remedial LP after heart attack

[Ed-Miami]

Dear Rip,

Can you use some input in understanding a Starting Strength remedial LP program after my recent heart attack. I'm 56 yrs. old, 5'6" , 192 lbs, and have been lifting consistently for the past 12 yrs after a 20 yr hiatus. my #'s were fairly "respectable" , recent workout 1RM's within past year ( squat 400, bench 320, deadlift 520, press 195) , fairly consistent/repeatable with slight fluctuations but tough to get beyond those (probably due to programming , diet, stress, age? , etc....) About 2 weeks ago, had some unusual tightness/and increasing aching following a squat session with a hi-rep finisher set. No extreme pain, just the ongoing discomfort, tightness - even, as ridiculous as it sounds, ate dinner to see if it would relieve my symptoms . Finally went to the hospital about 3 hours after my work-out. Turned out, I had a full blockage halfway down by LAD, and had a stent put in about 2 hours after I was admitted, , and was pretty much okay & just a little light-headed but able to walk etc. almost immediately afterwards. Now I'm on 5mg Lisinopril (blood pressure) , 25mg Metoprolol Succ ER (beta blocker), 80 mg Atrovastatin, 81mg Aspirin EC, all once a day, and 90 mg Brilinta (anti-platelet) twice a day. All pretty much protocol for the heart attack, medicated stent, etc.. Overall my cardiologist have given me the green light (two week checkup was yesterday) for physical activity but to take it slow & be mindful of how my body responds. He also scripted cardiac rehab so I'll do those sessions starting this week/next week. The blockage appears to have been the result of a plaque rupture at that location however I showed no other signs of any significant plaque build-up in my other coronary arteries and fortunately suffered minimal heart muscle damage so he expects me to have a full recovery. Have had borderline high blood pressure, borderline high cholesterol for years but never took anything, as I was concerned with side-affects - no other health concerns etc before this happening. Now, with the meds, BP is good.

Based on what I read on your past forum posts, there is mention of remedial LP but I just wanted clarification as to what this has entailed for others. Do these typically start at the bar and just adding weight, basically following a Novice Starting Strength program as detailed in Starting Strength or in the Barbell Prescription. I also have your Practical Programming book.

I'm going to begin getting under the bar and am deciding on what the starting points should be. Was thinking if I started at 25% my "pre-heart attack" 1RM's maxes and did a + 5lb/work-out progression, doing the most basic (from my understanding) Day A (squat, bench, deadlift) & Day B (squat, press, deadlift) workouts, in 4 months I would be approaching 85% of my previous 1 RM max for squat, 77% for deadlift, 63% for bench, and 87% for press . Of course, this is all theoretical & I may find the combination of meds puts brakes on my progression much sooner, but does is this approach consistent with what you've seen and Dr. Sullivan's recommendations?

Thanks,

Ed

[Mark Rippetoe]

You'll go through a fast recap of your linear progression, starting light and advancing faster than you did the first time, back to pre-event weights in 6-8 weeks. Putting this down in the Injuries forum in case Will or D'Agostino has anything else.

[mbdonner]

Ed, I went through the same thing (and am on the same medications) about 1.5 years ago. I'm 63, a little taller, weigh about the same, although you are much stronger. Anyway, I followed the protocol, did the cardiac "rehab" and started back on LP. Other injuries notwithstanding, I'm close to where I was, and all my follow up testing looks good.

[Ed-Miami]

Thank you!!

Ed

[Will Morris]

I’ve trained several individuals post-MI who were training prior to the MI. I think it might be a bit overly conservative to just start with the bar. Start with a relatively light / moderate load on each of the lifts. Make sure you have a mechanical safety on all the lifts, except for deadlifts, just ensure you are free and clear from a wall or other obstacle in case you get dizzy.

5# jumps aren’t necessary. Make larger jumps, as Rip mentioned, until things start getting heavy, then reduce the increases to 5#.

Happy hunting.

[Ed-Miami]

Hi Will,

Appreciate the feedback based your experience. Not going to lie, am going into it a little gun-shy since the general feedback I get from those around me is that "you've got to take it easier now" , etc.... (not something I'm accustomed to - & it's basically all from well-intentioned non-lifters , but it all has a way of getting into your head). Your, Rip's, and mbdonner's comments have been reassuring, and lifting is one of my fundamental essentials.

Ed

[Will Morris]

Sir,

Please don’t take my word for it. I am simply a physical therapist. I am not a world-renowned cardiothoracic surgeon, tenured faculty member at the school of medicine at Yale, and prolific researcher in the field of cardiology.....I am not, but Dr. Abeel Mangi is, and his videos on this website or the Starting Strength YouTube channel might prove to be very useful to you.

[mbdonner]

I had a doctor friend say something to me that really shook me. I'm not going to repeat it because it was flat-out wrong. Remarkable how the general medical knowledge is so limited. Like you, I was scared getting under the bar, but I followed the lifting protocol, the cardiac rehab people didn't know what to do with me because I was ready to "graduate" the day I got there (according to their model). and when I went for my one year nuclear stress-test I passed with flying colors. No heart damage, and extremely high scores on the test itself. Listen to Dr. Mangi's interviews. It came out after I started back, but it is quite reassuring.

[Ed-Miami]

Will, thanks for suggesting the Dr. Mangi videos. It's great stuff !

Mdonner, really appreciate your comments & observations. Unfortunately , my impression is very similar to yours regarding what I guess you can call antiquated thinking (for example, prior to this recent event, for a number of years I've been getting the " you need to limit your protein-intake, etc.. it's bad for your kidneys,etc..." , even though I rarely was able to even reach my 1 gm/ lb of bodyweight due to my own lack of discipline. ) - I wish my doctors had more personal experience with strength training, etc.. and hopefully resources (thanks Rip!) such as these will help continue to reinforce the benefits, etc. Dr. Mangi's interviews are definitely reassuring! I'm looking forward to bouncing back!

Keep safe,
Ed