Cardiovascular Training

I have had my PM for 2 weeks now. So far, so good. I was cleared to start riding my stationary bike last week and it feels great to be able to exercise again. My upper limit is set at 140 for now until my next visit with my EP. My question is that as I get into more and more training, is it possible to use your heart rate as a training tool? Before my PM all my training used a heart rate monitor and I would check my pulse first thing every morning to check my recovery status. Now that my lower rate is set at 50 I can't do that anymore. Do I throw heart rate training out the window and just go with perceived exertion?

4 Comments

HR as training tool

by ElectricFrank - 2011-02-23 01:02:06

The two main issues here are Rate Response and lower/upper pacing limit.

If Rate Response is ON then your HR is useless as a measure of training because the pacemaker is determining your HR.

If RR is OFF then at rates between lower and upper limit your natural sinus pacemaker is doing its usual job and training is one of its inputs. The effect of lower and upper limits are quite different.

When your HR drops below the lower limit the pacer initiates atrial pacing at the lower limit and the ventricles follow. So when you check your HR in the morning it will either show an actual rate due to training or the lower limit whichever is higher. 50 shouldn't be a problem unless you are really well conditioned. If you are you may be able to have the lower limit dropped to 45 or so.

The upper limit doesn't necessarily keep your HR from going over 140. If you don';t have 100% block then your natural nerve bundle will conduct pacing to the ventricles and bypass the pacers attempt to withhold pacing. (hope this makes sense). Otherwise, the upper limit is enforced by the pacer skipping beats. This can produce some uncomfortable results when at a high exercise level your heart goes erratic. At a time when you need the high blood flow your heart withholds it. I have found the best approach to it is to monitor the rate during exercise and keep it at least 5 bpm below the limit. I find there is a tendency for HR to overshoot when I stop or slow the exercise level. As an example if I'm hiking up an incline and when my HR reaches 130 I stop for a break it will continue on up to as much as 140 before starting back down. I finally convince them to set my upper limit to 150 even though I'm 80 yrs old. I obviously don't want to push it that high, but I take responsibility for it rather than let the pacer do it.

And one last thing. You may find your HR monitor gives erratic or inaccurate readings. The ECG based types are the worst. With a pacer our ECG waveform is altered by the electrical pacing pulse. So at times the HR monitor will see both a pacing spike and the resulting ventricular pattern count both as beats. This can give the disconcerting effect of seeing your HR suddenly double and lead you to believe you are experiencing a run of vtach.

A bit long winded..hope it is helpful,

frank

Thanks Frank

by Firefoy - 2011-02-23 09:02:23

Here is some more info for you. My resting HR has been as low as 29 before I got my PM. And that was an asympotmatic 29. The morning of my implant I was at 43 bpm without having done any type of exercise for 7 months. I got my PM because my SA node fails to increase my HR above 115 bpm. My PM is a completely rate response since that is my problem. If I get that function turned off, it will not help me with my problem.

If I understand your response, my heart rate monitor has become useless.

Tim

yep franks right

by Hot Heart - 2011-02-24 08:02:05

hi tim, this is something ive learned a bit about, quite a lot from frank actually.

let your body be your guide, there is no need to push yourself to the limit to be healthy. In laymans terms exercise to your ability, beyond it to an extent, but dont bother about the heart rate any more, i never check mine at the gym. You know how hard you are working. The only time i check mine is sometimes in bed before sleep to make sure its still beating! lol

Exercise

by lessachs - 2011-03-01 12:03:10

My pm is set at 60 on the lower end--130 at the top.
The Medtronics rep told me the PM will not allow my rate to go below 60. I can go higher than 130 but at that point the heart is on its own without assistance from the PM. I'm used to exercise rates at 150+. I'm really not interested in pushing it above 130 right now since I've only had the PM three weeks. I think I need more time to adjust to this thing. For now, 120-130 is a fine exercise rate.

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