Fifty Plus (50+) - Exercise induced stroke

Ok, the title was to get your attention, not necessarily based on facts.

Here's the deal. I've been riding seriously for three years. I ride 100-150 miles /week. I can ride 18 mph all day long. I can do 20-21 mph for quite a while when I am feeling good. I am 60 years old.

On Saturday, I went on a 50 mile ride on a beautiful day with a large local club. I got caught up riding with the A group. At mile 10, we were running 22+ mph pace line. At mile 15, we were doing 23-24 mph. I could feel myself melting down and dreaded moving into position when I would have to pull the line. That never came. My left side was cramping and I had to back off. I stopped for a rest, then picked up riding with 2 guys at 20 mph. I found myself weaving and having trouble keeping a straight line. I stopped at the 25 mile rest stop and ate a little and drank a little. I was drinking in a rhythm that always worked for me (drink water every 20 min, a Succeed electrolyte tablet every hour in cool weather).

Back on the road at mile 25, I slowed way down as I hit a fierce headwind. My bike mysteriously shifted and I looked down to discover my right hand was "laying there" and forced a shift. This happened three more times, and I knew I was done. I hailed the SAG wagon for the first time ever and asked to be taken in.

Back at the starting point, I found myself weaving around and repeatedly dropped my car keys from my right hand. I managed to get home and my wife demanded we call a doctor when she heard my voice slurring.

After two days of exhaustive tests, we now know I suffered a cerebral hemhorrage caused by blood pressure spike induced by extreme exercise stress.

I am very lucky. I have mild numbness all along my right side but nothing dysfunctional. The doctors believe I will recover completely with no damage and I will be back riding in a month or so. I came home from the hospital today and I am typing this myself (with a mild bit of difficulty).

Lessons I may have learned:

1. Pay attention to your blood pressure medication if you take it and monitor BP regularly.
2. No matter how great you feel, or how young your friends tell you that you are, you just might be a bit more age worn than you think you are. Be careful.

All constructive comments and discussion are welcome.

Bob

Bob,
Glad you are going to recover completely. This makes me glad I religiously take my 2 BP meds. I see my physician for a follow up visit Wednesday and I think I'll mention my cycling and be sure he is on board with keeping me riding healthy and working with me. I have a family history of heart disease and strokes. My father, paternal uncle and paternal grandmother died from strokes so I tend to watch things carefully.

Thank you for the heads up on something important.

Bill

Bob,
Glad you are going to recover completely. This makes me glad I religiously take my 2 BP meds. I see my physician for a follow up visit Wednesday and I think I'll mention my cycling and be sure he is on board with keeping me riding healthy and working with me. I have a family history of heart disease and strokes. My father, paternal uncle and paternal grandmother died from strokes so I tend to watch things carefully.

Thank you for the heads up on something important.

Bill

One of the things I would love to be able to do is monitor myself riding. The neurologist told me cardiovascular exercise has more benefits than risks if you don't push it to the limits.

I want to find out if a heart rate monitor and associated alarms would be useful to keep me out of trouble. I am also going to look into stress testing to see if there is a way to reliably determine how my body reacts to stress and avoid detrimental patterns. The doctor was going to let me return to cycling in a few days until my wife insisted "No you don't understand, my husband is crazy".

Bob

Hi,
I have a heart rate monitor and it tells me when I am feeling off, and the most important when I am approaching that max heart rate.
Many times I am tired or feeling a little off and the heart rate monitor will speed up to easily that a sign off fatigue or health problems.
Your on Bp meds cause you have a Blood pressure problems when you exercise to improve your blood flow to your muscles you may forcing your body to increase the blood pressure to keep up so, holding back a little although not very maucho may help your BP and heart to keep up.
There's nothing natural about pushing 100% when you only have 75% available that day.
I hope you recover completly. watch you balance, it may be a little off, some people with problems go to Recumbs if its off.
I have High BP too, and all the problems .
PSPS
Some beta blockers are known to slow your heart rate even when you exercise, I had to drop that med I now only take Lisproniol and a thiazide, both have serious side effects cause thiazides can dump salts, and lisproniol can raise Potassium dangerously, all meds can have side effects and thats if your healthy not fighting a virus or tired..
I found my heart rate monitor At Bike island the most cost effective.
I am 68 My max normal heart rate is 162 it drops 1 number a year, so you can guess your max, and remember 145 isn't bad if your working hard at my current physical condition 130 is crusing 140 and I am starting to breath hard and 118 coasting or recovery...


here a good starting point more or less depending on your health and meds.

http://www.wikihow.com/Calculate-Your-Target-Heart-Rate

I'm glad to hear you will recover from this and glad you shared it with us. A real eye opener!

