Running and Max Rate

I recently had a PM installed and the rest rate is set at 50 and Max rate is at 155. I'm 49 and consider myself in good shape and have run one full marathon and numerous halves, 10k's etc. I have never given Max heart rate any thoughts and never worried about it till now. I took 2 months off of running and am now getting back into it and find my self like a beginner again and starting all over. Does the pacemaker slow a person down, make your heart weaker because its being helped or what seems like I can't go the same speed any more? What should my max rate be set at or will I have any say on what it is set at. I am hoping to do a couple of marathons again this year but getting kinda worried. Did 11 kilometers last Sunday and average time was 5.29 klm.
Perry

12 Comments

New PacemakerP

by SMITTY - 2009-01-19 09:01:05


Hello PC,

I can't tell you why you find yourself like a beginner, as you say, since getting a pacemaker. That would be a question for your doctor. I will say that I doubt that the problem is caused by your pacemaker SETTINGS of low at 50 and high at 155.

So far as I know all pacemakers being implanted today are on demand pacemakers. That simply means the pacemaker monitors your heart beats and steps in to help out whenever your heart rate drops below a certain rate. As for the settings, the low setting, which you said was 50, means that your pacemaker will come on line when your heart rate drops below 50 and maintain a heart rate of at least that rate. The upper setting of 155 means that when your heart rate goes above that rate, the pacemaker takes itself out of the game but continues to monitor your heart rate.

There is another feature on our pacemakers called rate response. This feature is not always activated, but when rate response is activated it monitors your body movements and if it determines there is physical activity, then the rate response will increase your heart rate. This feature is a problem for some and just what impact it may have on a long distance runner, I'll not even try to guess.

I would suggest that you have a heart to heart talk with the doctor(s) that implanted your pacemaker. A pacemaker has an almost infinite number of settings. The wrong setting can be a real problem. The bad part is that not every doctor or nurse/technician can determine the best setting for a particular a person. So it make take several attempts to get the very best setting for you. Let me add here that the settings I'm talking about here are totally different from the low and high setting mentioned earlier. These settings mostly involve timing, delays and strength of the PM impulse.

Also on your questions "Does the pacemaker slow a person down, make your heart weaker because its being helped or what seems like I can't go the same speed any more?" a pacemaker should lot slow a person down, (I can't even think of how the PM could do that) and it should certainly not make your heart weaker. If I could make a guess about what you are seeing, I will say your pacemaker settings need some serious adjustments.

You say you got your PM recently. One thing many of us has learned is that the initial settings are not our optimum settings, but I don't necessarily feel that is a reflection on the doctor. A PM comes with some factory setting and then the doctor, based on his knowledge of the patient, will make the changes in those setting that he deems best. But sometimes these settings need to be fine tuned.

Again, discuss your situation with your doctor. A PM should only improve the quality of life for a patient.

Good luck,

Smitty

max rate

by Tracey_E - 2009-01-19 09:01:57

You didn't mention why you got the pm but it sounds like an av block. I will change some of my answers if it's an atrial problem :o)

It takes some time to get back to your old stamina, esp after 2 months off with a surgery in there. Work back gradually, you'll be back where you were before you know it. The body just needs time to heal. The year is early yet, you should be able to do marathons this year.

There have been some studies that say that over many years the pm can weaken the heart and make it less responsive to the impulse to beat. *shrug* So does aging, I'm not losing any sleep worrying about it! Having a very slow or irregular heart beat does more damage to our organs than the pm does to our heart so it's irrelevant, I think. Btw, I'm 42 and got my first pm at 27 and my EF (ejection fraction, how they measure cardiac output) is the same as it always has been.

Anyway, that's long term, nothing that would be affecting you now. Our hearts are still doing the beating, they're just getting the signal to beat from the pm sometimes rather than our own electrical system. The pm is filling in a gap in a circuit, not taking over how our hearts beat.

Max rate... they usually send us home with a max rate of 120 or 130. Mine is currently at 170, but it was bumped up that high gradually, not all at once. I kept hitting my max rate when I was working out. I'd fuss about getting dizzy, they'd confirm my atrial rate was going higher than the max rate (how high the ventricle is programmed to keep up with the atria) and make it a little higher. I still bump it occasionally, but my pm only goes to 180 so we don't want to put it any higher than it is now.

Long story short, there is no right number for the upper rate. However high your heart gets when you work out is where yours should be, plus a bit of a cushion. If you are having trouble getting them to adjust it so that you can work out easily, ask for a stress test. It can tell them more than the pm reports about what your heart does with exercise.

