Hypertrophy with Bicuspid Aortic Valve

Training Q&A [Moderated]
1

Hello everyone, I just found this forum and I think it’s great. I found some threads about topics similar to the one I’d like to discuss, but none really answered my specific questions. If I just missed some relevant past threads, please accept my apologies.

I have a bicuspid aortic valve, but the dilation at the aortic root/ascending aorta is sufficiently within the limits considered acceptable for sports participation (both measurements are below 40 mm / 1.57 in).

The only restrictions I have are:

  • no Valsalva maneuver
  • SBP <200 mmHg

My big problem is that I have never found a coach or doctor who could suggest how to achieve sufficient mechanical tension/stimulus for hypertrophy while staying within these limits.

I have no idea whether the best approach would be many sets at low reps or the opposite; whether I should use big compound lifts just to pre-fatigue the muscles and then train them with isolation exercises; whether I should skip compounds altogether; etc.

To give some context:

  • I have relatively low muscle mass, and you can consider my body fat to be around 20%.
  • My conditioning is decent, even though I don’t currently exercise very much.
  • I am currently clearly out of shape and detrained, although my muscle mass has not changed significantly.
  • Just to make things more complicated, I am autistic and process internal bodily signals somewhat differently, so RPE and RIR are concepts I currently struggle to use reliably. I will eventually work on this, but I need a different strategy to start with. This is secondary, though.

I’m not looking for medical clearance or advice about whether I should train — these restrictions have already been established with my cardiologist. I’m specifically interested in training strategies and practical experience: how people have approached hypertrophy when they need to avoid Valsalva and keep exercise SBP below a given threshold.

Has anyone here dealt with something similar? I’d really appreciate hearing about your experience, or what you’ve seen work for someone in a similar situation.

Many thanks!

2

Howdy,

Welcome to the forum. We’re glad you found us.

As you likely know, building muscle can be done over a wide variety of rep ranges, provided they’re taken somewhere near failure. This means that heavy, moderate, and light weights can all be used to get about the same effect.

That said, the Valsalva near failure is largely reflexive. Once a set gets hard you’ll hold your breath whether you mean to or not, regardless of how you’ve been cued or what you attempt to do it. What you can influence is the size of it. Lighter loads and avoiding long grinding single-rep efforts keep any breath-hold brief instead of letting it build into a sustained strain. We did a whole episode on this, linked below.

I am not sure that your BP can be kept below 200 with any strategy, though it depends how your doctor would plan on monitoring that. Most lifting will create a “spike” in BP towards the end of the set that often climbs about 200, but most measurements a clinician would do are after the set, which could be lower than 200.

So, there are some real issues with the recommendation from your cardiologist. I think you’d want to ask them directly about specifics, risks vs benefits, and come up with a shared plan. Most of the risks are unknown, unfortunately, which makes hard limits like this challenging to come up with. I’d want to have a convo about it.

As far as what I would do, I’d want to talk to you personally to suss out a recommendation.

Further reading