Thanks for the heads ups, and glad you are ok.

I'm crowd'n 60, just getting back into riding, I raced roads and crits 30 yrs ago. I'm the classic "the older I get the faster I was". I tend to push everything related to exercise so your post is a good warning for me. I have kept in shape with other sports over those years, running and swimming, but cycling is the only one that makes me push way beyond my limits. I will just about kill myself to not lose or to stay up with a group.

Your reminder, and the HM I got from my kids for my birthday yesterday (are they trying to tell me something), my help keep me out of the the emergency room.

Thanks and recover soon.

What a scare! I'm glad you got the good news that you should completely recover. I ponder on your #2 lesson quite frequently.... it's a sobering thought when you feel 25 but you're heading toward 60.:eek:

Eek :eek:

Glad you're going to come out of it okay.

This raises a question for me. I'm not aware of any heart or stroke issues. However, it's high summer here (ie, flamin' hot) and my commute home, just after the hottest part of the day, includes a 15 minute climb up a hill that's always pushed my heart to the max ... literally - it's the hill I discovered my max hr on two years ago. I haven't been wearing my HRM when commuting (just something else to pfaff about with), but maybe it'd be a good idea, at least while the heat is on, just to keep me this side of the red line - any thoughts? (note, I've already got the HRM, not talking about buying one). I guess if I feel the need to ask the question I've already answered it haven't I.

Richard

Nothing like a warning . . . you'll be fine, but learn to listen to your body.
Have pedaled over 300,000 miles and am 76 years old. No longer can I keep up with the A group . . . been there and done all of that.
Got in over 5,000 miles in 2008. No, am not as fast as I used to be; no, can't ride as far as I used
to; no longer get in 10+K a year either.
But can hardly wait 'til I get older!
So get better and get back on the bike . . . and listen to what your body is tellin' you!
Pedal on!

First off, congrats on going to the doc's and congrats on the prognosis.
Given my condition, this is a scary-a**ed story; I know I might push harder than I should.
Then, I do see my cardiologist 4 times a year and have had an annual stress test two years running.
Two years ago I was given the order: Never get your HR over 165bpm.
I set the alarm on my HR monitor for 165.
It beeped, I stopped and rested until it came down to 130 or so. Mostly...
I'd go over a little...166... 167 but, more, I would hit 165 and hold it. Sometimes for 10-15 minutes.
My cardio couldn't believe the improvement in my fitness when I went back for this year's stress test.
His order now? Keep doing what you've been doing.
I still feel like I'm dodging bullets sometimes, though...

Wow! What a frightening experience!

Like others have said I'm glad you sought medical help right away and are going to make a full recovery.

I don't take BP meds and although my mother had hypertension, I'm otherwise not at risk.

I regularly work close to my field-tested max HR. The other day cgallagh and I contacted a coach to have a VO2 max test done. We want scientific data, so we don't overload (his dad has had heart issues and so Chris has several risk factors. I just want to know because I'm obsessed with my numbers and limits).

As Yen said, point #2 is very sobering. It's hard to behave my chronological age when my mental age is half that.

Best wishes for a full recovery.

This is a good place to share this warning. Thanks. I knew there was a reason I don't push myself.

glad you are ok and it was not much worse.

As i have gotten older i am 57. i have found i just cannot keep up with the A group everytime i ride,sometimes yes,sometimes no. i take 3 different B.P meds a day and once my heart rare hits 166-172,that is it just like hitting a wall. Even though I push myself i have also adusted too the fact that I need to ride within my own limitations,not someone else's.
I still hammer hard,but also the biggest factor i have learned is more recovery rides and just keeping a fast good temp type ride works wonders also.

