Dr. Fett - Target Heart Rate During Exercise and Recommended Frequency of Workouts? [Archive] - A Mother's Heart PPCM online support group message board

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ncwahoos

01-02-2006, 04:02 PM

SusanD

01-02-2006, 04:59 PM

Hi Dr. Fett,

Hope your holidays were enjoyable.

I have two quick questions related to exercise for you today, if you don't mind.

1. How does someone with PPCM determine a good target heart rate during exercise? I am 35 and my heartrate ranges typically ranges from 100-130 during exercise and is more like 100 when I ride the recumbent bike and 130 when I workout on the elliptical machine, but it rarely gets above 135. My resting heart rate seems to float around 60-70.

2. How frequently do you recommend recovering patients exercise? Obviously, I am sure some form of exercise everyday is good but with three young children, heading to an organized workout facility daily is not feasible. What would you recommend as a routine? Besides going up and down my stairs all day long, I usually workout from 30-50 minutes several times a week at an organized facility but wonder if I would benefit from doing more than that.

By the way, I have no restrictions from my cardiologist regarding intensity or length of workout.

Thanks.

Stephanie

I'm not Dr.Fett, but I have a lot of experience helping heart patients with exercise. Target heart rate for heart patients/CHF patients/cardiomyopathy patients in general is pretty much a fallacy. Heart rates in this population can vary so much from "normal" because of the normal response of the heart in enlargment and/or failure (the response is to speed up the rate) and also because of the medications we are on (beta blockers slow the rate). In general, a rule of thumb is to go by your rating of perceived exertion (RPE). You can look up or google the phrase "Borg Perceived Exertion" and will find the numerical score. I generally try to keep patients in the 11-13 range. You should never feel like the exercise is HARD and you should always be able to carry on a conversation. For patients on extreme beta blocker doses (like Toprol XL 100 mg /day) we generally try to keep them within a range of Resting heart rate + 20-30 beats.

If you have had the benefit of a recent maximal exercise treadmill test, then a target heart rate is a possibility for you...you just need to talk to your cardio to find out your resting heart rate and the maximum heart rate you were able to reach. Multiply the top number by 65% and by 75-80% and you will get your target heart rate range. Most of us have not had a max treadmill test though. Please refrain from using those target heart rate formulas....they exist for "normal" unmedicated hearts.

We recommend a cardiovascular workout of 20-30 minutes 3-4 times per week. Research has not generally shown more benefit from more exercise than this and at some point more exercise can actually be detrimental. Your body needs some down time. I find that patients who alternate a day of weight lifting with a day of cardiovascular workouts (this is what I do myself) do really well...with a day or two off a week.

Research currently shows that the benefits of exercise for CHF patients lies not in an increase in ejection fraction (EF does not increase with exercise training) but rather from peripheral cell and muscle cell adaptation...specifically they are better able to take up oxygen and utilize it more effectively.

Good luck and remember a little bit of pushing is ok, but give your body time to rest. Rest properly and eat healthy and everything will balance out. Also, within your cardiovascular workout, I find that a little interval training really works as well. Try a few minutes at a moderate pace and then push at a higher speed for a few minutes and then back down to a slower pace and then back up. You can alternate your speed and grade to achieve this effect.

JAMESFETT

01-02-2006, 05:11 PM

Susan D has given a very good response, better than I could do. It's great you are working on conditioning. A good, vigorous, at least 20 minute walk is also a good alternative.

JD

ncwahoos

01-02-2006, 07:18 PM

Susan and Dr. Fett

Thanks for your responses. As Susan recommended, I checked the Borg Rating of Perceived Exertion (pasted below from a CDC website if anyone else is interested) and I am definitely in the range you recommend when I exercise so I think I am on the right track. I just got back from our clubhouse and a 30 minute workout on the elliptical machine where my heart rate was around 120 at max which is right in line with what I perceived as my exertion level based on the Borg scale. Now I just wish I could figure out how to get past the plateau I have reached regarding my weight loss. I am down to my pre-pregnancy weight but can't seem to get any lower even with the exercise.