When you get your pm interrogation, ask for a copy of the before and after reports. A couple of the guys here can tell you what all the numbers mean.

Pace maker adjustments

by PC - 2009-01-19 10:01:12

Thanks
I have just had the PM installed in Sept 08 because I fainted and my heart rate was too low and irregular (I think heart block, brachecardia??) My heart rate was 30 and I was up walking around and felt fine before surgery. I have fainted on and off maybe 6 times over the last 25 years or so, never paid much attention. This time I fell and wacked a concrete floor head first and knocked myself out. I also have frozen shoulder and I think a torn muscle on my right shoulder not left that I am still dealing with.
I just want to make sure the adjustments are correct and am learning lots from you guys and this site. After six weeks I went for a check up and they adjusted my low rate from 60 to 50 and max from130 to 155. I did ask for a print out of the interrogation and have this for reference.
Just read somewhere that if your max is set to low the machine does a skip beat so want to make sure that is not happening. You are probably right in that I just need to get back into shape and should give it some time. I have so many questions that I think I am over worrying about everything??
Perry

Upper settings

by heckboy - 2009-01-19 10:01:59

It was explained to me that a PM contraction isn't as efficient as a natural one and that an upper limit above 170 might not have the desired result even though a healthy heart can beat much faster than that.

There are many people with PMs that have run marathons and I am a relatively active 46 year old and go to the gym regurally. Keep adjusting those settings tho...there are many more things ot keep track of than just the upper and lower limits.

had same problems

by albie - 2009-01-19 11:01:09


I read the response by smitty and felt the need to chime in. He typed "the upper setting of 155 means that when your heart rate goes above that rate, the pacemaker takes itself out of the game but continues to monitor your heart rate". That is not true for the settings on my second device.

I too was having problems when I reached the high rate especially running on the treadmill. It would automatically drop my rate to 125 (that is what it was set at) and I felt like I hit a wall until I slowed down and let my body adjust to that rate. The Doc called it wonkey mode. He raised my high rate to somewhere around 180 and I haven't had any other problems.

Upper lImit

by ElectricFrank - 2009-01-20 01:01:10

As Tracey mentioned this is only for AV block which is what you seem to have.

The upper limit is enforced by the pacer skipping beats. It measures the time interval between beats and if a following atrial beat occurs in less than a set time it doen't pass that beat on to the ventricles. So what happens is as you near the upper limit your heart starts intermittently skipping beats as some beats come sooner than others.

If you keep pushing it every atrial beat is too soon so it skips one and of course the next one is OK so it beats, followed by another too soon, etc. The effect is that your HR drops to one half of the atrial beat. So if your upper limit is set to 150 and you push it to 160, your ventricular beat will be 80.

This is not a good situation. You are exercising at a level that calls for a 160 HR and are getting a 80 HR. At this point you fatigue rapidly. The answer is to monitor your HR and stay just below your set limit. If that works out for you then ask to have the limit increased to 160-170. I found that if I let the cardiologist know that I was monitoring my HR and keeping it below the limit he was more willing to increase it. They are used to the "jock" approach of just pressing on. Hitting the upper limit is risky enough at 150BPM, but not good at all at 170 and up. At those levels of exercise having your HR drop to one half leaves even your heart deprived of the blood flow it needs.

I'm 78 and have my upper limit set at 150. I try to keep it in the range of 140-145 and only use the 150 for some head room. Like I told the cardio, if I am being chased in the parking lot by a mugger I don't care what my target limit is!!

frank

12rwilson12

by 12rwilson12 - 2009-01-20 07:01:17

Hello. First time on site and response. In Feb 06 I passed out at my computer (looking for an income tax form so it's the irs's fault). End of story after many tests left the hosp. with a defibilator. I had polymorphic Vtac with tersaugue (SP?). Means I had screwed up electrical signals coming from many locations in the heart and fast heart rate 200+. tersauge means not a large chance of getting it but once you do the probability of getting it again is very high.
I try to be a runner. At first I couldn't get my hr hight enough to do much. I'ld run a 5K and be so tired at a 165 BPM even my eyelashes were tired (Max hr was 183 BPM--typical hr for last two miles of 5K were 170--175. Got the doc to adjust the program which helped a lot.
Then just about a year and a week later I had 3 therapies delivered (means I got shocked--heart went into Vtac) in 24 hrs. I went in and had ablat (SP?) done and while having the device removed from my leg it went off again. The next morning the defib was taken out and a combo defib/pacemaker installed (cloesest I'll ever be to owning a BMW). The idea is that my resting heart rate was so slow (45 bpm) that the heart was generating screwy signales in the rest breakes. the pacemaker keep the heart at around 70 then monitors when I start exercising. If my hr gets over 200 it looks real close and desides if its Vtac and if therapy should be given (nmot so far).
I'm experiencing something similar in that I can't seem to get my hr up much past 165 BPM which is to slow to compete at the level I need to. I've ran a couple of marathons this last year a 3:35 and 3:29.58 a month ago. In marathons I don't need my hr much above 155 as that is still in the easy run range. The problem I'm having is getting it above 165 for 5K's. Need to have it in the 170--175 range to be under 20:00 for a 5K. This may be a software problem will need to talk with doc at next appt.
For those of you that run any feedback would be great. Knows this is kind of long but thought you all might need some background.