I know it is easier said than done, but LISTEN to your body, it was trying to tell you something long before you called for the wagon. I am sixty as well and if I could do 18mph all day I would be quite happy. You are lucky on a lot of fronts. Slow down and enjoy it.

;)

I appreciate all the great comments and feedback. I am home from the hospital and resting for the week. Its 56 degrees outside with 3 mph wind and crystal clear blue sky. Its killing me to sit on the couch!

I was riding with a new Garmin 705 and figured how to extract the ride stats. Here is my heart rate plot. I am pretty sure the hemhorrage occured between 20 and 30 minutes into the ride.

http://lh5.ggpht.com/_QpthbE4CW-E/SWPTEKIhYvI/AAAAAAAADzQ/hGoH4ewaI4E/s720/screen%20capture197.jpg

I know it is easier said than done, but LISTEN to your body, it was trying to tell you something long before you called for the wagon. I am sixty as well and if I could do 18mph all day I would be quite happy. You are lucky on a lot of fronts. Slow down and enjoy it.

;)

Oh, believe me I was listening, but my hard head was arguing with it instead of making wise decisions.

Bob

The doctor was going to let me return to cycling in a few days until my wife insisted "No you don't understand, my husband is crazy".


Your wife is a wise woman. We are competitive by nature and may intend to take it easy, but end up pushing ourselves if another cyclist is in the vicinity. At least that is what I do. Can't stand being passed no matter what the age of the passer.

Interesting story. We all have different mixes of strengths and weaknesses, and there's nothing quite like a rambunctious pack and a dose of will power for a cyclist to discover their own weakest link - the hard way.

I've seen this scenario played out before. There simply is no "good way" to tell what's going on in everyday, real life situations. The older you get, while continuing to "play hard" - the greater the chances of negative physiological events.

Comments abouts using HR monitors as a method of assuring a measure of "safe exercise" are misguided. Heart rate is not a major indicator of stress on blood vessels, although I guess it is good at signaling the rate of diminishing positve-returns on your exercise experience.

HI,
better stay below the dotted line,Max heart rate 148, and remember some days we are a little off, if your not feeling well hold back.
Most sudden death in athelets occurs when they are coming down with a cold and don't feel real good.
Most people who die from heart problems don't have blood clots they have vertricular tachycardia.
or rappid heart rate .
Be sure your Dr knows that your using a salt supplement when you exercise it may be elevating your BP. for me I try and find Locarb energy drinks that have more Potassium than Sodium cause sodium can raise your BP. Most of the training drinks made have 3 x the Sodium to Potassium it should be the other way around for High BP. Salt isn't good for BP..
Thats why they put you on diuretics to lower sodium...
Doug

A fit jogger's risk of death from cardiac arrest jumps from an overall of about 3 per million person-hours of risk while not jogging to about 43 while jogging and recovering. That's a factor of about 14 increase in the risk of death. A sedentary individual has about 18 (from Physical Activity and Health, fig. 19.2)

We are all at greater risk while strenuously exercising, but over all, our rate of death from all causes is far less than than for the sedentary: A factor of 5 less for a very fit individual (fig. 9.5).

It's probably a good idea to build up slowly to a major increase in activity level especially if getting very active is a fairly recent lifestyle change.

Al

Robert, thanks for your story. When you get back on your R3, stay away from the A group.

Comments abouts using HR monitors as a method of assuring a measure of "safe exercise" are misguided. Heart rate is not a major indicator of stress on blood vessels, although I guess it is good at signaling the rate of diminishing positve-returns on your exercise experience.

I guess you are correct. Its way too complicated to boil down to simple measurement. I will say that I knew I was over stressing and I did not need any set of measurements to tell me so.

Bob

Robert, thanks for your story. When you get back on your R3, stay away from the A group.

I think a B+ group will work better for me. :-)

Bob

Here's a plot of a 27 mile ride from two days before where I was totally sane and felt great the whole time and got a good workout without over extending myself. I'll look at this as my poster child.

http://lh6.ggpht.com/_QpthbE4CW-E/SWP1cJi-bCI/AAAAAAAAD0I/SbT7ZhKFoqw/s720/screen%20capture198.jpg

Glad all is well but this can happen without the exercise part of the equation. My brother, age 53, had a stroke while driving to work and was found in a field. A passer by saved him. Had a blockage in the artery in his neck but no other issues. Stent, better diet, regular exercise and all is well right now.

