@pcray!

[BillCobit]

I finally started reading my shiny new copy of:

36th Bethesda Conference
Eligibility Recommendations for
Competitive Athletes With Cardiovascular Abnormalities

...only to find that all the stuff I love is verboten! Maybe this is intended for other people?

 

[MarkU]

I guess I'm just living on the edge...

So should I give up triathlons for riflery? Do I have to wear a helmet? What am I allowed to shoot? Maybe people who put out stupid guidelines about what I should or shouldn't be doing?

Mark

 

[Mary]

Aren't the guidelines only for mitral valve repair? I don't see anything about aortic valve replacement, so I guess I'm ok!

 

[BillCobit]

Aren't the guidelines only for mitral valve repair? I don't see anything about aortic valve replacement, so I guess I'm ok!

Sorry, if you read the manual, you'll see that you're not allowed to have any fun either!

Good to see you back, Mary. How have you been feeling?

 

[PapaHappyStar]

Aren't the guidelines only for mitral valve repair? I don't see anything about aortic valve replacement, so I guess I'm ok!

The recommendation for aortic valves is about the same, these are recommendations though ( as it says they are not based on sufficient data from clinical study ).

Also note the use of the phrases: "competitive athletics" and "vigorous repetitive exercise", I think most of us dont do enough to put ourselves in these groups ( according to these guys ).

I think keeping in shape is important -- the caution is to not to push ones limits too far...

Effects of exercise

There are insufficient data to determine whether vigorous repetitive exercise after valve replacement has any long-lasting effect on ventricular or prosthetic valve function. The patient should be made aware of these deficiencies in our knowledge before deciding whether to participate in competitive athletics. Because mechanical and most tissue valves have reduced effective valve areas, they perform best at normal heart rates. Therefore, a sustained heart rate greater than 120 beats/min might result in elevated valve gradients and cardiac outputs that are less than normally expected.

Recommendations:

1 Athletes with a bioprosthetic mitral valve not taking anticoagulant agents and who have normal valvular function and normal or near-normal LV function can participate in low and moderate static and low and moderate dynamic competitive sports (classes IA, IB, IIA, and IIB).

2 Athletes with a mechanical or bioprosthetic aortic valve, with normal valve function and with normal LV function, can engage in low and moderate static and low and moderate dynamic competitive sports (classes IA, IB, and IIA). Athletes participating in greater than low-intensity competitive sports (class IA) should undergo exercise testing to at least the level of activity achieved in competition to evaluate exercise tolerance and symptomatic and hemodynamic responses.

3 Independent of other considerations, athletes with a mechanical or bioprosthetic mitral valve or aortic valve who are taking anticoagulant agents should not engage in sports involving the risk of bodily contact (see Task Force 8: Classification of Sports) or the danger of trauma.

 

[tobagotwo]

Thank you for a good laugh, Bill.

I swear, if these pompous, control-freak medicos had their way, we'd only be allowed to plod along on a treadmill three times a week, with a rehabilitation specialist monitoring, and a rectal pulsemeter to make certain we stay within the prescribed heart rate. (Which, as is the nature of all medical "facts" would be changed every three years to a new, more perfect heart rate.)

Guess all the VR marathoners better quit now, before the Valve Police come for them. Next time I do something I enjoy, I'm putting make-up on my scar and wearing sunglasses...

Best wishes,

 

[MarkU]

Coincidentally, I'm scheduled to do a VO2 max test at my local bike shop next month. Will be interesting to see the results versus 'normal' people my age.

Although it is intuitive that my cardiac function may be somewhat reduced by my St. Jude valve, I will be curious to see how the numbers actually come out (I am fortunate to have a relatively large 27mm valve).

I do know that my resting heart rate has dropped from the low 70's to around 49-50 in the past couple of years that I have been doing serious triathlon training. My left ventricular hypertrophy has also reversed itself. I consider those results to be positive benefits of exercise.

I wear a heart rate monitor for long training runs/rides and my HR usually stabilizes around 145 BPM. This calculates out to 80% of my max heart rate, again right where it should be for 'normal' folks for the level of activity.

