Maximum bloodpressure - strength training after AVR

[Robbyha]

Does anyone have (scientific cardiologic) information about bloodpressure limits for people having a mechanical valve?

(Bloodpressure measurements when doing some exercises like push ups, dips - with your own bodyweight - and bench presses will give you the personal bloodpressure data you need)

I've found lots of information telling you not to lift more than 50 lbs after an AVR.
This restriction has to be valid for a young guy that could lift 350 lbs before surgery and a very old person? I can't believe it!
I think it's very individual what a person can lift and has nothing to deal with the maximum lifting weight.

Interesting article found (without bloodpressure data):

http://www.ismaap.org/index.php?id=67
The fitness studio

Time and again the question is raised concerning the medical value of power training in a fitness studio. Basically, it can be said that power training in order to stabilize the muscle substance and joint function is becoming increasingly important in medical rehabilitation. More recent investigations show that power training has a very beneficial effect in helping with everyday workloads.

Its earlier rejection by cardiologists was due to the unpredictable and poorly measurable peaks of blood pressure that occurred, which they suspected would damage the heart muscle. Following replacement heart valve surgery, it was feared, there would be considerable pressure at the site where the valve was attached to the aortic arch.

Investigations in the last 7 years have shown that moderate stamina training with weights of up to 50% of the maximum performance of the relevant muscle group pose no risk. The problematic blood pressure peaks occur at workloads of 65% to 80% of maximum muscle power, after more than 15 repetitions, or with a workload duration of more than 20 seconds. Short-term maximum exertion for less than 4 seconds is unproblematic, as measured on a power machine using a right-heart catheter.

Nowadays modern fitness studios offer very good, individually tailored exercise programs. Ask the studio about staff qualifications and their seal of quality

Author: Uwe Schwan, Graduate Sports Instructor, Clinic Bad Hermansborn, Bad Driburg (Germany)

 

[T-Money]

Great question. I don't have an answer, but am curious to hear what others say. I've had this same question myself and posted recently re weight lifting restrictions.

 

[mainframe]

I ask my surgeon (Miller) about lifting restrictions post AVR as I enjoy lifting weights and he said I had "no restrictions". I'm choosing to believe him and don't plan to discuss with my cardiologist.

 

[yotphix]

This is a very good question, to which I would also like to know the answer. I asked at my cardiac rehab centre when I was there and they were entirely unwilling to give a clear response. I suppose they were nervous about giving me license to stress myself too hard. For most of the course of my rehab I felt that they were too conservative and that something between what I wanted and what they wanted was probably best.

Last fall I had a cardiac stress test though, 18 months post AVR, and during it my BP maxed at 185 systolic, which they said was perfectly fine. I suspect you reach much higher numbers though, with heavy lifting.

Paul

 

[drivetopless]

Interesting question that I would like to know as well.
It seems if you've healed well it would probably be okay. I would imaging you wouldn't want to do to much extreme lifting until at least 1 year after the surgery to give the valve time to heal in completely and securely. And it woudl be important not to hold your breath while lifting.

 

[Freddie]

140/80 is what I've been told by my cardio. Not sure if this really answers your question.

 

[DebbyA]

No answers, but I've seen reference here to this site http://cardiacathletes.org/.

 

[normofthenorth]

No answers, but. . . I don't believe the mech valve itself would place any limits on your red-line BP. Blood Pressure compares the pressure inside your whole CV (art. & venous) system to the pressure outside, like at your skin or atmospheric pressure. It's not the pressure across a valve, or some other pressure readings you get from (say) an echo cardiogram.

So the basic concern is that too much BP will lead you to "bust a gut". Think Start Trek classic, with Scottie's voice saying "Cap'n I dinna think she can take this pressure for long, and I think she's going tae blow!" The part that's most likely to "blow" is more-or-less the weakest part, assuming they're all at the same pressure. (They're not. I think arteries live at higher pressure, closer to systolic, and veins at lower, closer to diastolic. And there's higher pressure at your ankles than your temples, when you're standing. . .)

Of all the parts of your entire CV system, the ONE part that can probably withstand the HIGHEST pressure is probably your mechanical valve! The stitches holding it in, and containing any new splints or grafts or repairs, those are all a different matter while they're fully healing. And any aneurysms or weak spots that have or have NOT been discovered, are also "a different matter". And if a weak spot "blows", there are risks associated with the "bleed" that are in ADDITION to the simple loss of blood, like especially if it's in a place like the brain. And ACT/INR is not a positive factor in a bleeding-type stroke, etc. (But most strokes are the OTHER kind, caused by clots, and ACT/INR generally HELPS those!)

So taking a new mechanical valve into a machine shop and pressuring it until it failed wouldn't tell you anything useful, and most of the crucial information about your own body -- like how strong your own weakest link is -- is probably unknown and more-or-less unknowable. (There's a new study suggesting that it may be worth doing routine brain CT scans on all BAV patients, because we're at elevated risk of undetected brain aneurysms. The little study found around 6 in around 60 random BAV patients!)

In those circumstances, I think it's probably not crazy to be moderate about that gold-medal clean-and-jerk. And don't hold your breath. And don't hold your breath on the toilet, either, while you're at it. If you're having a Dacron or tissue Aortic Root or Ascending Aorta implanted, the good news is that you'll probably be much safer against a "blow-out" after it heals and settles down, than you were before the surgery.

Does anybody have any stats on how many competitive weight-lifters "blow up" ordinarily while lifting (and grunting and groaning)? I'm not a fan of the sport, so I've got no idea. But (e.g.), has a weight-lifter ever keeled over with a stroke or a heart attack during a televised competition? You might be at (say) 10x the background risk 6 months after AVR surgery, and maybe 5x the background risk after a year or two. (Just my guesses.) But if the background risk is so low that it's unheard of, that's not as scary as if we "lose" a weight-lifter on camera every year or two.