Advised by doctor not to exercise, what do?

Medical Q&A [Moderated]
1

Hi Doctors,

Today I went to my university physicians for esophagitis, and in order to rule out heart problems, the doctor performed an EKG. The EKG came back with “incomplete right bundle branch block,” and it had the doctor pretty spooked. She said it was vague and could be an error with the machine, but I should not work out in any capacity until I am able to see a cardiologist. However, booking time with a specialist in NYC can take quite a while, and I’m not sure if the doctor has reason to specifically prohibit exercise or if she is just being extra cautious in her recommendation given the possible stakes and liability. While she might have more context, I still thought it might be worthwhile to kick it to the doctors perhaps most versed in the literature when it comes to resistance training and overall health. Does this fall under those cardiovascular conditions wherein one should not exercise (alluded to in the recent debate podcast in the context of, but not limited to, pregnancy)? If the condition is not known, should one cease exercise until tests can be done, even if that means no physical activity for weeks?

I am a 29 yr old male with no symptoms. Relatively well trained (Beginner template → Powerbuilding I) and meeting both the guidelines for resistance and cardio training. I recently quit smoking.

Should I still exercise, provided there are people around and an ER close by?

Thanks in advance,
Sam

P.S. Beyond potentially answering my one-off forum question, you all have had such a profound impact on my life and health! Thank you for the work you do!

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Several caveats up front: I have not seen your electrocardiogram or examined you, so cannot give you individualized advice here. If a doctor were “spooked” by such a finding in that context, I suspect they were relying on the automated computer interpretation, which can sometimes be incorrect, rather than interpreting it themselves. I would also have repeated the electrocardiogram to ensure correct lead placement, among other things.

With that said, there are a variety of potential EKG changes in athletes, some of which are normal/physiologic, whereas others do require additional investigation. Isolated incomplete RBBB is a relatively common training-related change. For a young, healthy, asymptomatic person with an incidentally-found incomplete RBBB and no other EKG changes or concerning findings on history/exam, I would not be advising complete restriction from exercise.

Reference: https://academic.oup.com/eurheartj/article/31/2/243/719826?login=false

The prevalence of incomplete right bundle branch block (RBBB) (QRS duration <120 ms) has been estimated to range from 35 to 50% in athletes compared with less than 10% in young, healthy controls … The ECG pattern is more often noted in athletes engaged in endurance sports, with a striking male preponderance … Incomplete RBBB does not require further evaluation in the presence of a negative family/personal history and physical examination.

Again, this may or may not be your situation, as I have not done an assessment myself – but it is the most likely scenario, given the context you’ve provided.