big john

Definitely not standard practice. Depends on the insurance you have and how hard your primary care doctor fights to get the referral. I was having a-fib symptoms a few years ago and after the first doctor referred me to a cardiologist the insurance denied it.. It took a second doctor and about an 8 month wait until the insurance finally agreed. By then the symptoms had diminished.

Marylander

I was referred by my GP. Besides bad genetics for blood pressure and cholesterol (things the GP could handle) I have an aortic aneurysm so I have to go for regular cardiology checks to see if it's getting bigger (so far so good).

PeteHski

Thanks. That makes sense now. Having never had any heart related symptoms I’ve never given it a second thought about whether or not intense exercise is bad for your heart and have never consulted a cardiologist about exercise or anything else.

But I do know that structured training, which includes periods of controlled, intense exercise, is certainly beneficial to your cardio performance and overall fitness. Limiting yourself to only moderate intensity exercise is guaranteed to limit your fitness, although any exercise is infinitely better than none.

PeteHski

That makes sense, thanks. I can fully understand how people in your position would wish to consult with a cardio specialist before starting any new form of exercise.

Mark Stone

Love this post, and it reflects my experience also. All (yes, all) of my family members that are around my age (68) are experiencing severe health and cognitive problems, along with most of my friends. My lifetime of riding (along with aerobic walking) sure colors my life differently. I've been an "activist" with my younger relatives and friends - start cycling now, do it for a lifetime, enjoy the scenery, and then when you're "old" enjoy the benefits.

peterws

I sometimes wonder about my heart. Guess I have done for the last 30 years; i get a blood test every year usually, and my doctor says I'm fine. But my doubts remain since I'm in my 70s (HR too slow, and misses a beat now and again when I'm reclining)
He will however, permit me an ECG which will convey a lot of info. His wife does the ECG . . .. .

OldTryGuy

Why not get an at home personal ECG monitor as a supplement for the more accurate professional. At least you will have immediate at hand current data.

https://www.healthline.com/health/ec...r#how-we-chose

hereandnow

Understood that obviously everyone is different, but i don't see "For a small percentage" in journals or medical discussions of the topic re: your second sentence above. I see it as much more applicable to everyone. For example (sorry I can't post links) take a few minutes to listen to Dr. Peter Attia's The Drive podcast #134 (Oct. 20,2020) with cardiologist Dr. James O'Keefe starting at around 21 minutes. Let's just say these are two data-driven and highly credentialed physicians who are former intensive exercise athletes.

Again, I love cycling and all that goes with it. Just interested in getting others' thoughts (ha, without intentions being misinterpreted!).

For those not int'd in listening firsthand, fwiw, here are some ROUGH, unproofed notes:

Exercise is a wonder drug for preventing heart disease, but if you don't get the dose right you are likely doing damage. The proper dose of exercise is relatively small. Your benefit goes down a lot with the wrong dose, you lose a third of the benefit with intensive exercise. When you're exercising hard, the soft, pliable chambers in the heart (the right and left atrium and the left ventricle) get distended, they overstretch. The chambers dilate up. We aren't evolutionarily designed for that. It throws off "exhaust" in the form of free radicals....after 45-50-60 minutes of hard exercise, you start overtaxing and damaging the heart muscle, with elevated troponin. There's small microdamage...tearing of the myocardial fibers...creates a high level of free radicals that are now unbuffered. Training for longevity is much different than training for peak exercise....so what are your goals? Are you serving the longevity master or performance master? You irritate your heart through too much exercise, it suffers. ~Each heart is basically capable of a predestined number of heartbeats...it's estimated that a person has about 3 billion heartbeats in a lifetime.

terrymorse 

Yeah, O'Keefe is "data-driven", but the data that drives him is: "I used to exercise intensively, and now I have a heart problem, therefore intensive exercise is bad".

The actual data say a very different thing:



The conclusion bears repeating:

no definitive data to support practitioners advice against high-level exercise

Print that out, tape it to your wall, look at it every time you get the feeling that exercise might kill you.

PeteHski

If high intensity exercise scares you, which I get the distinct impression it does, then simply don’t do it.

As for longevity vs performance I’ll actually take performance. But at my moderate level of performance I very much doubt it is a major trade-off! We’re not pro level athletes smashing ourselves into the ground to win Grand Tours and Olympic medals.

So just do whatever you are comfortable with and stop trying to justify it with cherry picked science. If you are reasonably fit then you will probably die of something else anyway.

The idea that you have a pre-determined number of heart beats is pretty tough to validate. But if true you will find that a fitter person with a lower resting HR will use them up at a slower rate than your average couch potato, despite relatively short periods of time spent at higher HR levels.

spelger

Serious question...how do you know you miss a beat? Sometimes I feel a bit of pressure either on an inhale or more rarely on an exhale but am convienced it is not heart related.

terrymorse 

To me, it feels like a fish flopped inside my chest, followed by a brief silent period where there are no heartbeats, then it's right back to normal rhythm.