Thanks again,
Stephanie

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Pasted from: http://www.cdc.gov/nccdphp/dnpa/physical/measuring/perceived_exertion.htm

Plug into physical activity, and feel the surge!

A third method of determining physical activity intensity is the Borg Rating of Perceived Exertion (RPE). Perceived exertion is how hard you feel like your body is working. It is based on the physical sensations a person experiences during physical activity, including increased heart rate, increased respiration or breathing rate, increased sweating, and muscle fatigue. Although this is a subjective measure, a person's exertion rating may provide a fairly good estimate of the actual heart rate during physical activity* (Borg, 1998).

Practitioners generally agree that perceived exertion ratings between 12 to 14 on the Borg Scale suggests that physical activity is being performed at a moderate level of intensity. During activity, use the Borg Scale to assign numbers to how you feel (see instructions below). Self-monitoring how hard your body is working can help you adjust the intensity of the activity by speeding up or slowing down your movements.

Through experience of monitoring how your body feels, it will become easier to know when to adjust your intensity. For example, a walker who wants to engage in moderate-intensity activity would aim for a Borg Scale level of "somewhat hard" (12-14). If he describes his muscle fatigue and breathing as "very light" (9 on the Borg Scale) he would want to increase his intensity. On the other hand, if he felt his exertion was "extremely hard" (19 on the Borg Scale) he would need to slow down his movements to achieve the moderate-intensity range.

*A high correlation exists between a person's perceived exertion rating times 10 and the actual heart rate during physical activity; so a person's exertion rating may provide a fairly good estimate of the actual heart rate during activity (Borg, 1998). For example, if a person's rating of perceived exertion (RPE) is 12, then 12 x 10 = 120; so the heart rate should be approximately 120 beats per minute. Note that this calculation is only an approximation of heart rate, and the actual heart rate can vary quite a bit depending on age and physical condition. The Borg Rating of Perceived Exertion is also the preferred method to assess intensity among those individuals who take medications that affect heart rate or pulse.

Instructions for Borg Rating of Perceived Exertion (RPE) Scale
While doing physical activity, we want you to rate your perception of exertion. This feeling should reflect how heavy and strenuous the exercise feels to you, combining all sensations and feelings of physical stress, effort, and fatigue. Do not concern yourself with any one factor such as leg pain or shortness of breath, but try to focus on your total feeling of exertion.

Look at the rating scale below while you are engaging in an activity; it ranges from 6 to 20, where 6 means "no exertion at all" and 20 means "maximal exertion." Choose the number from below that best describes your level of exertion. This will give you a good idea of the intensity level of your activity, and you can use this information to speed up or slow down your movements to reach your desired range.

Try to appraise your feeling of exertion as honestly as possible, without thinking about what the actual physical load is. Your own feeling of effort and exertion is important, not how it compares to other people's. Look at the scales and the expressions and then give a number.

6 No exertion at all

7
Extremely light (7.5)
8

9 Very light

10

11 Light

12

13 Somewhat hard

14

15 Hard (heavy)

16

17 Very hard

18

19 Extremely hard

20 Maximal exertion

9 corresponds to "very light" exercise. For a healthy person, it is like walking slowly at his or her own pace for some minutes

13 on the scale is "somewhat hard" exercise, but it still feels OK to continue.

17 "very hard" is very strenuous. A healthy person can still go on, but he or she really has to push him- or herself. It feels very heavy, and the person is very tired.

19 on the scale is an extremely strenuous exercise level. For most people this is the most strenuous exercise they have ever experienced.

SusanD

01-02-2006, 09:02 PM

Stephanie...thanks for cutting and pasting the Borg scale. I have used it for years with my patients and find it works really well.

I have found (with myself and my patients) that when I hit a plateu for weight loss, I do well when I increase my weight lifting and add interval training. I could walk for 30 minutes three times a week and never lose a pound...but when I do a 20 minute workout three times a week that includes short interval burts of increasing intensity, I really melt off the pounds and inches.

As I also mentioned, weight lifting is a very useful tool when done properly. There are some considerations for cardiac patients but overall it is a safe activity to pursue and will increase your muscle mass. The more muscle mass you have, the more resting calories your body will consume = more weight loss. Keep up the good work !