Cardiologist too conservative?

[zen cohen]

I had to take a treadmill stress test yesterday because I had minor right-side chest pain a couple weeks after a 40% spontaneous pneumothorax in my right lung, and the cardiologist was concerned of a possible heart issue. I suspect the test was overkill but I wasn't going to defy his advice in this situation.

He said he'd calculate 220 minus my age (49) so limited the test to 171 bpm. I told him that I sometimes approach 180 when exercising and that I'd like to see if there are any problems when my heart reaches that range. Also said I'd heard the 220-minus-age formula was arbitrary, He agreed but said it was a good rule of thumb and summarily dismissed my request by pronouncing I just shouldn't exercise above my 220-minus-age. I realize that there is some additional risk by exercising at higher heart rates but I'm willing to take some measure of risk because I like to push myself and better my performance. Nonetheless he stopped the test right at 171. I feel like the doctor didn't do me a service because he didn't provide a sufficient reason for this and it seems his refusing to let me go further may have left him in the dark about potential problems that could develop in these higher ranges if I don't follow his advice.

I get the impression this cardiologist knows plenty about counseling and treating sedentary or ill patients but has no interest in advising fitter patients who want to push their endurance without undue risk. Has anyone had experience with cardiologists who are more fitness-friendly? What have they said about the risks of exercising at or near max HR?

BTW, it took me 15:30 to reach my "max" HR of 171 (better than I'd expected given that it was about two weeks after a partially collapsed lung followed by insertion of a chest tube). He said his patients normally don't last longer than 11 minutes but heard of some accomplished athletes going over 20 minutes. I might've gone another minute or so but nowhere near 20 (with the speed/incline increases every minute). If you've done this test, how long did you go?

[zen cohen]

BTW, the cardiologist and his staff (all of whom carried plenty of extra pounds) made me feel like I was a superfit athlete, which puffed me up a little bit. Then I realized that almost all of his patients where elderly, overweight or sedentary. Maybe if/when I can crack the top 25% in the C2 rankings for my age group I can consider myself truly fit. I'll have to see what kind of times the 50-plus LWTs are pulling, since I'll be joining that category in September.

[Citroen]

Print a copy of this: http://faculty.css.edu/tboone2/asep/Robergs2.pdf and drop it on the cardiologists desk.

I've had my HR close to 200 (in the last year, although not since I broke my arm).

[TabbRows]

Z.C.

I had a similar experience back in March. But the treadmill test was even more conservative than yours! They only ran it until I reached 80% of 220-age! (131bpm). Took me 6.5 minutes to get there. And I wasn't even breathing hard. I think the liability lawyers and insruance companies have scared these folks into erring on the safe side. They don't know your condition or history and the last thing they want to have happen is for you to keel over on their treadmill.

My suggestion is if a person wants to get an accurate calculation based on the current level of fitness, go to a sports-medicine clinic or lab. And get your VO2Max tested as well. Or use one of the other formulas like Citroen's article suggests and calculate it on your own. If, you're consistently doing AT/TR type workouts at a higher rate than prescribed by your calculated max rate, your max rate has probably increased.

[Nosmo]

Year ago, a teammate of mine had his treadmill test stopped when he hit 225. The nurse became too frightened. He was in his early 20's. But he was far from the fasted in the club.

[LJWagner]

Frequent exercisers have hearts like much younger men. Some doctors will take what your max HR is and tell you that you have the heart of a much younger man.

Off and on the past two years I have hit 175 HR near the end of a moderately hard 2k, on purpose, as I accelerated the last 500m. I'm breathing relaxed, just pushing down the 500m pace stroke by stroke. This was not strenuous, and I'd also had a good warm-up. I could have taken my speed faster, and my heart faster.

I'm 55, so with 220 - age, my max should be 165 on that formula. Based on rowing exercise, I have the heart of a 40 year old, but on blockages of a typical 90 years old.

My cardiologist cut my most recent stress test on a treadmill at 151, and said not to exercise over 130. On a treadmill, I do stay closer to 130, but exceed it a little.

