Extreme Cardiac Rehab

After my ICD implant and second ablation someone (I don’t remember who) suggested that I sign up for “cardiac rehab”. I’m not all that familiar with cardiac rehab, and perhaps someone who is can tell me differently, but from a brief investigation I concluded that it involves mostly daintily pedaling a stationary bike, perhaps lifting some purse-sized weights, touching toes and the like. I felt that, despite what I’d been through, perhaps cardiac rehab might be a bit, um, basic.

My version of cardiac rehab began as soon as I could move my left arm over my head again, about six weeks after ICD surgery. Basic fitness returned pretty quickly. I got back on the bike and went from a barely catatonic 45 minute-ride to a sprightly three-hour jaunt in about two weeks. That lasted for a month or so until it all broke down again as my condition deteriorated into September. Finally, three weeks after my third ablation , with the heart beating like a Swiss watch (sort of), I resumed a right proper training regime: Extreme Cardiac Rehab.

For six weeks beginning the first week of November I ran or rode every day. My minimum run was half-an-hour, the minimum ride was one hour. Most days that was all my schedule would allow; occasionally -once I got some miles under my belt- I’d try for 2 to 3 hrs. The idea was to get my heart used to a light endurance load; nothing like what I used to do when I raced, just enough to spark a training effect and put these past months of neglect and deterioration (some would say care and recovery) behind me.

This was as much a mental exercise as a physical one, to prove to myself that I was fixed, and to gauge my “new” heart’s ability. In the darkest moments of the past months I felt as if I was never going to be able to do more than walk up a flight or two of stairs, and I should learn to be happy with just that. Now it seemed that I might have a whole heart again I wanted to use it as much as possible.

The other goal of the six-week Extreme Cardiac Rehab program was to get myself prepped for a return battery of testing, the one I failed so miserably last time . Approximately eight weeks after an ablation they call you back in to run the treadmill, and get knocked out and electro-stimulated – the dreaded NIPS test. I wanted to arrive at that day with “confidence in my heart.”

Endurance sports...the hidden killer??

and cigarettes are good for you...

Lately my blog has been linked to several sites that contain strange anti-exercise screeds or imply in some way that endurance training is detrimental to one's health. One site,CrossFit, seems to be holding me up as some sort of caveat against “too much” endurance training, or maybe the CrossFit guys simply think my blog is cool. Either way let me dispel some myths about my heart condition and endurance training.

As I've said before , there is no reputable science that suggests or concludes that endurance training by itself leads to dangerous arrhythmias, or other heart conditions. A cocktail of conditions may encourage arrhythmias, and there is a very small segment of the population that has a genetic predisposition towards certain heart conditions, (AVRD/C, below) and to those people endurance sports and training can be detrimental in the long term. But for the vast majority of people, endurance sports are simply not going to damage your heart in any way. And to the vast majority of people a modest routine of aerobic endurance training is beneficial for heart health. For those who happen to be crazy about a sport that pushes endurance training to the extreme, as in my sport of bicycle road racing, or marathon running or cross-country skiing, there is nothing deleterious about pushing those limits, as far as heart health is concerned.

If my past behavior had any impact on my current heart condition, it was most likely the times when I raced or trained while sick. I’ve raced in subtropical countries, eaten bad food, drunk bad water, raced through colds and flus and bronchitis. The most likely reason for the scar on my heart that caused my arrhythmia is a viral infection that I was exposed to somewhere along the way. My condition was not caused by the overall training volume of my life to date.

There is a chance (genetic tests are still pending) that I am one of a very few who have a genetic condition known as Arrythmogenic Right Ventricular Displasia / Cardiomyopathy. While, technically, I do have ARVC (Arrythmogenic Right Ventricular Cardiomyopathy), the cause of this condition in most likely not genetic, but rather idiopathic (which basically means that they don’t know for sure). Genetic ARVD/C is a gradual weakening of the walls of the heart through the degradation over time of the muscular tissue. With this condition endurance exercise accelerates the process of degradation. Doctors recommend nothing more than walking, bowling, or golf as activities. Really bad cases of ARVD/C end up as candidates for heart transplant. The disease is still quite unknown, and more is being discovered every day.

Thus far my doctors have been pretty certain that I do not have genetic ARVD/C. There is no cardiac history in my family, and I have only a few of the telltale signs of ARVD/C that show up on an EKG. Even without these indications, I am having the genetic testing done just in case, but I have confidence in my doctors and, since November ‘08, have resumed a modest training program.

Regarding CrossFit and its anti-endurance anti-Long Steady Distance philosophy, I think there is some truth in it at the most basic level. “Specialist” endurance training is not for everyone, and certainly us “specialists” have grave weaknesses in all around fitness (don’t even ask me to do a pull up). But the notion that somehow short, predominantly anaerobic training will make you competitive at anything but the most amateur level in a specialist endurance sport is misguided, nor are most people committed to a specialist sport particularly interested in the kind of fitness CrossFit results in. In the case of bicycle road racing, for example, endurance-overload training effectively recruits fast-twitch muscle for slow-twitch use, extending endurance at the end of a 4 to 6 hr event, thus many road racers limit their anaerobic strength training. Fast to slow twitch muscle recruitment only happens with an LSD program. There are many other effects of LSD endurance training that are necessary to compete at the top level of these specialist sports, but that is a rant for another day...