Part Five
Along the way I’ve written about hangs, overshoots, peaks, shoulders, recovery and resting heart rates. I’ve written about the body and the different physical scale of the body parts that contribute to the heart rate profile (HRP). I’ve written about the different time scales necessary to effect change of the HRP. Now let’s put all of this together as an exercise to understand how you can use HRBT to improve your health. By the way the reason this website is called “When You Are Serious” is that this is not for the weak of will or the dilettante. When you are serious about your diabetes, your heart disease, your mile time, or just living long and well…when you are serious about these things doing HRBT is the single most important thing you can do. Read that again…the single most important thing you can do. If you are not serious read on but you won’t do the work to change your life…I make that charge if once you understand the power of HRBT you then do not utilize it.
With any training there are three basic limiting factors:
- Heart
- Lungs
- Mechanical
Mechanical includes muscles/tendons/ligaments/joints. In some cases neurological diseases make the brain and spine seem like a limiting issue but actually for our purposes the net effect is still mechanical. This will become clear. Once you start doing HRBT and you look at your HRP and the work done what limited your effort? Was it heart, lungs, or mechanical? This is a central question. Legs gave out, ran out of breath, just couldn’t go on. Look at the work product, what you did and how you did it, and then what did the HRP look like?
With this in mind I’m going to describe 5 scenarios to illustrate how to think about HRBT for you own case:
- An obese 55 year old women, very badly out of shape, never very fit and wanting to lose some weight with no family history of heart disease and recently cleared by her doctor to begin an exercise program to aid with diet changes. She notices exertional shortness of breath while climbing one flight of stairs. She has no chest pain but still finds herself either stopping at each landing if she climbs more than one flight or goes slowly to accommodate her breathing. She has only recently climbed stairs if she could help it and is doing so now only to begin becoming more active. Her previous attempts at working out and loosing weight have been what she calls and was taught to call ‘cardio and resistance’ training; this has been coupled to several different types of diet from Vegan to Adkins. All of the diets she has tried seem to work for awhile but she ends up at the same point each time: 6 months later and 10 pounds heavier. She has been doing her stair routine daily for a month and is getting tired of it and seems not to be making any progress. She then buys her heart rate monitor and discovers that her resting heart rate, she determines this as the number before she begins working out, is in the 80-90 beats per minute range. She discovers further that her heart rate is different at different times of the day. She is not willing to do a formal workout log and to thus discover her true AM resting heart rate. She finds that her heart rate gets as high as 160 if she even hurries a one flight set of stairs. She does not experience overall fatigue if she does ‘resistance’ exercises instead of stairs but is tired later in the day and the next day if she does 3 flights of stairs on a daily basis since her doctor told her to ‘workout every day’. A closer look at the HRP shows that her heart rate goes up to the 160-165 range after 20 seconds of exertion but that it stays above 150 for a full minute when she stops. It drops quickly after that however. While she complains of leg fatigue and shortness of breath such a heart rate response to exercise tells us the real limiting factor for her is her heart. She adjusts her workouts so that she does the stair intervals only once a week and then only for three flights of stairs. Within three weeks she finds she cannot get her heart rate up near as quickly so must push her pace and that it will begin dropping from her peak in less than 15 seconds with a 30+ heart rate recovery in one minute. She does not experience fatigue the next day and feels like overall she is finally making progress. Her resting heart rate drops to the 75-85 range. This simplified example illustrates an overtraining effect. Yes, I said an overtraining effect. Given her prior level of fitness and obesity, and, frankly her basic strength, she was hitting it too hard too soon and was never going to make progress; or if she did it would have taken much, much longer and risked injury in the process. And injury is the best that could have happened; she might have had undetected heart problems. HRBT is one of the best ways to document and measure overtraining. Overtraining will impede any health or fitness goals you might have and might even make things worse as it frequently does in the hardheaded type such as myself.