I consider my athletic limitations to be more due to age and physique rather than having anything to do with my mechanically-repaired heart.

I also count my blessings that my AVR has allowed me to continue to pursue an active lifestyle - I know that there are many others here who are not able to do so. I'm a very lucky guy.

Mark

 

[Mary]

Sorry, if you read the manual, you'll see that you're not allowed to have any fun either!

Good to see you back, Mary. How have you been feeling?

@doublepcrap!!!!
Well, everyone who knows me, knows I do what I want anyway, so obviously, the guidelines won't apply to me!!!!

I feel really, really good Bill. I'm not worrying about when I can get back to swimming (well, that's not quite true), but I'm prepared to be patient.
My "new" life feels like an endless stretch of highway, and I can take my time traveling it.
Mary

 

[Ross]

Valve Police

Someone looking for me?

 

[MarkU]

Valve Police?

Valve Police?

Someone looking for me?

Why does Barney Fife come to mind?

Mark

 

[gadgetman]

Why does Barney Fife come to mind?

Mark

LOOK OUT!!!! He's slapping his gun!!!!!!

Or is he reaching into his pocket??????

WE don't have enough sense to make up our own minds, someone out there has to control everything.

May God Bless,

Danny

 

[Harpoon]

Oh good, I don't see "firefighting" on any of the no-no groups... =)


I gather from the powers that be that I've gotta submit myself to a department physical at some point... That could be interesting....


"Do you know you have a murmur?????"






I think what's more important than running little lists and categorizing risk groups and the like is to have an individual approach.

My cardiologist knows my condition inside and out. He also knows what I'm doing, what kind of activities I engage in and how much I do it.

I know where my limits are, I know how to tell if I'm getting close to one or more of those limits and I make sure EVERYONE around me knows and understands that if I feel like I'm working too hard, I WILL stop, you can't tell me otherwise.


To me, those look more like "guidelines" than anything else, based on the most common type of valve repair/replacent using a sample group that encompasses the most "median" cases.


Autoracing is OK, but skateboarding is not?

Baseball is in two categories. Softball is OK, what about fast pitch, what if I get hit in the chest or the head (and I'm on anticoagulants)?

What about martial arts? Which? Thai-Chi, Yoga, and Qi Gong are all non-contact martial arts. They're generally slow, methodical, meditative movements intended to develope balance, tune motor control, and improve flexibility/mobility... They're not neccesarily fighting styles....

How is diving OK but swimming not?

Most cardiac rehab clinics have rowing machines.... How's that different than rowing in a boat besides the possibility of sinking or running aground???




Ummmm... Yeah, OK, whatever you say boss...

 

[Gemma]

Harpoon, did you also notice that RODEOING is lower down the chart than cycling? Isn't that where they stick you on a bull and let it jump around until it shakes you off? Always looked hard work to me.

Perhaps you're allowed to dive as long as you just float to the surface and let someone pull you out of the water .

Pam - orienteering is a map-reading exercise where markers are planted around the countryside and you have to navigate from one to the next in order. I always thought it was more mentally than physically taxing, but Jim always says I'm rubbish at directions so maybe that's it. (Of course I'm not really, but he likes to feel like he's in control of any situation involving getting from A to B. Maybe it's a man thing ).

BTW, Bill or Burair - what do the asterisks and cross symbols on the table denote?

 

[Mary]

Pam - orienteering is a map-reading exercise where markers are planted around the countryside and you have to navigate from one to the next in order. I always thought it was more mentally than physically taxing, but Jim always says I'm rubbish at directions so maybe that's it. (Of course I'm not really, but he likes to feel like he's in control of any situation involving getting from A to B. Maybe it's a man thing ).

Just to add a little to what Gemma wrote:
It's a timed event (orienteering) and they usually put the markers in pretty rough terrain. The fastest time wins (as long as they have found the markers in the order placed). It is pretty strenuous, since participants are generally running full speed as they cover the course.

