MoAlpha

This is the general experience of fit people going for stress tests. The procedures, limits, and diagnostic criteria are for a high-risk segment of a sedentary population and no one wants patients crumping on their treadmill.

GhostRider62

I know you are a Doc.

When I had two cardiac stress tests from two different Cardiologists, both wanted me to max out. Having had a CT calcium scan and echocardiogram already, they were looking for something a little different than blood supply.

On the first one, the Techs were *****ing and moaning how long it was taking to get my HR going and wanted to abort the test early (130 bpm approx) I jumped off and said, "fine, call Doctor so and sowho was the Chief at the hospital before going private practice exclusively). After some debate, they restarted the test and followed the orders prescribed.

On the second stress test, an echo was done just before the test and once I maxed out at 183 bpm and 18.xx metabolic units, they immediately did another echo cardiogram but I had to hold my breath for 20 seconds while they got whatever data they wanted. 183 bpm and holding the breath at my age was damed hard to do. I did it because they told me to do it. BL: do what the Cardiologist wants you to do.

As for OP's question about setting HR zones, it depends on your objective. If you want to build you aerobic capacity, ride lots and lots at a HR where you can just talk but with some slightly additional effort. If you are racing, get a PM and lactate meter.

Carbonfiberboy 

No, that's backwards. The unfit person can more easily attain their max HR. Just riding moderately will cause the unfit rider to have a HR in what will become the upper range of their Z3.

Why? Because as one becomes fitter, one's heart gets stronger, literally more muscular, and plasma volume increases. These things lower one's HR throughout the HR spectrum. It's a larger effect of increasing aerobic fitness than any increase in skeletal muscle strength.

There's a metric which puts a number on how much one's HR increases when power is held steady. The more fit one gets, the lower that metric, thus the longer one has to hold high power to attain high HRs, one of the big advantages of using power instead of HR when doing intervals.

Bald Paul

"I'm not a cardiologist, but I play one on the internet."
When my cardiologist tells me I shouldn't exceed a certain HR, I tend to listen to him. You do what you want to do.

terrymorse 

I'm not a cardiologists, either. But I've heard that some cardiologists are not accustomed to working with trained masters athletes, who have a different profile than the general population.

"It is worth emphasizing that in the most heavily trained athletes, a standard Bruce graded exercise protocol may not be sufficient and other more aggressive exercise studies may be needed. More aggressive graded exercise protocols such as the Astrand and Astrand-Saltin are done at increased speed and incline to help accommodate the greater aerobic capacity of an athlete. Often times, however, graded protocols fail to push an athlete to exhaustion. In these cases, a non-graded sport specific protocol can be designed for the athlete using very high intensity intervals. It is important to emphasize testing athletes in a manner that most closely reproduces the demands of the sport, both training and competition (e.g., exercise rowers with an ergometer). These specially designed protocols should take into account the strains unique to each athlete's event."

-- Peritz et al, The Role of Stress Testing on the Older Athlete, American College of Cardiology

MoAlpha

Not being a cardiologist, I'm not sure what all of that was about, but the general goal of stress testing is to look for evidence of cardiac ischemia under exercise conditions and that can be done in a number of ways, including the ECG, thallium scanning, echo, etc. The fact that they pushed you makes it sound like you have a smart cardiologist who knows you're an athlete and understands that you're going to go out and push it. I don't think that's the norm, but maybe it's changing.

Carbonfiberboy 

Yeah, I had a stupid cardiologist who gave me the standard 15' instrumented nuclear treadmill test and told me there was nothing wrong with me. With my issue, my HR has to very gradually come up over say 30' to over 120HR, at which point I have heart pain and would pass out if I didn't stop immediately. Had 2 syncopes on my rollers proving that point, but so far can't get a cardiologist to instrument me and let me push it. It's been 7 months of seeing the same 2 cardiologists, one a electro doc and the other a cath doc. The cath doc put in 2 stents which made no difference at all. That would have been $75K w/o insurance, not that I'm sorry he did it.. Meanwhile, no diagnosis, nada, just one inconclusive appointment after another, all because they don't know what they're doing when it comes to an aging athletic heart. I'm trying to get an appointment with a sports cardiologist. My PCP is pretty sure the problem is electrical. I'm not particularly hopeful - it's gradually getting worse.

pdlamb

Just to be clear, my cardiologist had cleared me "to do whatever you want to do" at my previous appointment. Like GhostRider62's tech, my tech was reading off a chart without factoring in I'd been doing a lot of cycling for years. (Though riding slower than my cardiologist!)

MikeWMass

Ask your cardiologist for a loop monitor, wear it while you do your ride that makes you symptomatic, and push the button when you start feeling your symptoms.

Carbonfiberboy 

I suspect that might be in my future. My first cardiologist put one on me, but told me not to exceed a 110 HR. I didn't and no result. See what I mean about stupid.

But lets get back to the thread subject. More than enough about me.

Kai Winters

Meh, do what you want, ride as you want...

staehpj1

How reasonable or unreasonable the 110 HR restriction is would seem to vary with your MHR. If you have a high MHR a HR of 110 might not even let you get to the very bottom of the aerobic zone. It seems really odd for the doc put you on a loop monitor and essentially say no aerobic exercise at all. I'd probably be looking for a different cardiologist which it sounds like are doing. Hopefully your primary care doc can steer you to one that will take a better approach.

staehpj1

Die as you want?
On a more serious note. I guess it is almost always a bad idea to ignore the docs advice, but I might have pushed the HR the extra 10 BPM beyond his restriction while wearing the monitor to get the data.

Kai Winters

If you want...sure...not my monkey, not my circus...

rbrides

HAHAHAHAHAHAHAHA! Very nice!

Classtime 

I think our cardiologists are learning a lot from us. Mine used to tell me to take it easy. I said ok. Then went about my business of riding. The whole point of getting my heart surgery was to get back to living and that meant doing what I do. He doesn't say take it easy anymore and when I tell him what I do on the bike, he says ok.

scottfsmith

Back on the original topic, one way not mentioned to set the top of zone 2 (a good benchmark point) is to do a long (say 2-3 hour) consistent effort and if HR doesn’t creep up (assuming not dehydrated hungry etc) it means you are not over the top of zone 2. I informally use this to gauge if I overdid it on a long “zone 2” ride and it helps calibrate things over time.

oldbobcat

My cardiologist just found a ventricular tachycardia, so my orders are, take your meds, wear a HRM, and don't overdo it until we learn more about it. My prescription heart monitor is on order.

Kai Winters

And that is one reason not to use a 'regular' doctor and testing to determine max heart rate for an aerobic athlete.
Sports Doctor's services would be more appropriate as they are testing for athletic max rather than keeping you 'alive' as would a regular doctor.
Don't mix them but also be aware of your health level 'before' seeking the testing of an athletic based medical service.