thanks for listening (?).

bob

totally confused now!!!

by PC - 2009-01-20 11:01:13

Now I'm not sure where I should be in my max rate, the PM is set for 155 does anyone know roughly what should my max heart rate be set at or is this too vague a question. I not sure if my PM has any programming that affects me when I go over the 155. I do have the print out of the interogation if anyone here could decipher it, just ask me what I should look for on the print out?? I havn't ever checked my heart rate when I run. If I get to breathless I usually just slow down until its under control.
Perry

max rate

by Tracey_E - 2009-01-21 06:01:03

Perry, the max rate should be set about 10 bpm faster than you usually get when you work out. There is no magic number that works for everyone. If you are getting breathless, you are probably going above the max rate, that's what happens to me also. If in doubt, I'd ask for a stress test because it can tell them exactly what happens when you exercise, how high you get.

Frank and a few of the others can tell you what the numbers on the report mean. Just post them here.

Bob, if you're on medication and/or had ablations, your hr is going to change significantly. As I told Perry, ask for a stress test because it can tell them exactly what's going on when you get your rate up with exercise. You may not be able to safely get above 175 now, most pm's max out at 180 so they won't program it above 170. That's where mine is set and I try to stay under 160-165 when I work out so I dont' bump that upper limit.

Target HR

by ElectricFrank - 2009-01-22 12:01:20

Look at the following site for a discussion of exercise heart rate target. Keep in mind that these calculations assume a person with a normal heart.

http://www.righthealth.com/topic/Target_Heart_Rate_Formula/overview/fNaturalStandard?fdid=bottomline_ungraded_targetheartrate.xml§ion=Summary

If your pacer is set for a max HR of 155 it will definitely start skipping beats when you exceed it.

frank

I'm apparently in good company

by rogood - 2009-01-23 06:01:36

I'm a 57 year-old male who has been a runner for nearly 30 years (6 marathons, 30 halfs, countless 10k's and 5k's. I had a complete heart block, electrically speaking, and my heart rate was in the high 20's/low 30's. Other than being a little more tired than usual, I was largely asymptomic and never even came close to fainting. My PM was implanted on 12-1-08 and I started exercising on the 3rd, went skiing for 4 days a couple of weeks later and ran my first 3 mile run today (it wasn't freezing cold). My treadmill is boring, my stationary is fine (I read the paper and watch the news) and I did squats, sit-ups and started push-ups again (I was up to 100 per day, including on the day of my implant). I plan to run a 10-miler in May and a half-marathon in September. I also will be doing some modest to strenuous hiking overseas and in Vermont later this year. All sounds good and it is. I'm not much of a "group person", but I'm glad you're all here to learn from and share with. One of my near-term goals is to build up my chest muscles and shoulder muscles so that any strain from exercise, working in the yard, etc., can be absorbed by those muscles. I did the same sort of thing to keep my knees from getting worse. Any thoughts? I also look forward to pushing past 150 on the upper end - not there yet. Thanks, Bob

I replaced my pacemaker

by vitdoc - 2009-02-15 11:02:15

I developed 3rd degree AV block after heart surgery for an aortic aneurysm and aortic valve. I had two previous aortic valves at age 29 and 35 with my most recent surgery at age 58. With the multiple surgeries I developed complete block requiring a pacer. The pacer only went up to 150 max. It could not be increased with any software adjustments. Since I bicycle over 100 miles per week I had problems with my atrial rate wanting to go occasionally over 150. As previously mentioned when this happens there is a sudden precipitous drop in heart rate.
This was not fun. I tried to watch the rate with a monitor and slow down when it started to climb into the 140+ range but I was not always successful. So about 8 months after the initial pacer was placed I did some research and found one that was similar in its features to the one I had but could go up to 180. I convinced my local cardiologist to place it. He had not placed the first pacer. Aside from the risk of infection there is not too much to worry about so I had it done.
It works fine. I now can go over 150 without fear of dropping to 100 suddenly.

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