Exerecise and Cardiac Health

[erijon]

I have a question on what exercise levels are best to maintain good cardiac health. About me, in Feb 2005, I had a little scare with some chest pain and went to the ER to be safe. They kept me overnight to do an echo, thallium stress test and more blood tests to see where I was which we did, all came back normal. Turned out to be GERD.  When I saw a new cardiologist a year later as reccommended, she repeated all the same tests, all normal again.When I had my annual visit last fall she saw no need for a Thallium stress test but wanted to do an echo  to check my EF% again and compare it to the that last two years. In January 2007 I improved my diet and started working out on a treadmill EVERY day for 45 - 60 minutes maintaining a target heart rate of 130 - 140 which is about 80-85% of my max heart rate for my age. I am 50, male, never smoked , controlled cholesterol  (TC 151, LDL 58, HDL 40), I have controlled HBP which normally runs 110/70 or less now, have no family history of early onset heart disease and do not have diabetes. I have managed to loose 60 pounds but still have 50 to go. In fact, at my last meeting with my cardiologist last fall to review a new echo, she told me that my EF has not changed from 55 -65% in three years and my heart was still normal and I really no longer needed regularly scheduled visits with a cardiologist and that my family doctor could manage my care and refer me back if necessary.

I have been getting some mixed messages about the level of exercise I should shoot for. My family doctor feels I should keep my heart rate more down around 110 -120 which will give me the most benefit to my heart, slower and steady. My problem is that at that low of a level it's not much of a work out. I really feel best when I maintain a rate more in line with 85% of my max, how do you feel about this? Also, is there a timeline when these tests should be repeated to check one's cardiac health?

Jon

[Lee Kirksey, MD]

I commend you for your proactive approach to your personal health. You took a frightening event and used it as motivation to alter your life style. Its obvious that you know your important lab numbers and your absence of risk factors. Lifestyle changes like you're doing make people healthy, not the frequently mentioned fad diets. Gradual loss of weight thru dietary manipulation with limited dietary fat, lean proteins and fruits and vegetables is critical.

The target heart rate for aerobic conditioning, cardiac tone is 80-85% of maximal heart rate as you described. Your max heart rate was probably calculated by subtracting your age from 220. I think as long as you have a clean bill of cardiac health and tolerate this exertion well, it seems reasonable.

There is no good recommended time line to evaluate cardiac health especially in some one who had two consecutive normal profiles. I personally promote a more aggressive monitoring and think that even if was normal, given your high blood pressure risk profile, your stress test should be repeated 3-5 years provided there are no new clinical findings to require it earlier. Additionally, youre weight may still place you at risk. You should also have a carotid ultrasound to evaluate for plaque within your carotid vessels. This one of the most commons causes of stroke.

Finally, if you would like to be very aggressive and use the state of the art in screening, you might consider heart scan to provide you a calcium score and risk stratify you for development of heart disease. Dietary intake is a key compliment to your diligent exercise regiment Good luck and keep of the hard work

[erijon]

Thanks for the kind words, you are correct, a scare from a little chest pain was all it took to get me serious. I travel 3 weeks a month and even then I find my way to the exercise room every day to get my work out in. It makes me feel great plus I use it as an indicator of any other symptoms that may come up, none ever have but as long as I can do the work and my numbers stay good it helps me keep a good outlook and motivates me to continue.

thanks again and I'm glad to see this new board on the forum. I think more time needs to be devoted to prevention and not recovery out of necessity!

Jon