Riding with a heart condition

First things first, if you have any kind of heart condition talk to your Doctor before taking up any exercise.  I don’t want to put anyone off, but all heart conditions are different and only you and your Doctor know your condition in any detail.  This post is about my experiences and what worked for me, hopefully it will inspire others to start cycling to improve their health, but PLEASE always seek medical advice prior to starting any new exercise regime.  I cannot stress this enough.

If you have read my first post you will know that 4½ years ago I had a Myocardial Infarction (MI), more commonly known as a heart attack, and that I took up cycling again as a way to improve my fitness and overall heart health.

I say took up again, that’s probably taking the phrase too far, as other than my morning paper round in the 1980’s I hadn’t done much cycling prior to my MI in 2011. My most active year on the bike prior to that was 2009 when I headed out just sixteen times over the summer.  This was in a time before the likes of Strava so I recorded my rides in Excel, looking back I had clocked up a wapping 260 miles with an average speed of 11mph.  I did actually ride with a heart rate monitor back then, my averages over those rides were: max heart rate (MHR) 172 and heart rate (HR) 140.

The longest ride that year was the 45 mile Palace to Palace (Buckingham Palace to Windsor Castle) in aid of the Princes Trust. My family were shocked when I said I was entering.

Palace to Palace September 2009
A 260lb me finishing the Palace to Palace ride –  Sept 2009

Return to the bike…

I took it easy for the first couple of weeks after being discharged from hospital before I started any real exercise.  Initially by walking around the garden, increasing the distance each day until I felt I could manage a lap around the block. Within a couple more weeks I was walking into the local town centre to pick up a paper and pint of milk.

It was twelve weeks before I felt comfortable venturing out on two wheels, I got the bike out of the shed, the first time it had seen daylight since Palace to Palace almost two years earlier.  That first ride was a venture into the unknown – I don’t know who was more nervous at the time, me or my partner.  I’m thinking, is this the right thing to do and would it bring on another MI, whilst Sue was at home thinking exactly the same whilst waiting for the phone to ring again…..    I cycled 3.3 miles in 17 minutes (average speed 11mph, MHR 155 and average HR 135) probably one of the longest 17 minutes of Sue’s life.

It’s not just about the person who has the heart condition, loved ones are affected just as much, if not more.

For me those 3.3 miles / 17 minutes were the start of my return to cycling, this time it was serious.  Over the next six months to the end of 2011 I was to cycle a further 1170 miles on my road to recovery, culminating in a 62 mile ride around the Isle of Wight (on a cold and windy day in December) in the Wiggle Wight Winter Sportive, details and full stats on Garmin Connect.

Tackling a 62 mile ride just 9 months after a MI might seem a bit irresponsible, I didn’t just decide to ride this distance out of the blue.  I had built up to this distance over time, regularly riding 11 miles during the week and 15 – 20 miles at the weekends.  Leading up to the event I did a couple of 40 milers and a 50 mile ride.

VeloViewer 2011
Distance over time – 2011 (Strava data presented in Veloviewer)

Riding with a Heart Rate Monitor

Obviously I don’t want another heart attack, so the most important item I ride with is a heart rate monitor. I bought a Garmin Edge head unit as I also wanted to record my routes as well as all the other stats.

Just having the heart rate monitor isn’t enough, you need to understand your own heart, so much so that I became obsessed with it.

I set about working out my MHR,  I didn’t know there were so many different ways and views on how to calculate it, having spent ages with the various different formulas, collating all the results and then taking an average of them all my MHR should be 178.6  If you want to know what your MHR is, save all the complicated formulas and just subtract your age from 220.  I’m 42 so my MHR is 178.

Having got my theoretical maximum, I needed to know my resting heart rate.  This is an average of your waking heart rate taken every morning for a week.  Rather than sleep with your heart monitor on all night just to see your waking heart rate I used a great smartphone app from Azumio – all you have to do is put you finger over the camera lens and hold there for thirty seconds.  I have found it to be extremely accurate. Yes, I’ve tested it by wearing my Garmin chest strap whilst taking my blood pressure (did I say I was obsessed) to my utter amazement all three had the same result.  My resting HR is 54

Azumio iPhone Instant Heart Rate App
Azumio iPhone Instant Heart Rate App

Having a resting HR of 54 bpm is normally a sign of somebody who is very fit or a professional sportsperson – prior to my MI my resting HR was in the 70 to 80 range.  I was doing a lot of cycling at the time, but I was still overweight with a 40 inch plus waist, so I wasn’t that fit!  Having spoken to my Doctor my lower HR is a result of my medication,  in this case a beta blocker called Bisoprolol Fumarate.

Before the calls of “doper!”,  I’ve checked all my medication against the WADA prohibited list for cycling in the UK and none of them are prohibited. Not that it matters as I cycle purely for fitness, but it’s nice to know I could compete if I wanted to.  Now, archery is a different matter as the slower heart rate means you gain an advantage as you will have a steadier hand to hold the bow, thereby increasing your accuracy.

I mention the effect of the beta blocker as if it effects my minimum HR I need to consider if it has a similar effect on my maximum.  Therefore and to err on the side of caution I’ve set my MHR at 171.  If you are starting out exercising speak to your Doctor, Cardiologist and/or Heart Failure/Rehab Nurse about what your heart rate should be.

Knowing your min and max heart rates allows you to calculate your exercise zones, I do this through Garmin Connect but there are numerous websites available that you can use to calculate yours.

Garmin Heart Rate Zones
Garmin Heart Rate Zones

When I started out cycling after the MI I would try and avoid going above 153 bpm (85% of MHR) which would give be a buffer up to 165 bpm and I would still be under by MHR.

I probably have too much data on my Garmin training pages, although you will notice that every one shows my heart rate.

My Garmin Screens
My Garmin Edge 800 screens all showing my heart rate

I normally ride with the last page showing the graph and HR in bpm and %max.  I’m quite happy to let it go up to the high 160’s now for short periods of time, but like to keep it below 85% for the majority of the ride.

The point I’m trying to make is I know what my limit is, if I hit 172bpm my Garmin will alert me and it’s time to ease off, if that means getting off and walking up a hill, I get off and walk.  I have no problem in getting off and walking, I would rather get to the top by walking than not at all.   It does not matter what other people/riders think or say, it’s my heart and I would like to keep it.

It’s only a hill, it will still be there the next day and the day after that, just make sure you are still here to attempt it again.

Knowing my limits and training has allowed me to enjoy my cycling and improve my fitness.  By pacing myself and utilising the gears/cadence to stay in the different heart rate zones I can now get up most hills without walking, occasionally one will still get the better of me.

The photo below was taken almost one year to the day after my heart attack, yes that is me 45lbs lighter and climbing Blissford Hill (25% gradient) in the New Forest whilst staying under my self imposed 171 MHR limit.

Me at 216lbs - New Forest Spring Sportive - April 2012
Me at 215lbs – New Forest Spring Sportive – April 2012

As I said at the very start of the post, if you have a heart condition please seek medical advice first, but I hope that my story has inspired you to consider cycling as a fitness option.  Remember you don’t need to be doing 60 mile rides with lots of climbing, a regular easy spin around the block for twenty to thirty minutes three times a week could do wonders for you, just speak to your Doctor before you start.

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