- A 60 year old man with Adult Onset Diabetes who recently had two stents placed in the arteries to his heart after a heart attack. He is on medication for his diabetes and to slow down his heart. Now this one presents a common problem but I will suggest a different approach to solving it. The medication to ‘slow down his heart’ is almost always prescribed in the setting of diabetes and coronary artery disease, i.e. ‘hardening of the arteries.’ It is a class of drugs called ‘beta-blockers’. There are many versions and variants of this medication. It’s role is to limit the work of the heart such that the heart is unable to beat forcefully enough to exceed it’s need for blood flow to itself. In other words if the heart has a limiter or governor put on it thereby it cannot work more than the available blood supply will safely support. Sounds good; keeps you out of trouble. And that is true if you are indifferent to the quality of your sleep, in increase in your diabetes, an inability to lose weight, in fact help in gaining fat weight. If you are OK with those side effects it is a great drug. Oh, it will make having an erection even more problematic. Other than that list beta-blockers are great! And, make no mistake, they do increase the time until your next heart attack. But what they also do is prevent, I said ‘prevent’, you from ever healing your heart problem. Your world just got smaller. And this is a critical place for the application of HRBT. If (!) you ever get safely off your beta-blocker, tracking your heart rate response to exercise is critical for two reasons: the first is to make sure that your heart workload is not going to help you wake up dead and secondly it will allow you to train in such a way as to actually ‘heal’ the disease that led to your heart attack. This is big stuff and not to be trifled with. (SEE ALSO: Drugs or No Drugs) Never attempt what I will here outline without very careful medical supervision. In the case under discussion the patient was able to exercise to a maximum heart rate of 135 on a treadmill in the cardiologist’s office without evidence of ischemia; i.e. evidence that his heart was running out of adequate blood flow. The medication prevented his heart rate from getting any higher. The body will never provide positive adaptive change without a demand from your behavior that it make such changes. If you are taking a drug that will a priori prevent your heart from making positive adaptive changes it will never do so; this should be no surprise, the body hates excess manufacturing capacity. OK, under careful supervision our patient was able to get off his beta blocker. Retesting on the treadmill showed that EKG changes suggestive of mild reversible ischemia, inadequate blood flow, at a heart rate of 145. He had no chest pain at this level. By the way, the patient felt much better off the drug but understood that he was to be careful about his heart rate outside of a monitored setting. Now the fun begins. With his Heart Rate Monitor always in place he began to examine his heart rate response to normal daily activities. Going up a flight of stairs, walking the dog, arguing about which television show the family was going to watch. No problems his heart rate rarely got over 110 BPM (beats per minute) and gradually came down after any elevation. His resting heart rate seemed pretty fixed at about 85; first awakening, middle of the day it was always about the same. He experimented with some breathing exercises and found he could get his heart rate down about 5 BPM but that it would not stay there more than a few minutes and would then pop right back up. After careful training in intense core recruitment he began graded work on a very steep hill. The hill was at a 27% grade (!) and the ascent phase was 100 yards long. He began by working very slowly and never getting his heart rate over 115; this entailed very slow movement, core always recruited, and still he was able to maintain even a very slow pace and keep his heart rate under 115 for 30 seconds. At this point he would rest until his heart rate was below 100 and he would then repeat this process for 5 repetitions. While his heart rate at the beginning of this exercise was 85 he found that his heart rate stayed near 100 for 20 minutes after his workout. He repeated this routine 2 times a week for 3 weeks and then found that using the same 115 heart rate max he was able to sustain work for 45 seconds at his slow pace and that his return to 100 took only 45 seconds rather than his previous 30 seconds of work and 1 full minute of recovery. Never more than 5 reps of this pattern and only 2 times a week with at least 48 hours between attempts. When he was able to get 5 reps in the 100 yards with the 115 max heart rate he began to increase the pace until his heart rate 120. Quickly he was only able to get 4 reps in the 100 yards rather than the previous 5. By the way we will always be working with from 3-5 reps in this set scheme. At four he increased his heart rate max to 125 BPM. His tail, the time after workout that his heart rate stayed elevated was shortening throughout this phase. By the time he was doing 4 reps at 125 his heart rate stayed elevated, a ‘tail’, only about 5 minutes. This process was continued until he was working at a heart rate of 145 and his tail was only 5 minutes and his resting heart rate was down to 70; he felt better too. Now the scary part began: he began working above the level where he had shown ischemia. By careful monitoring he was able to work the same hill with a maximum heart rate of 160 and in only 3 intervals and with a resting heart rate of 65 and a tail of only 5 minutes with no ‘shoulders.’ Shoulders were an important hint of time to progress or delay progression but I will illustrate this in an easier case later. His repeat stress treadmill EKG showed no ischemia at a much higher workload than before. It also showed an amazed Cardiologist!
End Of Part Five
Part Six: Bodybuilders, CEO’s and Other Stress Cases
