

This ability (if your device is capable) may give you and your doc a bit more security with your training. See if this is feasible. Either way, I’d take Mark’s recommendations to your cardiologist for approval. He sounds like he wants to work with you and is tolerant of some level of risk in order for you to achieve your goals.

Good luck!

Wow. Thanks for the thorough response. I really appreciate the input. You are correct, I have Arrythmogenic Right Ventricular Cardiomyopathy. This causes me to go into Ventricular tachycardia, hence the AICD. It took two years to get diagnosed and all that time I was lifting. Never had an episode while lifting but had several while playing basketball. I underwent a VT ablation in November that was successful. I'm working with a doctor at Johns Hopkins where they have a dedicated program for ARVC. He's confident we have the VT under control with the surgery. He thinks the risk of me being sedentary is greater than the risk of doing some exercise. After 1.5 years of being sedentary I agree. I've packed on some LBs and missed the work. I'm on in-home monitoring for my device so reports are regularly reviewed by my doc in betweens office visits. I'll discuss reviewing my heart activity during workouts. Thanks for the advice and encouragement.

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Originally Posted by qnrtc

Thanks for the advice and encouragement.

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No problem. You sound like a survivor. I think you should be sensible and work with your cardiologist. Again Mark's advice sounds sensible to me. I'd just run it by your cardiologist who sounds like a mensch.

Sorry! Bad editing. That post should have read:

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Originally Posted by qnrtc

Thanks for the advice and encouragement.

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No problem. You sound like a survivor. Again Mark's advice sounds sensible to me. I'd just run it by your cardiologist who sounds like a mensch.