Weight Lifting and exercise with hypertrophic cardiomyopathy: Tips?

Welcome @annyfreeze, I think you're asking a question that many living with hypertrophic cardiomyopathy ask and for which there is no "one-size-fits-all" answer.

@jkbrooks started a related discussion here that may interest you:
- Endurance athletes & HCM https://connect.mayoclinic.org/discussion/endurance-athletes-hcm/

I tagging fellow heart and HCM members like @karukgirl @mrnomad @pete398 @scottij @chrisvaz99 @jess51 and @kelliw to share their experiences with staying active and guidance they received from their specialists.

I recommend sharing your new exercise approach with your cardiologist. It sounds like you're feeling good.

Thank you for replying! I did read that thread before I signed up and it was very helpful, especially knowing I can ask specific questions. Oddly, I got to see my cardiologist in between writing that and now. He said to go for it! He also talked about my situation being particularly sucky 😉 and that I am afraid of breaking, or just waiting for the next valve to not work. So off to weight lifting, and letting things go… However, I would still love input if anyone has had a good experience with exercise and HCM.

It looks like you are in your late 50's. What we don't know is your weight & general health.
I had the same surgery w/ 2 bypasses a year ago and quickly started doing P90X cardio but didn't push it. At the 9 month mark I went full on P90X with weights, hard cardio, etc. 5 days a week and for about an hour a day. I'm 57, 174 lbs, and you probably eat a little better than me. I plan to do "The Murph" on Memorial Day but will likely take an hour or so to do it.
I'd suggest an Apple Watch (or Samsung if an Android user). Unless your Dr says otherwise I'd push it as card as you can. If you overdo it your watch will tell you that you are going in to A-fib.
The Murph = https://themurphchallenge.com
P90X (Beachbody) = https://www.beachbodyondemand.com/?locale=en_US

Dale Gooding

Hi Annyfreeze -
I understand the overwhelm on this topic. Bravo for getting after it a bit! Good for you. I'm not a doc (let alone a cardiologist) but having suffered a "Sudden Cardiac Death" episode, I'm a frequent flyer among them. I've got different issues than you (no valve replacement, few afib ablations but no structural surgery.) 17+ years ago when I dropped on the sidewalk, the guidance from the docs (post fact) was "don't even think fast thoughts!" It was pretty grim. So I mostly avoided anything more interesting than walking. Thinking in the medical community around HCM has evolved to encourage activity. Here's where I've landed (I'm pretty active but I've shifted and accommodated my age & heart issues.)
* I ride (my bike) 10-12 h week. 95% of this I do BELOW 75% of my heart rate max. The other 5% of the time (ie 30 mins) (roughly roughly roughly) I try to accumulate minutes in 90% of my Max HR. I do this through interval training & some group rides with hills that are wicked hard for me.
(I'm on some meds (including a beta blocker) so figuring out my HR max was a bit of a process. I'll add a pretty good equation at the end; run that & round down as a place to start. ) So, that's what I shoot for, but if I just dont feel like busting my hump, i'll fall back to low intensity volume. Volume Volume Volume . . . way before intensity. Bluntly, it's safer & it's more sustainable.
* I lift weights a couple times a week. Once with a trainer and once either at the Y or my home (i've got a very good set up for weightlifting at home.) There I focus on lots of reps. I NEVER do heavy heavy. Like I never do sets of 3-5 at 85% of my One Rep Max. That's a young persons game. I do 4-6 exercises (eg bicep curls is one), 3 sets of 12-15; if I can get to 20 reps, I increase the weight. I'm looking to improve strength and muscular endurance. Lifting heavy will just wear you out, drive your blood pressure up (probably bad given heart stuff), is less sustainable, and wont get you the results you're hoping for. Strength and endurance are what you're hoping for. You dont need or want to lift heavy for that. Working with a trainer once/week or so to ensure you're executing good form will be safer than trying to sort all this stuff out on your own. Work out with a trainer once & have them put together a workout for you to do solo 1x/week. I love the Y. Lots of normal people and their trainers aren't wicked expensive.
* I do a sorta strength class at the Y 2x week. Lots and lots of reps. Almost a cardio HIIT class although my HR never gets above 60% of my max HR. Lots of body weight moves (eg planks, pushups, etc). I look at that as good "functional strength" . . . lots of movement, lightly loaded if at all, . . .

So, my suggestions are;
1) Join the Y
2) Get a trainer 1x / week
3) Sign up for a class 2x/wk where you can meet some folks. Make sure you're ok doing it half-assed if that's where you're at on any particular day. Modify the movements, don't work as hard as you could, . . . but go. "Anything worth doing is worth doing half assed!"
4) Walk 4-5 days a week for 30-60 minutes. Dont worry about looking like a goofball with handweights or whatever. Just get out and walk. I'd walk for 60 days then MAYBE start thinking about how fast you're doing it.
5) My doc used to tell me "you can't out run the fork." I really didn't like that. And yet, somehow it's true. I exercise 12-16 hours/week (more in the summer with longer rides) and I still have to watch my food intake. Sucks and yet, it's still true.

The half assed thing is legit. Sometimes the biggest win is just walking through the door for the class. In my case it's throwing my leg over the bike knowing I'm gonna put an embarrasingly low amount of effort into it. And, often, not always, I feel like working a little harder. Sometimes I dont. But I always have a ceiling on effort related to my HR (below 75% max HR in most cases)

Keep in mind that three 15 minute walks on three days is better than one, hour-long walk on one day (and HoHo's and ding dongs the other days!) I'm a believer in 1) do the work; go through the motions. 2) no pain, no gain is ridiculous even for teenagers. There's no science that suggests thats smart. NONE.

