Exercise

[salman1943]

I had angioplasty in March 2004. Ever since I've been on a beta blocker ( Metoprolol- 25 mg ), Altace ( 5 mg ), baby aspirin, Lipitir 20mg. Recently I had an exercise stress test, reached just over 100% of my target rate ( 220 less age 66 ). My Mets were 11. Is that a good score?
I am required to exercise an hour a day; I take an hour's brisk walk daily. But it appears that my walking speed of 4 miles an hour( 6 kilometres ) is not pushing my heart rate up to the 147 a minute required. It goes up to about 120 a minute.
My question is: Should I push for 7 or 8 kilometres an hour to increase the heart rate?

[Raymond657]

Does internal training on a treadmill help your heart.   I had 6 stents about 5 years ago and 4 years ago I had a ICD implanted.  My EJ was very low about 19 and in the last 2 years it has improved to the low 40's.  I do take coreg, plavix, zocor and a blood pressure med.  With internal training I usually set the speed at about 5 on my treadmill for about 30 sec and then for 60 sec reduce the speed to 2.5.  I continue this for about 20 minutes.  I was just wondering if this was just as beneficial vs a constant speed of 5 for 20-30 minutes.  I am able to get my heart rate up to about 120 during the internals.

[ed34]

It sounds to me like your heart is much fitter than appreciated. If you have to push yourself too hard to get it to 140+ then I don't see the point. The easiest way to check your heart fitness, is by reaction time. However, when you have had heart disease, you are recommended not to allow your heart to jump up a gear too quickly because rhythm problems may occur. However, if you start your brisk walk until you have a heart rate of 120, then you suddenly stand still, how long does it take your heart to fall below 90?
I'm not talking about it dropping back to resting rate, just below 90. My cardiologist told me that they look for this drop because it should be quite quick, then the drop down to resting rate takes longer. When I had my bypass, my heart would jump to 186 during exertion within 20 seconds, then it would drop to 88 in 15 seconds. The surgeon said this was the sign of a good healthy heart. Your heart is likely achieving the same results at 120 bpm that my heart was producing at 186bpm because you are generally fitter. I'm sure you've seen someone unfit who has just taken up jogging. Their heart is pounding like mad and they are panting so much they drool everywhere. However, over time, their heart will become fitter as will the rest of their body. I know for a fact that I couldn't manage 60 steps, I struggle with 14 and get short of breath. I think you are fitter than you realise.
Beta blockers restrict some of the receptors on the heart which respond to hormones such as adrenaline. This restricts the rate which your heart is able to reach, and the higher the dosage, the more receptors are restricted. When you come off beta blockers, those receptors are all suddenly non restricted, and the heart can react much more. Usually more than it normally would and it takes time for it to readjust. It took mine about three weeks to settle down but the trip was a strange one. Breathing felt very odd in the first few days, it was like it took more effort to draw air into my lungs. I could also feel my heart bouncing around in my chest and hear it at night. Three weeks later I couldn't hear it and my resting rate dropped from 87 back down to 68. I felt quite reassured hearing my heart and feeling it, it kind of showed me it was working ok. Now that I can't hear it or feel it, it feels very odd.

[salman1943]

My heart rate with brisk walking is 120 BPM; if I climb 60 steps it goes up to 138 BPM and the same if I jog for a minute. Since the exercise specialists at the hospital have given me a target of 127 to 147 BPM for 30 to 60 minutes, I cannot do that right now at all. It will be too much for me. Why do they want to push me, I wonder?
There is no way I can jog for 60 minutes. Or maybe I could do it in spurts. Jog a bit and slow down.

Thank you for your replies ED34. Much appreciate it.

[kenkeith]

With the talk about exercise heart rates  we're assuming a normal "sinus" rhythm (exercise induced sinus tachycardia to be precise). Normally the electrical impulse to trigger the heart beat starts in the top of the heart in the 'sinus node' as we all know.

