Chronic Heart Disease and Weight Training

[A_man]

Hi All,
I recently attended the Starting Strength Seminar where it was suggested to me that I post my questions in this forum. I want to thank everyone in advance for any advice/knowledge you can share.

First, to describe my situation, I have been diagnosed with the following conditions.
Tricuspid atresia: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002100/
Hypoplastic Right Heart Syndrome: http://www.wisegeek.org/what-is-hypo...t-syndrome.htm

As described in the links, I have gone through multiple surgeries including complete fontan.

In the past, I was told to not to perform any significant exercises altogether. However, after a recent health scare, I've decided that I must do something to improve my health. Of course, I talked to my cardiologist and got his okay to begin weight lifting as I saw fit, as long as I don't overdo it...

So my question is, how would weightlifting affect my health and vice versa?

Also, I'm 5'10" ~207 lb male.

Again, thank you for your help.

[Mark Rippetoe]

Thanks. We'll ask Dr. Sullivan for his thoughts.

[Jonathon Sullivan]

I'm operating on the assumption that the tricuspid atresia has been corrected, either through valvuloplasty or placement of a prosthesis or graft, and that while your right heart function is probably not optimal you have fairly good left heart function. I'm also assuming you have normal renal function and no other major comorbidities. You mention a "health scare" but do not elaborate; I'm assuming that matter is resolved. All of these are big assumptions, making this discussion and my comments even more strictly academic than usual. I'm not your doctor, I don't know the particulars of your case, I haven't examined you, and I'm not a pediatric cardiologist or cardiothoracic surgeon.

All that being said....

Your cardiologist is a clever bastard, isn't he? He distinguishes himself by being smart enough and informed enough to know that resistance exercise is indicated for you, while he covers all eventualities with "don't overdo it." Nevertheless, I further assume that he is correct that your present hemodynamics permit weight training, based on your history, comorbidities (if any) and hopefully a recent echocardiogram.

You can expect your condition to have an effect on your training. You will want to increase the dose (weight) as in any progressive resistance training program, but probably more slowly. You must discontinue training immediately and seek immediate medical attention if you experience chest pain or shortness of breath that does not resolve quickly (within 1-2 minutes) after a set, or if you have untoward symptoms such as vomiting or fainting or you feel sick. (Training should be hard, but it shouldn't make you sick). You and your doctor must come to the mutual understanding that the addition of resistance training is the addition of a new medicine, and that, as after the institution of any new medicine, closer followup is indicated to insure that the patient is tolerating it and responding favorably. In other words, he'll want to re-evaluate you sooner.

You can expect the training to have an effect on your condition. I would not expect the training to enhance your right-sided hemodynamics very much, but your left heart will definitely benefit by getting stronger and probably thicker. Your heart will have to adapt to large preloads, afterloads and metabolic demands during training. The training is likely to have salutary effects on your blood pressure and metabolism, and naturally it will increase your exercise tolerance. And, of course, it will make you stronger, and harder to break. And that's always a good thing. In short, you can expect the training to have beneficial effects on your cardiovascular function and overall health. But your heart disease is structural, and I'm sure you understand that training will not correct it.

You will be adding weight to the bar more slowly than novices, if you are wise, and therefore you will have a somewhat more moderate nutritional intake than most novices. But you will still be eating more, unless you are already a fatbody, and particularly more protein. It will be even more important than usual for you to read the book, get the DVD, and do the exercises and the program correctly, with assiduous attention to all the details. You're not just fucking around here.

I do hope you will start a log on the forum, send us form checks, and keep us abreast of your progress. You will get a lot of support without coddling from people here, and we will be delighted to watch your progress and hear of your continued good health. Good luck.


This is not a medical consultation, and no doctor-patient relationship is in effect. This post is for educational and illustrative purposes only, and does not represent medical advice for any person, patient or condition.

[Mark Rippetoe]

Thanks, Sully. Aman attended our seminar in Monrovia this past weekend, and he did a fine job with all the lifts. I have no doubt he'll continue to improve his form and strength on all the lifts. We both appreciate your time.

[Mike C]

Thanks, Sully. Aman attended our seminar in Monrovia this past weekend, and he did a fine job with all the lifts. I have no doubt he'll continue to improve his form and strength on all the lifts. We both appreciate your time.

Monrovia, Ca?

[Mark Rippetoe]

Yes. Monrovia, California.

[DCP]

Good luck on your quest Aman! Great to see someone take charge and accountability towards their health. Do keep us updated with a log or something because as Dr. Sullivan said there are plenty here who would be interested.