Focus on volume. Stay away from the HIIT stuff. It'll just wear you out (best case) or you'll hurt yourself because there's plenty of 25 year old class instructors who aren't focusing on making sure they're people are executing with decent form. Get the volume (low intensity) in for at least 90 days. After that, maybe you can do a HIIT class because you think it'll be fun or you want the challenge. The P90X stuff that Dale mentions below is mostly high repetition/functional/strength and endurance. You might like that. Lots of people do. I'd find a class where you can start to accumulate a "tribe" of folks you like and enjoy that are all in their sweating like dogs just like you!

Here's some stuff on the "Polarized training" (bulk of work at low intensity.) Stephen Seiler (American endurance research scientist that’s been working in Norway for ~20 years; https://www.fasttalklabs.com/training/polarize-your-training-stress/)

Here's three ways to estimate max HR. I use #2 and ROUND DOWN
[ 220 – Age ] – most common and widely used maximum heart rate formula
[ 207 – 0.7 x Age ] – more precise formula, adjusted for people over the age of 40
[ 211 – 0.64 x Age ] – slightly more precise formula, adjusted for generally active people

An apple watch (or a garmin watch), fitbit, etc will give you insight into what your heart rate is while exercising. The most precise way to do this is by connecting that watch (or bike computer in my case) to a Heartrate Strap. To my knowledge, the Polar H10 is the most accurate strap on the consumer market right now. Garmin makes straps that are also good (I've got each.) I'm sorta neurotic about paying attention to my HR. That might just be a me thing . . . and it took me about 6 years of regular exercise paying attention to it before I became convinced that I wasn't gonna have another cardiac arrest. 😉

Hope that helps
Best,
John

I came across this article the other day and it validated a lot of what I was doing (lower intensity, higher reps). . . and I learned some new stuff! I thought I was doing my thing that way because I just didn't want to work all that hard! Turns out, there are good reasons for my "lead with lazy" approach!
https://scottsbateman.medium.com/weightlifting-over-50-gain-with-a-little-less-pain-abd47c7c4bfe

"muscle strength and endurance" is a solid goal. It'll help you be able to rake your yard or do yard work for several hours without needing to spend loads of time recovering afterward. I spent saturday working with a bunch of my college friends cleaning out our fraternity house. Sweeping, carrying, bags and bags of garbage. . . Pretty hard work for 6 hours or so (hard for me anyway; sweating like a bugger.) I'd ridden my bike 65 miles the evening before and rode my bike 30 miles the day after. I couldn't have done any of it if I'd not been executing my little "go half-assed" plan 😉

I'm absolutely NOT one of the fast kids. And I'm aware that no amount of training is going to solve my "stroke volume" issues. Also on my list of things that I dont like yet are somehow still true. But I go and I do. And I've made friends on the same journey along the way. I'm super grateful for that. It's also enabled me to ride my bike solo, self-guided, self supported (carrying my own stuff) across france three times, down the SoCal coast twice, the Oregon coast, etc in the past two years. No way I could have done those things if I'd not been grinding away, low and slow on my stuff.

"Proof of Life"

@annyfreeze
Hey there! Welcome to Mayo connect. I was a consistent exerciser and dieter (as a good consistent diet, never to lose weight) for many years until I could not breath one day in March of 2019. Against my will my wife took me to an emergency room where I was diagnosed with Stage 4 Congestive Heart Failure. Essentially all my good efforts masked a growing heart failure problem. The subsequent emergency valve surgery did not work and I was sent to Mayo in October of 2019 for heart transplant evaluation. I did not look ill as I had a lot of "residual health" due to my exercise and diet. From the first day of the evaluation, the team at Mayo encouraged me to do whatever i could to keep as much health as possible. The more health I had coming into the hopeful surgery the quicker I would recover. It was the hardest thing I ever did. A small incline would make me stop and catch my breath. No hiking, no biking, no weights, definitely no yoga (constriction poses made breathing impossible). I was drained emotionally. I love to move and here I could only shuffle a few thousand steps a day. I had started to lose muscle mass due to cachexia which made moving even harder.

I made the list and resigned myself to a long hopeful wait. But then my personal miracle happened. The perfect heart became available only three days after officially making the list. I remember having walked 14,000 steps on that day on 9% ejection fraction.

When I woke from surgery I wanted to slay dragons. With the new heart I quickly got back into shape and now three years out I am averaging 38,000 steps a day from crunches, yoga, elliptical trainer, walking, hiking, biking, and a few weights. ( I hate lifting weights). Oh and I started an Over 60 and Under 6 basketball league. We play on Fridays. Vitals this morning had me at 137 lbs, Body Fat at 12.5%, BP 105/70, Pulse 105 (no vegus nerve so a transplanted heart runs fast), Temperature of 97.3 (I run cool now). And I assume I am 5' 10" but the two new hips last year (consequence of one of my immune suppressant drugs and activity) might have made me a bit shorter. The pants seem to be a bit long anymore.

I do not classes or follow a program. Exercise for me is a solitary activity -- sort of my personal mediation time. I also don't like coaches or instructors yelling at me to "do one more". Not for me at all

However each time I stop -- morning crunches, a hike in The Tortolitas, a bike ride, a walk with my wife, 45 minutes on the elliptical, I always pat my side and say "Thanks, Jxxxxxx" Because without his donated heart I would not be around to do any of this.

So do what you can with what you have. As my team at Mayo reminds me, "what is the point of being alive if you are not living."
Best always,
s!
Scott Jensen

What an incredible story @scottij ! You're an inspiration!

Tortolitas? Must be Tucson. If so, know that Dr. Jill Tardiff is a specialist in HCM and works out of Banner. In no uncertain terms, Jill is brilliant and supports those patients who maintain an active lifestyle.