 

[PapaHappyStar]

BTW, Bill or Burair - what do the asterisks and cross symbols on the table denote?

figure and caption:

Figure 2. Classification of sports. This classification is based on peak static and dynamic components achieved during competition. It should be noted, however, that higher values may be reached during training. The increasing dynamic component is defined in terms of the estimated percent of maximal oxygen uptake (MaxO2) achieved and results in an increasing cardiac output. The increasing static component is related to the estimated percent of maximal voluntary contraction (MVC) reached and results in an increasing blood pressure load. The lowest total cardiovascular demands (cardiac output and blood pressure) are shown in green and the highest in red. Blue, yellow, and orange depict low moderate, moderate, and high moderate total cardiovascular demands. *Danger of bodily collision. ?Increased risk if syncope occurs.

 

[PapaHappyStar]

To me, those look more like "guidelines" than anything else, based on the most common type of valve repair/replacent using a sample group that encompasses the most "median" cases.

These are recommendations for competitive ( likely professional ) athletes with heart disease -- some are not based firmly on large sample quantitative study, perhaps mostly inferred from clinical experience.

You should be OK if you play almost any of these sports at a recreational level -- I would expect... cardiologist told me not to go bungee jumping when I asked about restrictions .... I think she might have the same opinion about rodeoing

 

[BillCobit]

These are recommendations for competitive ( likely professional ) athletes with heart disease

Well, actually, the intro mentions amateur masters athletes...but I'm zeroing in on the word "competitive." I'm not even close to being "competitive." There's my justification for ignoring the study!

I'm wondering, though, who/what they observe when the guidelines are developed. There is bibliography out the wazoo in the paper...perhaps there is some legit analytical methodology buried in there, but I'm wondering if they've looked at real heart-patient athletes. Maybe we should contact the author and offer our assistance? How about I offer that the lot of us will come visit their next conference (when it's someplace nice like Paris or Honolulu), as long as they pick up our travel & lodging expense?

 

[PapaHappyStar]

Well, actually, the intro mentions amateur masters athletes...but I'm zeroing in on the word "competitive." I'm not even close to being "competitive." There's my justification for ignoring the study!

I'm wondering, though, who/what they observe when the guidelines are developed. There is bibliography out the wazoo in the paper...perhaps there is some legit analytical methodology buried in there, but I'm wondering if they've looked at real heart-patient athletes. Maybe we should contact the author and offer our assistance? How about I offer that the lot of us will come visit their next conference (when it's someplace nice like Paris or Honolulu), as long as they pick up our travel & lodging expense?

Nope -- its in Bethesda, Maryland, bunch of 'em tote their golf clubs down every year... doubt if they see any pro athletes in their practices atleast those that have valvular disease -- arrythmias and cardiomyopathy are more common

I guess we ( patients ) are somewhat brainwashed ( indoctrinated ) into accepting their authority -- we tend to react to quasi random paper fillers they come out with at every backslapping conference

 

[PapaHappyStar]

Conference preamble:

The focus of this 36th Bethesda Conference is the trained athlete with an identified cardiovascular abnormality. The goal is to formally develop prudent consensus recommendations regarding the eligibility of such individuals for competition in organized sports, and to present these considerations in a readily useble format for clinicians. This document constitutes an update of the 16th (in 1985) (1) and more recent 26th (in 1994) (2) Bethesda Conferences. Once again, we have attempted to ascertain by the consensus of an expert panel which cardiovascular abnormalities (and with what degree of severity) place the competitive athlete at increased risk for sudden and unexpected death or disease progression so as to justify medical recommendations against participation in all or certain competitive sports, for the purpose of reducing that risk.

This is for the "trained athlete" to "develop prudent consensus recommendations regarding the eligibility of such individuals for competition in organized sports"...

note the use of "expert" and "consensus" -- what they are saying is they dont have much data and havent been able to convincingly extrapolate any either...

 

[Gemma]

Mary - I forgot about thetimed aspect. I used to do a bit of orienteering with my family when I was about 11 and my younger brother 9, but we never got into the racing part of it.

Thanks for the caption Burair. The bodily contact makes sense, but I doubt many people really faint while doing most of the things marked as such. Maybe the odd one or two but I'd be surprised if it was a regular occurrence even among their "target" groups...