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Old 09-11-13, 06:48 AM   #1
Pattobin
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For "Darned Hearts" - How much cycling is too much ??

Hi,

This post is generally addressed to my fellow cyclists who have experienced heart conditions. Notwithstanding, anyone's advice and insight is welcome.

I'm 50, and have undergone a quadruple bypass surgery in February this year. I have taken up cycling since April following the operation. Over the last few months I've cycled regularly 3-4 times a week. I finally built up to my longest ride on Sunday last, and did 120 km in 8 hours interspersed with halts. I was tired, but ready to ride 24 hours later. No adverse effects whatsoever.

My Cardiologist has now said I am doing too much and I should stick to not more than 2 hours cycling a day, on any day. I am most disappointed and quite put out. I was hoping to go on to doing the 200km Brevet in Oct.

I do not intend to disagree with medical advice which I know is well meant, but need to get some perspective from those who have been in my situation.

I have been through sections of the 50+ Forum and have found members who have achieved a lot in terms of fitness goals and miles on the bike at very senior ages.

I wish to know if
(a) I am doing too much too soon ?
(b) Has anyone felt held back despite personally knowing they could do more ?
(c) How did you progress after the operation ?

Thanks,
Patrick

Last edited by Pattobin; 09-11-13 at 06:52 AM. Reason: correction to text.
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Old 09-11-13, 08:28 AM   #2
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I would suggest

1. A second opinion
2. Use a heart rate monitor on a long ride, and take the printout from it to the cardiologist for his opinion. Perhaps you can ask "If I keep my heart rate below xxx bpm, can I ride for 8 hours?"

My guess is that no doctor would tell you can't go for a 4 hour brisk hike, so if you could keep your HR around what it would be during hiking, perhaps that would keep the doc happy.
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Old 09-11-13, 08:45 AM   #3
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Ask your doctor why. Folks seldom do this and just take the doc's word as gospel.

Once you know why, it will be easier to determine if compliance with the advice can be stretched.

IME, docs have little experience with people living an active, healthy lifestyle. They tend to apply advice meant for the sick and sedentary (Read: Ordinary Americans) to us. The "walk for a half-hour a day" advice comes to mind. He may be so used to trying to get patients out of the chair that your two hours may be a significant mind-stretch for him.

Another possibility (this is sheer speculation) is whatever the medical term is for the enlarging and the thickening of the heart muscle walls. In most folks, that's indicative of congestive heart failure. In endurance athletes, it's a normal and healthy body response to the effort. Maybe he's concerned over stressing the bypasses?

Anyway, this is why the why needs to be asked.

Last edited by tsl; 09-11-13 at 08:50 AM.
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Old 09-11-13, 08:52 AM   #4
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My Cardiologist has now said I am doing too much and I should stick to not more than 2 hours cycling a day, on any day. I am most disappointed and quite put out. I was hoping to go on to doing the 200km Brevet in Oct.
If you don't trust your cardiologist, get another opinion, but I would be wary of overdoing it until you have a consensus.
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Old 09-11-13, 08:57 AM   #5
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If you go for a second opinion, try to find a doc that also cycles, runs, kyaks or treats athletes--better yet, a doc that is fit and treats athelets. Don't know about your cardiologist, but if I went to one who was not in healthy shape, I'd find another.
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Old 09-11-13, 10:08 AM   #6
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A lot of good advice above. IMO, seeking a second or even a third opinion is almost always warranted in any significant medical situation. Most insurance covers it. I try to find physicians that specialized in sports medicine if at all possible. Certainly physicians that are athletes themselves are much more likely to understand your issues, how important your sport is to you, and how to optimize recovery with respect to maintaining fitness and speeding return to your sport.

Your doctor's offhand recommendation to limit activity to two hours seems rather simplistic and weak. Certainly intensity needs to be factored in as well. I would imagine that an optimal recovery program would have you gradually increase volume and intensity while monitoring your condition.

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Old 09-11-13, 11:30 AM   #7
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A lot of good advice above. IMO, seeking a second or even a third opinion is almost always warranted in any significant medical situation. Most insurance covers it. I try to find physicians that specialized in sports medicine if at all possible. Certainly physicians that are athletes themselves are much more likely to understand your issues, how important your sport is to you, and how to optimize recovery with respect to maintaining fitness and speeding return to your sport.

Your doctor's offhand recommendation to limit activity to two hours seems rather simplistic and weak. Certainly intensity needs to be factored in as well. I would imagine that an optimal recovery program would have you gradually increase volume and intensity while monitoring your condition.
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Old 09-11-13, 12:10 PM   #8
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try to find a doc that also cycles...
Agree. Thankfully, I have no known cardio problems. My doc is a road cyclist, and he understands.
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Old 09-11-13, 12:38 PM   #9
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I don't second the second opinion. Theres no guarantee the second opinion will be more valid than the first unless the second doctor has expertise in sports related issues.