I had a bypass surgery in January 2006, and have numerous blockages besides those they fixed. Of my three mains, two are totally blocked, the third 80% (as of two years ago).

I do a lot of research on www.pubmed.gov . What I have found related to the heart and cardiac rehab, is that people should exercise as hard as they easily tolerate. Discomfort and forced/ or uncontrolled rapid breathing are to be avoided since it indicates the heart is getting insufficient oxygen, which is when things might get dicey. But if you can pass the talk test, you can exercise as long as you want at whatever heart pace that is.

I know my heart responds differently to different activities, and I did find research articles that backed up what I do, which is tailor my heart rate based conditioning based on how the heart responds.

Long hard cardio like what many/most on the C2 users do helps build cardiac collaterals, which give you an additional set of small or large arteries to supply the heart, that let you go way beyond what the unfit are capable of. My cardiologist and surgeon said mine were what they would expect to see on an Olympic marathoner. I walked into an ER talking about unstable angina. After an angiogram, they asked if I had been bedridden and on oxygen, my normal cardiac supply was so poor.

My doctor did say that I should not back off on my exercise, since it was keeping me very healthy. I'm sure that goes for everyone else who is an active athlete, no matter what their age.

[iain]

I think the liability lawyers and insruance companies have scared these folks into erring on the safe side. They don't know your condition or history and the last thing they want to have happen is for you to keel over on their treadmill.

From HR topics on UK Forum, there are fast ergers with Max HR significantly below 220-Age. If the average is 220-age and this can be 30 beats off as suggested (I have hit 194 at 39), then people with slow max HR's would be pushed too hard by your cardiologist, so his approach is far from safe!

I thought that erging increased the volume / stroke rather than increasing the max HR as suggested here, have I got this wrong?

Regards

Iain

[Robt.Lee]

My doctor is not a cardiologist, and I have not had a stress test.

I am 63 and frequently exercise with my HR at 180 sometimes I run it up a little more. My doctor and coach have both told me that when I get to my maximum I will know it. At 180 bpm, I can talk, I am not panting for air. I am stressed, but not experiencing any pain. I suspect that my real max is closer to 190. Last year, I did run it up to 195 on several occasions, but I have been working out at 180 for about 7 years and I feel completely safe at that level. The 220 - age formula is useless as far as I am concerned.

[johnlvs2run]

two weeks after a partially collapsed lung

Do you have an idea of what cased the partially collapsed lung?

I thought that erging increased the volume / stroke rather than increasing the max HR

Yes, as the heart becomes more efficient with training.

[zen cohen]

two weeks after a partially collapsed lung

"Do you have an idea of what cased the partially collapsed lung?"

The pulmonologist has no idea. I was doing heavy (heavy for me) weights without paying attention to breathing technique but he doesn't think that caused it either. When I researched this on the web I found two support groups for this malady and there are people whose lung(s) collapse spontaneously on a regular basis (every couple months in some cases) and require painful surgery to permanently repair it.

Thanks for all the helpful responses.

[Carl Henrik]

Has anyone had experience with cardiologists who are more fitness-friendly? What have they said about the risks of exercising at or near max HR?

Are you searching for someone specific near your area or looking to find enough data for a general view on cardiologists? The latter might be hard to find enough of here.

I went to a cardiologist after having experienced heart beat concurrent pain in my left chest area. I told the doc I was going to compete in a 2k event and after the exam the doc was more convinced than I was that I would be ok. The pain was put down to something close to the heart, not the heart itself.

It's a fact though that individuals who are doctors are not necessarily trained to help create athletes, but to keep you uninjured/unsick/undead


You could use the term healthy, but there is a mix up between healthy and fit/athletic/strong and the doctors are absolutely not solely responsible for this. The fitness industry loves to interchange these words in an arbitrary and erroneous fashion.

[iain]

It's a fact though that individuals who are doctors are not necessarily trained to help create athletes, but to keep you ... undead

I know some people don't like doctors, but i have never thought of them as creators of vampires before

[johnlvs2run]

I know some people don't like doctors, but i have never thought of them as creators of vampires before

As long as you have insurance... anything is possible... before they get rid of you.