However there are people who's hearts will start to add beats when things get reved up, beats that don't come from the 'sinus node'. They going into a different cardiac rhythm (ventricular tachycardia or a re-entry tachycardia/PSVT or other scary rhythms) that can originate in a different part of the heart and leading to a short circuit type of thing....can trigger arrhythmia in the vulnerable person.

The danger of exceeding the generally accepted formula is the risk of having a heart attack.  With risk for a heart attack aside, the heart rate above the generally accepted level does not give the best bang for the buck...not really beneficial aerobically unless the goal is to burn calories.

[ed34]

"Any thoughts on alcohol intake? I usually consume a beer and 2 glasses of wine a day. Is that too much?"

I would say that there is little evidence to support that amount of alcohol would cause any damage.  

[ed34]

When you come off beta blockers your heart rate can increase for a while, this is very common and is usually why a doctor will ween you off the medication gradually. With regards to Jon's comment about running your heart at 100% is correct. There is no real reason to do this unless you wish to become a serious athlete because the heart and other systems in the body will start to make adaptations, such as enlargement of the left ventricle with thickening of the wall, along with others. You just want your heart to be healthy and 70-80% is still working the heart hard. Imagine a rev counter on an engine, you are talking of running it in the red, while Jon is saying keep it below the red line which is still well above tick over.

[salman1943]

I was on beta blocker Metoprolol 50 mg twice a day, but the cardiologist asked me to stop taking it, because my BP and heart rate were fine, and he said long-term use can effect the libido. I told him that I could **** till the cows come home. He said you are a very lucky man. However 6 months later I told him that once in a while my heart rate was racing, so he put me back on 25mg twice a day. My resting heart rate now is between say 60-72 and, when I walk at 6 kilometres an hour ( my usual speed ) my heart rate goes up to around 115 BPM; since at the Rehab they've given me a target rate of 147 BPM, based on the results of my stress test, what I was saying was that maybe I should increase my speed to 8 kilometres an hour to get my heart rate up to the target of 147, or mix a bit of jog with brisk walking.
The exercise specialist too said that pushing your heart rate over the targets can impact the heart negatively. Wonder why? It does make it difficult to maintain a balance. Can't keep checking your pulse all the time, just to make sure you are within the target. Once in a while is okay.

Thanks for your inputs.

Any thoughts on alcohol intake? I usually consume a beer and 2 glasses of wine a day. Is that too much?

[ed34]

I have to say that I'm a bit confused as to why you are still on a beta blocker. Six years is a long time for such a medication if your heart is in such good shape. Why not ask your Doctor if you can come off them? Not only do you notice your heart running free when you stop them, but you feel more energetic. If your Doctor recommends you stay on them, I would definitely be asking exactly why.

[RadioAstronomyObserver]

I didn't realize that anything over 70-80% was at the point of diminishing return.  Either way, while walking I too can't get my heart rate up much above 80-ish bpm for more than a couple minutes walking up a steep hill (100-110 is rate) out of the 30 minutes of walking time.  What i did was to get a bike!  Now i could easily double my max rate if i choose and for as long as I want! :-)

  In fact, did about 100 ft of riding the first day. then 1/4 mile the next, then one mile, I'm up to just under two miles a day with spurts of 5 every so often.  It's just over two weeks since I started and my legs are just starting to feel less sore each day but I feel great :-)   I want to tinker with generating my own electricity to save a couple dollars, one way is to hook up a generator to a bicycle to charge batteries to run the lights in the house so I'm using the heart as an excuse to ride and the riding as an excuse to build stamina to charge those batteries.  I just hope it'll save me enough money to make the whole deal worth while.

[erijon]

When you say you can't get to 147 BPM as required, what do you mean? You should exercise at 70% - 85% of your max heat rate, anything above that does not provide any benefit to the heart and can in fact be detrimental. It may be hard to achieve a higher BPM while you are on a beta blocker as they tend to slow your heart rate. I can predict my heart rate on a treadmill, for me 3.7 MPH at 5% incline will get me to 130 BPM. If I want to achieve 150 I need to do 4 MPH at 5% incline, works every time.

Your numbers during your test were good, you achieved your target and m.e.t.s. look fine as well.

Hope this helps,

Jon