Hi barbell medicine,
I have been training my Dad for the last few years following a variety of linear periodised powerlifting programs and making good progress. 1 month ago he had a stent procedure to open up an artery which had a 60% blockage, the other coronary arteries are clear. He has a history of AF which was successfully stabilised with ablation 2 years ago, he has never had any form of MI/TIA and does not have high blood pressure. I have been trying to find good guidelines as to how we should progress him back to some serious training. There seems to be no structured approach to weight training in the literature apart from advising against using the vasalva technique to enhance bracing. The exercise guidelines seem to be for people in poor health who have had a cardiovascular event. Prior to the stent we were weight training 3 times a week for 1 1/2 hours and he ran twice a week for 5kms. If you could give any suggestions or know of specific contraindications I would appreciate your advice.
Can you explain a bit more about what specifically led to the stent being placed, if not an MI? For example, was he experiencing something like chest pain with physical activity that led to an abnormal stress test and angiography?
Has he ever been referred to cardiac rehab before, or has his cardiologist discussed this?
Hi Austin,
thanks for your reply. He had some intermittent but regular feelings of breathlessness in the last few years when running and during an angiogram plaque build up was noted in the artery. My Dad was told the stent could possibly help with his breathlessness and that it would be a preventative measure against stroke potential in the future. The breathlessness could also have been related to a pneumonia episode which may have led to a lobe collapse about 18 months ago as it sometimes responds to symptomatic ventolin treatment. He has not been referred to cardiac rehab and has aced his stress tests on the treadmill on the past few years when doing his check ups. He sees his cardiologist at the end of the week and will discuss the situation with him. When previously asked the cardiologist seemed reluctant to give specific advice as they don’t seem to know what to do with a patent who has a high level of strength and general fitness compared to his peer group at 70 years of age.
It’s interesting that, given that there were multiple possibilities for the cause of the breathlessness, he was taken directly for angiography and stenting rather than undergoing a stress test or myocardial perfusion scan, which would have helped elucidate whether the plaque was actually significant enough to affect the heart muscle and precipitate symptoms.
Regardless, that’s done at this point, and I agree that discussing with the cardiologist makes sense as a first step and potentially inquire about cardiac rehab. For someone who was already in relatively good shape and exercising regularly, who was never limited by chest pain symptoms, and who did not have an MI, I think that returning to their routine exercise based on individual tolerance is reasonable. I do not know of good evidence to support the valsalva recommendation as a general principle, as it is unrealistic to avoid the valsalva in daily life for most individuals (e.g., during bowel movements).
Hi Austin,
thanks for your answer. I think the history of AF was a big factor in the decision to go the cardiac route. I also feel that the blanket statement to avoid the vasalva technique seems overkill unless there is a significant issue with high blood pressure. At this stage we have just had him working at about 50-70% of 1 rep max for lots of sets of 3-5 reps with no issue and we were planning on gradually getting back to full capacity over the next 4 weeks. I had been trying to stop him pressurizing strongly prior to lifting due to the vasalva caution so it will be good to be able go back to a true bracing strategy to enhance performance and for back safety.
Thanks very much for your time, it is greatly appreciated.