Training with HR Limitations

No this is not a HR zone question.
38M/5’7/200lbs
Training history: Consistent for many years. Have competed some. Won USPA drug tested national age group in 2022 before medical issues began. No history of any kind of supplementation other than the occasional protein powder (bbmed vanilla)

I have been cleared and encouraged by multiple doctors to continue trying to train.

Long story short, after 3 ablation procedures on various areas of my left atria, I am finding training too difficult. My resting HR is a normal 74, a slow sustained conversational jog my HR will sit around 125. If I were to run a 200m sprint, it would be at 135 and I would be fainting. I am missing those higher “zones.” Instead, I fatigue very quickly and need prolonged recovery periods. For barbell training, after 3 reps with a 5@8 load is too overwhelming. If I am allowed to breath freely I could easily do sets of 12-14. Pretty much, if it’s well inside of my capability I can easily perform the sets x reps. I am trying to understand how to build a training program out of this. I am good for 3 reps and think grounding my program in intesity with sets of 3 is easy enough. This is not enough for hypertrophy though which is where I get into issues. Sets of 5 with relevant percentages is too much. The combination of getting into “higher” reps with training intensity is not sustainable for more than a single set. Is it possible to build a program around triples and higher volume very low intensity work? Obviously not ideal, but I do have a goal of competing at worlds for the first time and would like to see that through.

Hey there! Welcome back to the forum, though I wish it was under better circumstances. Sounds like the last few years have been very challenging, though you’ve been trying your best!

I think there may to be a bit more info related to the condition you have as well as the management that would likely be explanatory and perhaps instructive. I suspect this and your programming would be better fleshed out via a consultation, but I do have a few thoughts…

For strength-focused programming, you are able to tolerate lifting heavy enough for multi-rep sets, as you report 3 @ 6 (~80% 1RM) is fine. I would liberalize your intensity, rep, and RPE selection to include more work in the 68-75% range, where sets up to ~ 6 reps are likely possible for you.

For hypertrophy, loads as light as ~ 30% 1RM are doable provided you get somewhere near failure. I’d be curious if you could do sets of 6-15 reps @ RPE 7 or higher on isolation exercises, which I would likely favor in this situation for hypertrophy-specific training.

Thanks for the welcome back! I mostly lurk. Especially enjoy the conversations and content around plantar fasciitis. My sample of n=1 has shown drastic improvement to foot health in jogging while doing the recommended towel under the toes calf raises.
You are spot on with the more isolation based exercises. I have a hip belt squat and am able to push much harder than I can with a barbell, not just in volume but intensity. The lack of needing to valsalva feels like it’s a line in what is more doable. With squats and deadlift I fall off pretty hard after 3 reps. There isnt a linear relationship with the RPE. Effort and muscular capability seems to divorce right about that level. Definitely interested in a consultation.

Makes sense! Shoot us an email at support@barbellmedicine.com and we can get you sorted.

In the meantime, I do think that some isolation and non-barbell exercises would be useful for some of your training.