Good morning,
I have a client who has told me he has presented with moderate levels of slowly progressing Aortic Stenosis. His medical practitioner specifically told him he needs to stop lifting heavy weights and focus on cardiovascular fitness. The individual in question has a 35 inch waist line and is not overweight and maintains a BMI under 25 and is only 45 years of age.
I have no literary legs on which to stand, and do not have article references to make a cogent argument one way or another. I want to help them make the healthiest decision possible, and I am happy to pivot their training to a much more hypertrophy oriented and cardiovascular training structure, but their doctor more or less said not to lift anything heavy at all. Nothing which would require Valsalva was the client’s take. “No increased intrathoracic pressure from lifting,” was the doctor’s quote, from the client to me. the client said their doctor specifically stated “Heavy lifting can progress stenosis more rapidly.”
I do not know what to advise, or where to head from here. This is far outside my lane, and want to help them be as healthy as possible, but simply stopping all heavy lifting feels like a wrong answer. Advise on what I should say / do for this client would be appreciated.
Thank you.
It’s tough to comment on this situation confidently without knowing more details, such as:
What specifically led to the diagnosis of aortic stenosis? For example, was it an incidental finding on a test done for another reason, or were there specific symptoms that led to the suspicion and diagnosis of AS?
What is the severity of stenosis?
What is the management plan moving forward?
Was this clinician a cardiologist, a general practitioner/primary care physician, or a non-physician clinician?
I will say that this:
“Heavy lifting can progress stenosis more rapidly.”
Is completely made up out of thin air, and is not accurate.
The individual would probably be best served seeking out other opinions on the matter.
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Good morning.
The client had reconstructive heart surgery in their infancy. I only know because my intake form asks basic medical history. They were cleared by a doctor to lift, and they have Echo every two years, and ECG every year as part of routine checkups. They have never reported symptoms to me, and did not mention any in the conversation. The doctor who diagnosed was their regular cardiologist. They did not confide in me for management plan moving forward, and they stated “moderate stenosis,” but did not provide a specific percentage. I will encourage them to have at least a second opinion, and for the time being, will recommend they continue to train as they are comfortable with? I don’t want to force them into a emotionally uncomfortable state either, but would not want them to stop training in what I view as a relatively young age.
thank you,
Kevin.
I would have a very hard time placing substantial, life-altering limitations on an individual who has no symptoms and had this as a completely incidental finding on a screening test, particularly when we have no evidence that resistance exercise accelerates/worsens the progression of aortic stenosis. If the individual is at such high risk from recurrent elevations in intrathoracic pressure from lifting, then theoretically they should be barred from performing the valsalva to pass a bowel movement – which was probably not recommended.
A lot of the time medical professionals end up far too deep in their “silo”, thinking only about their specialty’s organ of choice without considering the downstream/off-target effects or other trade-offs of placing such restrictions on an individual. However, given that you report this individual has a cardiac history, I can’t really comment much further on the matter, and agree that obtaining other opinions would be wise.