I can tell you that most doctors err on the side of caution, because we don't want to feel responsible for you hurting yourself.

Since doctor hunting can be time consuming and expensive, I wonder if there are web sites that give traiinng advice to heart patients. In theory there is no reason such web site shouldn't exist, although in practice, in America, most liability insurance coverage does not include advice given over the Internet.
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Old 09-11-13, 12:43 PM   #10
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One question - do you have any heart damage, e.g. from a previous MI? That could be a factor. Otherwise, the advice given here about finding an athletically-inclined doctor is good. Why not ask to have a 24-hour Holter monitor next time you have a strenuous day planned? I had my quad bypass at 59, so your may have a faster recovery time, but it takes longer than you might think to fully recover - it was 18 months before felt totally 'normal' even though I was back at a moderately physically-demanding job in nine weeks. Take it easy. No rush.
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Old 09-11-13, 12:55 PM   #11
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Triple bypass 14 years ago when 52. I wanted to get as fit as possible as soon as possible and started exercising on the bike after about 4 weeks. Mountain bike and I had to get away from the agressive ride position so bars up and back to relieve pressure on the sternum. Built up milage and at 12 weeks did a hilly 40 miler on the road that if I knew how hard it was going to be- I would have trained a bit more for. That ride hurt but not on the chest or heart. Sat down to take off my shoes and stood up to find I had shin splints. Enough training on getting the heart working but not enough put into the rest of the body.

A Year later and I was fully fit and in training for the hard 100 mile offroad I used to do when another medical setback put me back for another couple of years. My problem after the 2nd problem was lethargy- No need to chase up the hills- had a bypass- no need to do the extra milage- had a bypass- no need to go out today cos it's raining- Had a bypass. Decided to do that 100 miler and trained for it and did in 2003. It hurt and hurt a lot. Pushed myself too hard- bonked- Pulse rate was way too high for the effort I was putting in but I had done it.

So set the target--You have already done- get the heart monitor for peace of mind only and start training. Just stay within your limits and expect a slower time than you want. Once that is over and done with you will have recovered.
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Old 09-11-13, 12:59 PM   #12
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Do some research so that you can have an informed discussion with your doctor. Doc's like to err on the side of caution. I got my doctors attention by sending him a link to a Strava of one of my rides. Using a HRM is important if you are going to do this. MI in '08 and again last year. Three stents. Diet is now fanatically followed after the second "event". Did my first 20k TT last weekend, 38min, 28 sec @ 150 BPM, no problems. Have done two Metrics this year, and will be doing a full Century next month-6200ft vertical.

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IME, docs have little experience with people living an active, healthy lifestyle. They tend to apply advice meant for the sick and sedentary (Read: Ordinary Americans) to us. The "walk for a half-hour a day" advice comes to mind. He may be so used to trying to get patients out of the chair that your two hours may be a significant mind-stretch for him.
+1

I had a checkup with blood work before the race and had an elevated CK enzyme count. This is a test for damage to the heart muscle from a heart attack. Further research told me that this can be elevated by strenuous strength training that requires muscle tissue to repair itself. I discussed this at the appointment, and the docs agreed. They are prone to listen to me after the shock of seeing that Strava track last year.

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Old 09-11-13, 01:28 PM   #13
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I can't fathom your doc's advice. I'll bet a good bit that a sports doc that cycles would advise differently. You might not want to get to your max heart rate....but 4 times a week excessive? That's crazy. Even for a heart patient. 70miles in 8 hours? Even with some stopping that's not a very fast pace. I concur with getting a second opinion and a heart monitor. Keep in mind the medical background we all have here in this forum...
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Old 09-11-13, 01:54 PM   #14
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I would follow my Doctors advise assuming you trust his advise. I had two stents done to replace 2 100% blockages. My doctor told me to go at my own pace. He said my body/heart would let me know if it was too much. He said to do all my body said I could do. In fact, when I go to check-ups and tell him I am riding 20-30 miles per night he says "everything looks good." I guess he figures if I can do that my heart is good? lol
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Old 09-11-13, 02:23 PM   #15
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I don't second the second opinion. Theres no guarantee the second opinion will be more valid than the first unless the second doctor has expertise in sports related issues...
Agree, but two opinions are better than one. If they concur, it improves the chances they are correct and the first guy wasn't wack. If they differ substantively, then further research or even a third opinion is warranted. In my experience, the more docs you talk to, the more info you'll get.

But it's certainly better to seek out a doc with experience and interest specific to your situation.

My last serious injury I went to three docs and they told me three different things. I went with the one that told me what I wanted to hear.

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Old 09-11-13, 05:43 PM   #16
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My 5 bypass surgery was in January 2005. They put me on a beta blocker, which severely limited my heart rate, hence cycling. I only rode easy that first year. But I have increased my pace and annual miles every year since. This year the doctors say my tests look good enough to go off the beta blocker. Hallelujah!

