Training with dilated cardiomyopathy

Many thanks for all of the material you put out, I wish I discovered BBM years ago. I’ve been bingeing your podcast and YouTube channel for the last month or so, and have read and shared a number of your articles.

Me

  1. 38 years old
  2. Male
  3. 6’3"
  4. 367.2 lbs (down from 434 on September 20th)
  5. 49.8 BF% (BI scale)Goals1. Fat loss/general health
  6. Strength
  7. AestheticsConditions
  8. Dilated cardiomyopathy (Carvedilol, Jardiance, Entresto, Inspra)
  9. Sleep apnea (CPAP)
  10. ADHD (Vyvanse)
  11. Osteoarthritis in left knee (sleeve when squatting)Daily Nutrition
  12. 2000–2200 kcals (weighing and measuring very strictly)
  13. 180–200 g protein
  14. ~2000 mg sodium
  15. Little to no thought/effort towards specific carb and fat intakeTraining
  16. Starting Strength Monday/Wednesday/Friday
  17. ~8 weeks into my novice linear progression
  18. Power cleans bothered my OA knee, switched to rows
  19. Press is done seated due to ceiling height
  20. Latest lifts: squat 215, deadlift 240, bench 180, press 100, row 135
  21. Elliptical every non-lifting day for 45 minutes, maintaining heart rate of 120–130 BPM (per cardiologist’s direction)Home gym equipment list

Squat rack, barbell, adjustable bench, lifting shoes, plate-loaded dumbbells, ez curl bar, high/low/mid cable machine, elliptical, heavy bag.

Questions
Curious to get your overall opinions on what I’m doing and how to optimize it, given my conditions and medications, diet, and goals.

Lifts are really starting to tire me out. Haven’t missed a rep yet but feel close on a couple lifts. Should I adjust cals/macros to counter this? Maintain current levels to prioritize fat loss? Other?

With consideration to the contents of my home gym, which training template of yours would you recommend for after my LP? I’m leaning towards Powerbuilding I.

Thank you very much for your time.

Hi there,

Glad you’ve found the material helpful! Awesome work with your training and fat loss so far, too.

It looks like you are on all the right medicines for your heart condition, which is great to see. I assume you’ve been screened for diabetes/prediabetes, but if you somehow haven’t, that would be worth doing.

You are already doing a great job with your training, and I do not think there’s much that needs to be “optimized” aside from keeping it enjoyable and sustainable over time. Given what you are feeling with the lifts, I would simply move on from that program to another. There is no “optimal” or “perfect” program to choose next, whether you wanted to try something like the Bridge, Powerbuilding, or any other – and you can further customize the templates for your own needs. For example, adjusting the movements to your preferences, or the RPE targets to your desired/preferred level of exertion, etc.

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Thank you for the quick reply.

I was strongly considering the Bridge until its FAQ said:

For a very overweight person who is seeking to lose a significant amount of body fat quickly, this likely isn’t the best program either.

Since you know more about me (just from this thread), I’ll hold your direct advice in higher regard than the FAQ – the Bridge is back on the table!

With that said, what features of a program would make it more or less suitable for someone losing a lot of fat?

A program without conditioning, autoregulation, and a progression model that does not comport with human adaptation would make a program ill-suited for weight loss (and other goals).

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If I may piggyback on this thread to ask a related heart/training question…

A friend told me he’s not supposed to lift with a belt due to his hypertension. This was confirmed to me in Greg Nuckols’ The Belt Bible article:

If you have blood pressure problems or issues exacerbated by blood pressure elevations, you’d probably be better of not using a belt (or the valsalva technique at all, for that matter).

I found a post by Dr. Baraki from 4+ years ago dispelling the last part about the valsalva maneuver.

My BP is consistently in the normal range but given my own heart issue, should I have any concern with using a belt, or the valsalva technique for that matter?

Thanks!

There is no direct evidence on this kind of thing, so any advice (from anyone) is going to be pure opinion.

Given that you are on those 4 medications, are training and maintaining a very high level of function - seemingly without symptomatic limitations - I think it is pretty unlikely that a belt would pose any significant risk in your situation. With that said, you are not missing out on much if you were to train without one, either.