Do you know what your Max HR is by chance? I see where you have loaded in the various zones but just wondering if you've done any tests (either by a professional or self test) to determine your actual Max. Based on what you described and viewing your download I would guess it to be in the 180's.......

Did your doctor provide any guidance around what ranges you should ride in.......or did he stay out of Zone 4 and 5?

For the medical professionals-what is the correlation between increased HR and BP. Is it a linear increase, exponential, etc. I'm assuming a greatly elevated BP is a factor in strokes??

I'm glad your OK, Bob. It sounds scary to me, too.

At almost 61, I had my first (and I hope last) heart attack - while sitting on the couch - 32 days ago. A stent holds open the walls in one of my arteries, which was 100% blocked.

Six days later, I was back on my bike - albeit slowly - as per my cardiologist's advice. I ascribe my survival, with minimal damage to my heart, and my quick recovery, to the prompt medical attention I received, and my otherwise good physical condition. After 24 days, results from my stress test and electrocardiogram indicated I could return to my regular exercise.

That I would die on my bike from a heart attack has seemed a given to me for a long time. It would be a good way to go, although I'm not looking forward to it. While I don't race, I like to ride up steep hills and I like to push myself while doing so. My first post-heart attack ride up a hill, with my new heart rate monitor in place, saw me hit 171 bpm, and that's where I held it for the rest of the short time it took to climb a hundred more feet.

That seems like a high heart rate from what I see here, yet I wasn't anywhere near what I know my maximum effort could be (not that I want to find out). I know, as I regain stamina and strength, I am going to push harder. But will i blow a gasket doing so?

From what you've written, Bob, I think I've learned something, too: I need a stress test administered by a sports cardiologist to assess just how much effort I can put out without fear of risking a heart attack or stroke.

Glad all is well but this can happen without the exercise part of the equation. My brother, age 53, had a stroke while driving to work and was found in a field. A passer by saved him. Had a blockage in the artery in his neck but no other issues. Stent, better diet, regular exercise and all is well right now.

That type of stroke happens 80% of the time and I understand is not closely associated with exercise. The type of stroke I had (bleeding) is much more likely to occur with exercise. The two are almost polar opposites. People who have a blockage are put on blood thinners. People who have hemhorrages should avoid blood thinners, aspirin, and advil.


Bob

Do you know what your Max HR is by chance? I see where you have loaded in the various zones but just wondering if you've done any tests (either by a professional or self test) to determine your actual Max. Based on what you described and viewing your download I would guess it to be in the 180's.......

Did your doctor provide any guidance around what ranges you should ride in.......or did he stay out of Zone 4 and 5?

For the medical professionals-what is the correlation between increased HR and BP. Is it a linear increase, exponential, etc. I'm assuming a greatly elevated BP is a factor in strokes??

I don't know the answers to any of your questions. The zones were put there by Garmin after I answered questions about age, weight, and height. I intend to ask these and more when I meet with the neurologist at the end of this month for a followup. He leads a stroke team in the area and is reputed to be pretty knowledgeable.

Bob

My first post-heart attack ride up a hill, with my new heart rate monitor in place, saw me hit 171 bpm, and that's where I held it for the rest of the short time it took to climb a hundred more feet.

That seems like a high heart rate from what I see here, yet I wasn't anywhere near what I know my maximum effort could be (not that I want to find out). I know, as I regain stamina and strength, I am going to push harder. But will i blow a gasket doing so?

At 171, I'm starting to get anerobic, but that's me.

Bob

That type of stroke happens 80% of the time and I understand is not closely associated with exercise. The type of stroke I had (bleeding) is much more likely to occur with exercise. The two are almost polar opposites. People who have a blockage are put on blood thinners. People who have hemhorrages should avoid blood thinners, aspirin, and advil.


Bob


Being dehydrated can cause atrial fibrilation, which is where clots can develop in the heart and later move to an artery. Always stay hydrated.

At 171, I'm starting to get anerobic, but that's me.

Bob

Based on the 171 starting to get anerobic, my guess is that your Max HR is probably in the high 180's to low 190's. Will be curious to know what your neuro says about HR levels and if there is a Not to Exceed target based on your history. That is assuming BP greatly increases as HR increases. Also be interesting to know if the vessels in the brain repair themselves over time......

