help

Hi, I need some help. I am fitness trainer who has a 60 year old client who has a pace maker. i am concerned with training him as he is very stuborn and doesn't listen to instruction well. i ask him to take it easier, but because he is in a group with fitter people, he tries to keep up. I am worried he is going to have a heart attack on my watch! I often tell him that i think he is training too hard (he literally looks like he is going to die) and that his heart rate is too high, but he shrugs me off and tells me that it is impossible for his HR to get too high with the pace maker. I don't know enough to give him a more educated argument or reason for him to slow down. I am nervous to train him, and was wondering if i could give him any restrictions with regards to what his heart rate should be at, or any other limitations i should be suggestion for him so he is training safely and effectively. thanks!

5 Comments

Not True

by Genie - 2010-06-22 02:06:33

It's not true that his heart won't go above the pacemaker settings. There are plenty of posts on this site from people who have exercised beyond the top rate at which they are paced, have gone into heart block, and their pulse has plummetted. He's no more likely to have a heart attack than any other person with similar fitness, but he could pass out if his heart rate suddenly drops. He should have taken advice from his cardiologist about what is safe for him. Perhaps his doctor could write you a letter confirming what his limitations are/are not?

Perhaps you could encourage him to join this site? He could talk to others about his training. Without knowing the specifics of his problem and his PM settings it's impossible to advise you.

Genie

Good Luck

by SMITTY - 2010-06-22 04:06:59

First, this is not a subject that can be covered very well in a few sentences. I suggest you go to Google and put in "How A Pacemaker Works." You will getlots of reading material you want on this subject.

I suspect your client is like so many people when they first get a pacemaker. They think that pacemaker takes total control of making their heart beat. Nothing could be further from the truth. The pacemaker simply keeps the heart rate from gong to slow and it can help provide a more regular heart rate, but not much else.

My suggestion is have this gentlemen to get a note from his doctor stating his exercise limits. I don't think you need the information, but my guess it will take the doctor to "maybe" convince him there are limits to his physical activity even though he has a pacemaker.

But for now, just let me say his pacemaker will not keep his heart rate from getting "too high." As we said a pacemaker increases the speed of slow heart rates. There are two settings on a pacemaker. One is the low setting which tells the pacemaker to not let the heart rate go below that number. (The high and low set points can be different for different people.) The high setting is the point at which the pacemaker will stop helping maintain a regular heart rhythm. When the heart rate passes the upper set point it take itself out of the picture except to monitor the heart rate until it drops below the high set point.

Good luck to you,

Don't focus on the pacemaker...

by COBradyBunch - 2010-06-22 07:06:13

As an ex fitness instructor and current pacemaker transport system I guess my question is did you, or any of the other fitness instructors know this guy before he had his pacer? He may have been working out this way his whole life and just because he has the pacer he might not want to change his routine, or even need to (although he might want to listen to you, especially if he is out of shape and trying to get back in shape).

Rather than focusing on his pacemaker why not focus on teaching him about zone training. Teach him about base building for endurance and talk about fat burning at the lower zones (even though you really do burn more calories and more fat in the higher zones, but that is a whole other debate). By focusing on his pacemaker you are likely making him even more stubborn and less likely to listen but if you teach 'the class' and thereby him about basic fitness ideas and zone training you just might win him over. If you don't, well like I said he may have been working out like this forever and at age 60 he is going to be a tough person to get through to.

Oh and as far as pacemakers, please remember that having a pacemaker doesn't mean you are likely to have a traditional heart attack because pacemakers are often (as is the case with myself) due to screwed up wiring while the plumbing is in great shape.

Upper limit

by ElectricFrank - 2010-06-23 02:06:39

There is an upper paced limit that is set in the pacer. This may or may not actually limit the upper HR. Any time his heart is beating on its own without pacing (happens when the block isn't 100%) there is no way the pacer slow it down.

Actually the more serious situation is where the person is paced 100% and they try to push past the upper pacing limit. The pacer enforces the limit by causing the heart to skip beats which results in a sudden drop in HR along with irregular rhythm. The result is a drop in blood flow when his body needs it most. Not a good thing. You might check his pulse when he is pushing it.

A am 80 yrs old and very active. I ran into this when I first needed a pacer 5 yrs ago. I had a bit of a bruha with the cardiologist but finally had my upper limit set to 150. At my age I don't go there but it is up to me to monitor it. I'm still good for around 140 which is well past what the charts say for my age, but they are just conservative estimates.

hope this helps,

frank

ElectricFrank.... our own little Energizer Bunny

by COBradyBunch - 2010-06-26 08:06:00

He just keeps going, and going, and going... At 80 Frank I hope I am half as active as you are...

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