"lub-dub, lub-dub, FLOP!, (brief silence), lub-dub, lub-dub"

It's not really a skipped beat. It's called Premature Ventricular Contractions, or PVCs. Mostly benign, but they can be annoying.

I recorded this with my Apple Watch when I was getting frequent PVCs in 2019 (I dialed back my training volume, and the PVCs went away for the most part):



An Apple Watch ECG showing two PVCs

GhostRider62

Does your GP take an ECG at your yearly checkup? If not, they would likely not detect a rhythm problem. What bloodwork is taken yearly?

I am amazed how long it takes to get an appointment for a Specialist in the UK but at least it is free.

Champlaincycler

Except that it does not always go back to normal contractions. Sometimes your heartbeat stays irregular. I've been reading this thread for a bit and was/am hesitant to chime in. Guess it's time. I'm 68, have always had the so called trained heart with resting rates around 50 even when I fell out of shape. I set up a bike on a trainer and a rowing machine in my outbuilding this past winter. Did lots of HIIT workouts, really enjoyed the challenge as I like the feeling of busting it hard and being out of breath. Did them 5-6 times a week for 3 months, lost 25 lbs and felt great. Once outside on the bike, I followed it up by doing hill repeats and intervals and generally just trying to get faster then I've been in past years. My pulse is easily taken, at night watching tv, it began to drop to low 40's. Thought that was good. It sometimes went below 30 and I began to be concerned. Then it became erratic. HR monitor while biking was just chaotic and it was freaking me out even though I felt ok. Dr. time and EKG, and Holter monitor confirmed that I have significant PVC's. Echo cardiogram shows my heart is great but HR is a bit crazy, they could not even take my blood pressure as HR wasn't consistent enough to get a reading. First appt with a Cardiologist is 2 weeks from now. I'm taking easy bike rides and not pushing it until we figure it out. I have 5 older brothers that are on the edge of slovenly and have no cardiac issues, I'm the one that always ran/swam/biked, played basketball etc. . I really don't know why this is occurring, but the only thing different in my life over the past 6 months was a lot of HIIT workouts. maybe irrelevant, maybe not. So, none of us really knows what's going on with the other. I can't even figure out what's going on with me.. I do like to read about experiences and thoughts of other forum members, seems a good group.

PeteHski

5-6 times per week is a lot for true HIIT workouts. 2-3 times max is the usual recommendation I read. Hard to recover from more than that. I’ve always followed structured training plans and they never have more than 3 high intensity workouts per week and often only 1 or 2.

PeteHski

I don’t have yearly checkups and never had an ECG ever. I’ve had literally 2 blood tests in my life and one general checkup at 50. Now at 53 I might start thinking about more regular checks, but I don’t suspect any issues. I do wear a HRM 24/7 and that has never shown any erratic data. Blood pressure has always been fine too, the odd time I’ve had it checked.

alo

A lot of people let themselves get unfit. Then the advice is, don''t overdo it. A better approach is to maintain a decent level of fitness as you get older.

GhostRider62

I never suspected anything either. ECG showed an abnormality. Turns out my heart stops for 4-8 seconds many times per evening while sleeping.

My BP is fine. Heart rate monitor doesn't complain. Blood work is fine. No blockages in heart. Just a little electrical issue on mine.

PeteHski

I wear my HRM in bed and have never seen it stop or even drop very low. It records every 5 seconds, so I guess it could miss the odd stoppage, but I'm sure it would pick up anything significant.
A check wouldn't do any harm of course, but I don't worry about it too much.

bikemig 

I know my recovery times have gone downhill over time. I watch my sleep and slack off if exercise gets in the way of my sleep. I schedule one hard work out a week.

GhostRider62

I am 100% sure it would NOT

PeteHski

I'm curious why you think it would miss a very low HR if it was lasting for more than a couple of seconds?

philbob57

I think an HR of 12 beats at the right time would fool an HRM that samples every 5 seconds. That's probably too low for a human being.

GhostRider62

I did not say that and neither did you.

I am curious why you are putting words into both of our mouths. Please read what you wrote, my response, and then do a little research.

terrymorse 

You just checked off a bunch of factors for getting PVCs:

• lifetime athlete
• high intensity training
• little or no recovery days

I've been there, ramped up my training too fast without adequate rest, and the thing that reduced my PVCs was adding more rest days (then taking a long COVID season on the couch).

The good news is that PVCs are very common in endurance athletes, they are not associated with an increased risk of cardiac death, and they almost always reduce in response to rest.

Since I tend to overdo my training, I've been watching the Garmin Connect's 7-Day Training Load graph, keeping the training load within the green (optimal) zone:




There's also a "Relative Effort" graph on Strava that's useful for dosing your weekly training and recovery:




The goal is to keep the weekly effort within the gray band.