I listened to my doctors, but kept them informed as to how much I was riding and questioned, from my own research, what they told me. After all, I pay for their opinions but I am the head of my medical team. Suggest you do likewise.

(God willing, I will do my 69 pie ride next week.)
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Old 09-11-13, 05:47 PM   #17
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My experience, for what it's worth: After my heart attack (moderate damage) I decided that since I had to get back in shape I'd like to do a century. Doctor's response was "okay with three conditions." No racing - plan to finish in the back part of the riders. Not the Hotter n Hell. Not this year, the first year after my MI. We agreed on the San Diego Century a year and a half after my MI. I finished in 8 hours including rest stops. Eventually we refined the criteria to include no strenuous riding over 95 degrees and avoiding getting my heart rate over 85% of max. I always ride with a heart rate monitor. It took some negotiation but we are both satisfied.
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Old 09-11-13, 06:46 PM   #18
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My experience, for what it's worth: After my heart attack (moderate damage) I decided that since I had to get back in shape I'd like to do a century. Doctor's response was "okay with three conditions." No racing - plan to finish in the back part of the riders. Not the Hotter n Hell. Not this year, the first year after my MI. We agreed on the San Diego Century a year and a half after my MI. I finished in 8 hours including rest stops. Eventually we refined the criteria to include no strenuous riding over 95 degrees and avoiding getting my heart rate over 85% of max. I always ride with a heart rate monitor. It took some negotiation but we are both satisfied.
Sounds like you have a pretty cool doctor.
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Old 09-12-13, 01:06 AM   #19
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Agree. Thankfully, I have no known cardio problems. My doc is a road cyclist, and he understands.
I agree absolutely. In my experience, a doctor who keeps up an intense physical regimen is very hard to find. Probably not their fault.
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Old 09-12-13, 01:08 AM   #20
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One question - do you have any heart damage, e.g. from a previous MI? That could be a factor. Otherwise, the advice given here about finding an athletically-inclined doctor is good. Why not ask to have a 24-hour Holter monitor next time you have a strenuous day planned? I had my quad bypass at 59, so your may have a faster recovery time, but it takes longer than you might think to fully recover - it was 18 months before felt totally 'normal' even though I was back at a moderately physically-demanding job in nine weeks. Take it easy. No rush.
No I do not have any heart damage. My blocked vessels were discovered due to symptoms of breathlessness. I was lucky to get away with the heart intact.
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Old 09-12-13, 01:22 AM   #21
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Triple bypass 14 years ago when 52. I wanted to get as fit as possible as soon as possible and started exercising on the bike after about 4 weeks. Mountain bike and I had to get away from the agressive ride position so bars up and back to relieve pressure on the sternum. Built up milage and at 12 weeks did a hilly 40 miler on the road that if I knew how hard it was going to be- I would have trained a bit more for. That ride hurt but not on the chest or heart. Sat down to take off my shoes and stood up to find I had shin splints. Enough training on getting the heart working but not enough put into the rest of the body.

A Year later and I was fully fit and in training for the hard 100 mile offroad I used to do when another medical setback put me back for another couple of years. My problem after the 2nd problem was lethargy- No need to chase up the hills- had a bypass- no need to do the extra milage- had a bypass- no need to go out today cos it's raining- Had a bypass. Decided to do that 100 miler and trained for it and did in 2003. It hurt and hurt a lot. Pushed myself too hard- bonked- Pulse rate was way too high for the effort I was putting in but I had done it.

So set the target--You have already done- get the heart monitor for peace of mind only and start training. Just stay within your limits and expect a slower time than you want. Once that is over and done with you will have recovered.
Stapfam, it was your earlier posts that really got me moving towards progressing steadily and I was very impressed with your achievements.
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Old 09-12-13, 01:27 AM   #22
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Sounds like you have a pretty cool doctor.

Agree !!
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Old 09-12-13, 07:40 PM   #23
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Agree !!
Thanks. I had my 4 year checkup today and I agree he is pretty cool. He is a runner and hates bikes but wants me do to whatever works to stay healthy.
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Old 09-14-13, 10:01 AM   #24
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maybe the doc is just trying to cover his/her arse with respect to insurance, lawsuits etc. Maybe he does not want it coming back on them ....he said I could........
me...im lucky.....I got a doc who is a biker ( currently doing Cycle Oregon).
he pushed me for years to start riding a bike.....and I did not....hey I ride motorcycles
this past march I started riding .....love it...now have 3 bicycles, looking at a 4th....and might inherit a 5th

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Old 09-16-13, 09:46 PM   #25
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After stent work and a little heart damage, getting adjusted to the medications, "moderate" riding (not exceeding doctor recommended heart rate for a year** my cardiologist did a nuclear stress test. A Garmin computer with cadence and heart rate moniter help me stay in the "zone" and helps select the proper gear. Makes me feel safe and in control. Second nuclear stress test two years later show improved heart condition. 68 years old in December.
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