Well crap, I forgot to take my Diovan this AM. I'll remedy that right now.

Best wishes for a complete recovery!

It is tempting to finish a ride even if it kills me. I am glad to hear that you successfully fought that impulse and wisely chose to listen to your body. I am also glad to hear that you suffered no permanent damage.

"Moderation in most things" is still a good motto by which to live. Just as we should stretch to the point of discomfort, but not pain, we should probably push our cardiovascular systems to an analogous level, but not higher. Fortunately, I have never been race material, so a nice ride with the C group or maybe the C++ group (this is San Diego County, with lots of geeks) is plenty for me.

. . . I've seen this scenario played out before. There simply is no "good way" to tell what's going on in everyday, real life situations. The older you get, while continuing to "play hard" - the greater the chances of negative physiological events . . . .

I look at it another way, starting with the unhappy consequences of lethargy. It seems to me that paying attention to the way we are feeling and going as hard as our bodies want and staying vigorously active on a regular basis is better for us than slipping into low gear and staying there.

Bob,

Glad you are still with us. Please, take care. Keeping a good thought for you.

Best,
Jeff

I look at it another way, starting with the unhappy consequences of lethargy. It seems to me that paying attention to the way we are feeling and going as hard as our bodies want and staying vigorously active on a regular basis is better for us than slipping into low gear and staying there. Right, "slipping into low gear" is not what I'm talking about.

There is something worth understanding from this thread- adults that choose to exercise vigorously later in life - do increase their chances of certain systemic catastrophic health events.

And among those aging adults - the one's who had never exercised regularly and have a history of periods of inactivity and weight gain/loss - are at even greater risk for dire "health events."

This is the big $63,000 question doctors get asked by every aging cyclist or marathoner. And I can guarantee, all doctors answer with an educated guess.

It's also the reason I find advice about "finding your MHR" given to people trying to "get back in shape" about the most reckless advice of all.

My doctors knows I'm a time bomb - and if you talked to many doctors you'd find they never rule anybody "totally free" of risk - especially over age 50.

"Moderation in most things" is still a good motto by which to live. Just as we should stretch to the point of discomfort, but not pain, we should probably push our cardiovascular systems to an analogous level, but not higher. Fortunately, I have never been race material, so a nice ride with the C group or maybe the C++ group (this is San Diego County, with lots of geeks) is plenty for me.

Moderation kills is my motto as the criteria is too subjective. It takes a lot of study to know how to translate "moderation" into something that one can apply and few take the time.

If one does not increase his activity level too quickly, then there's no issue of driving the heart to it's max if one is in reasonable health. I've been doing it for about 5-years and I'm 69. However, I've had a strenuous exercise program since age 23 when I began to get fit to cure a high blood-pressure problem.

Pain is very relative. For me it's just discomfort.

The more physically fit one is, the less his risk of death per unit time at any age according some pretty extensive data in the literature.

A great book on the subject of exercise, fitness and old folks is Younger Next Year. In that book as well as another called Spark, both written by Md's, you won't get the "moderation" message. Basically, it's pretty much "full-out" for the level of effort; again with caution on the rate of build-up and health.

Al

Followup with more information from my doctor

I had a followup with my family physician yesterday. I see the neurologist in a couple of weeks. I have begun to understand that what happened to me may not be very age related. I have exercised regularly for 3 years and my blood pressure had never been really high - basically well managed on the same med for several years. My physician told me to ask questions about having follow-up studies after the blood has cleared out completely and they can see better. He said I may have a singular aneurism that needs to be followed up with repair. My BP has been averaging 130/68 for the last 10 days. In the meantime, he said I could begin exercising lightly and keep my HR below 120. I'm putting my bike in a trainer as a trial and may go for an easy ride this weekend.

Bob

Glad you are feeling better - those pace lines will do that every time!

What you mention is very interesting - moderation in everything is the key...

For my entire cycling life I've been like you - I can ride all day between 13-16 (or 17) mph, but, when I'd pick up the pace to 20, my heart would start skipping beats or I'd start feeling sudden fatigue (not a good sign)...