[Mike C]

Yes. Monrovia, California.

Fuck! When's the next SoCal trip? 2014?

[Mark Rippetoe]

Not before. This one was a secret.

[A_man]

Thanks for the support everyone. I really appreciate it. I'll try setting up a log in the coming weeks.

I'm operating on the assumption that the tricuspid atresia has been corrected, either through valvuloplasty or placement of a prosthesis or graft, and that while your right heart function is probably not optimal you have fairly good left heart function. I'm also assuming you have normal renal function and no other major comorbidities. You mention a "health scare" but do not elaborate; I'm assuming that matter is resolved. All of these are big assumptions, making this discussion and my comments even more strictly academic than usual. I'm not your doctor, I don't know the particulars of your case, I haven't examined you, and I'm not a pediatric cardiologist or cardiothoracic surgeon.

Your assumptions are correct. I had my last surgery ~15 years ago which allowed my blood to completely bypass the right side of the heart and go straight to the lungs. The health scare was a TIA that lasted about an hour. We found a clot at this time which has since dissolved thanks to blood thinners.

All that being said....

Your cardiologist is a clever bastard, isn't he? He distinguishes himself by being smart enough and informed enough to know that resistance exercise is indicated for you, while he covers all eventualities with "don't overdo it." Nevertheless, I further assume that he is correct that your present hemodynamics permit weight training, based on your history, comorbidities (if any) and hopefully a recent echocardiogram.

Hah! I actually rather like my doctor. He's always been very helpful and is clearly very smart. I imagine he just doesn't have much experience with questions regarding strength training. Your assumption regarding my hemodynamics would also be correct.

You can expect your condition to have an effect on your training. You will want to increase the dose (weight) as in any progressive resistance training program, but probably more slowly. You must discontinue training immediately and seek immediate medical attention if you experience chest pain or shortness of breath that does not resolve quickly (within 1-2 minutes) after a set, or if you have untoward symptoms such as vomiting or fainting or you feel sick. (Training should be hard, but it shouldn't make you sick). You and your doctor must come to the mutual understanding that the addition of resistance training is the addition of a new medicine, and that, as after the institution of any new medicine, closer followup is indicated to insure that the patient is tolerating it and responding favorably. In other words, he'll want to re-evaluate you sooner.

Like I said, when I last talked to my doctor, I made sure to explicitly state that I intended to do barbell exercises. However, I don't think he considers it a "medicinal". He would rather I did Yoga only...and even that is an improvement over the previous recommendations.

You can expect the training to have an effect on your condition. I would not expect the training to enhance your right-sided hemodynamics very much, but your left heart will definitely benefit by getting stronger and probably thicker. Your heart will have to adapt to large preloads, afterloads and metabolic demands during training. The training is likely to have salutary effects on your blood pressure and metabolism, and naturally it will increase your exercise tolerance. And, of course, it will make you stronger, and harder to break. And that's always a good thing. In short, you can expect the training to have beneficial effects on your cardiovascular function and overall health. But your heart disease is structural, and I'm sure you understand that training will not correct it.

You will be adding weight to the bar more slowly than novices, if you are wise, and therefore you will have a somewhat more moderate nutritional intake than most novices. But you will still be eating more, unless you are already a fatbody, and particularly more protein. It will be even more important than usual for you to read the book, get the DVD, and do the exercises and the program correctly, with assiduous attention to all the details. You're not just fucking around here.

I do hope you will start a log on the forum, send us form checks, and keep us abreast of your progress. You will get a lot of support without coddling from people here, and we will be delighted to watch your progress and hear of your continued good health. Good luck.


This is not a medical consultation, and no doctor-patient relationship is in effect. This post is for educational and illustrative purposes only, and does not represent medical advice for any person, patient or condition.

Of course, I don't expect this to correct my right heart. Although, does the general strength of heart have much of an impact on velocity of blood flow? Would my condition negatively impact my recovery after training?

I'm little fat and would probably benefit more from losing some of the weight. In the past few months I've been eating as much as I can for most strength gain but now, I'm going to start tightening my diet. I figured I'd eat at sedentary maintenance level and let exercise help reduce some weight.

Also, how slow do you think I should be adding weight? Right now, I'm adding the following:

Deadlift: 10
Squat: 5
Power Clean: 5
Bench Press: 5
Press: 2.5

I had hoped to reach 315, 225, 135, 135, and 115 before I half each increment. Of course, in the end, I'll reduce the increments as necessary to continue gaining strength. I had thought that these were small increments for someone whose current working sets are as low as mine at 185, 155, 75, 115, 65.