After two treadmill tests my Dad's cardiologist found the same thing - my heart would start skipping beats when the treadmill was turned up to it's maximum. The doctor found no reason for this, other than my having an "irritable heart", but, years later I did discover that I was born with a certain birth defect that has had an effect on my spinal cord, so, perhaps that's something to consider...

I've been more aware of this issue in someone our age ever since John Ritter passed away suddenly from a birth defect left undetected his entire life, but, all we can do is our best - it'd be wrong for us to stop out of fear of something unexepected happening, since a life lived in fear is like a boat on dry land (or a bicycle with a broken chain)...

LOL

Take care,

Glades2

Followup with more information from my doctor

I had a followup with my family physician yesterday. I see the neurologist in a couple of weeks. I have begun to understand that what happened to me may not be very age related. I have exercised regularly for 3 years and my blood pressure had never been really high - basically well managed on the same med for several years. Bob

Strokes are not generally age related until late 70's. It's mostly our lifestyle and a minor genetic component. I was fortunate in getting my wake-up call back in '63 when the ignorant but good doctor wanted to put me on medication for high blood pressure. I refused and cured it myself with jogging. That began an interest in studying lifestyle issues and some 45 years of strenuous aerobics and I'm up to almost 30 years of strenuous weight training. I also have done mods to the diet and that continues as more and valid information becomes available.

With all that, you wouldn't think I would have suffered a stroke, but I had a biggy at age 54. All blockages/ruptures in the head are called strokes. Mine was a shredding of the inner layer of the Carotid artery which caused complete blockage. It's extremely rare unless you're in an auto accident. They told me survival was 20% and escaping brain damage was far less likely than that.

Well, I beat that based on my excellent condition they (a team of three neurologists) told me. However, I was supposed to live incapacitated. I pushed the envelope on building back-up my aerobics and weight training; all with extensive consultation with a neurologist and dissolved the blockage as proved with an MRI. The neurologists were amazed and said it should not have happened to anyone over thirty.

Now they know why. It's all clearly spelled out in Younger Next Year (check out that thread on this site) and Spark which are both written by Mds. I'm 69 and I can run my heart rate over 80% of max (measured) heart rate for an hour and 20 minutes while mountain biking and do so periodically.

My advice would be to read Younger Next Year, Pollan's In Defense of Food, and Allport's The Queen of Fats. Skip Allports recommendations though, she got a little over her head. I'm convinced that the changes in the American diet over the last 80(?) years where Omega-3's (only DHA and EPA are useful) have been systematically removed from our diet and Omega-6's systematically injected in our diet, is a significant cause (inactivity is the major cause) of our epidemic of cardiovascular problems.

O-6 causes inflammation, thickens the blood and causes he blood to clump together, O-3 has the opposite affect. I'm almost convinced that an imbalance on the O-6/O-3 ratio is what caused my carotid problem. O-3 should be spread through-out the cell structure. If you have an insufficient amount compared to O-6, then you can run into cell structural problems. I met a 29 year old lady a few months ago who had a milder case of the same carotid problem.

The O-3 issue has found it's way as a possible contributor to the epidemic of cancer. That can be found in Servan-Schreiber's (Md, PhD) Anticancer, a New Way of Life. The foods listed are relevant to cardiovascular issues as well. I'm keenly interested in cancer as I've had prostate cancer twice and have exhausted both "cures".

Al

Thank you all for this Thread and best wishes to the OP.
---------------
I am 67 and have been biking over 20 years, the last ten seriously.
Biking is my chosen form for exercise. I bike at least 60 miles per day and often more. My interest is overall health. It is no good to exercise and get a stroke because of it IMHO.
I participated in two CC Tours. The last one had two Heart Attacks. One was fatal. The affected bikers were the strongest in the group.
This has made me more cautious. I can be very competitive and few bikers pass me.
Because of the experience on the CC Tour as well as reports like this, I am trying to be more restrained. My physical condition is excellent. I can push beyond limits with willpower.
However I am now setting a limit of HR 140 to 150. I am not sure what else I can do. Life is a risk no matter what we do.
We talk here about the risk of Stroke or Heart Attack. What about Depression or general Unhappiness?
Intense exercise does wonders for psychological problems. Yes, it will present a risk.