athletes in cardiac rehabilitation aaron w. harding, m.s., rcep, aacvpr coordinator, cardiac...
TRANSCRIPT
Athletes in Cardiac Rehabilitation
Aaron W. Harding, M.S., RCEP, AACVPRCoordinator, Cardiac Rehabilitation
Disclosures
Names, photos and medical information presented in this lecture is either public knowledge or permission has been granted for use.
I am peddling a book from one of the athletes.
Young Athletes
Cause of SCD in young athletes (<35yr)- Hypertrophic Cardiomyopathy 26.4%
- Commotio Cordis 19.9%
- Coronary anomalies 13.7%
- LVH 7.5%
- Myocarditis 5.2%
Maron, BJ. N Engl J Med 2003; 349: 1064-1075.
Athletes Over 35 yrs
Most prevalence cause of sudden cardiac death is atherosclerosis
Prevalence of Cardiovascular Risk Factors in Athletes
- 10-year evaluation
- 623 athletes (529 men, 94 women)
- Age 13-77 yrs
- Amateur and professional
- Soccer, cycling, triathlon, running
De Matos, LDNJ. Med Sci Sports Exer 2011; Vol. 43, No. 6, pp 943-950.
Prevalence of Cardiovascular Risk Factors in Athletes
- 17% of distance runners had dyslipidemia or glucose alterations
- 9% had hypertension
- Age correlated with risk factors
- <35yr 39% had LDL >100mg/dl
De Matos, LDNJ. Med Sci Sports Exer 2011; Vol. 43, No. 6, pp 943-950.
What do you do when he shows up in cardiac rehab?
NOT your Grandfather’s Cardiac Rehab
CRAIG
-43 yrs old
-Elite masters runner (OTC)
-Feb. 2011 10km (33:11)Year-end #2 US #8 World
-March 25, 2011 MI/Stent
CRAIG
High RHR (55bpm)
High training HR (150-170bpm)
Goal: Return to competition
One of the Experts
Paul Thompson, MD
Director of Cardiology
Hartford Hospital, CT
A Past President of ACSM
Ran in 1972 Olympic Trials marathon
Finished 16th in 1976 Boston Marathon
Research on Running and the Heart
Atrial Fibrillation in Endurance Trained AthletesSorokin, AV, et al. Br J Sports Med 2009.
Cardiac autonomic neural remodeling and
susceptibility to sudden cardiac death: effect of
endurance exercise training.Billman, GE. Am J Physiol Heart Circ Physiol. 2009
Oct;297(4):H1171-93. Epub 2009 Aug 14.
-Risk of SCD increases 5-7 fold for marathon and strenuous activity (only doubles for most fit)
-Risk 30-50 fold for weekend warriors/sedentary
-Risk of overall SCD 30-50% less for regular exercisers
The Risks of Running and SCD
-Risk of SCD increases 5-7 fold for marathon and strenuous activity (only doubles for most fit)
-Risk 30-50 fold for weekend warriors/sedentary
-Risk of overall SCD 30-50% less for regular exercisers
Dr. Thompson’s Advice
Encourages athletes not to push their hearts to the upper limit of intensity.
If athlete really wants to engage in ultimate performance again, he first gets LDL to the 60mg/dl range 2 years to stablize plaque.
Back to CRAIG
Started with walking, then included jogging intervals after reaching about 6 MET level.
Used HR, BP and RPE to guide increases
Used HR monitor and recent history of training to guesstimate AT
CRAIG Back to Competition
June 17, 2011 8km (26:58, 5:26 pace) in local road race, 1st place overall
3000m on track (9:29.1) 1st master
Year-end #2 US
Achilles is now limiting factor
Quote from CRAIG about cardiac rehabilitation
“I was very happy with the cardiac rehab program and I can’t imagine someone not going through the program following a cardiac event. My cardiologist described it as very optional, but not going to cardiac rehab would have been a big mistake.”
STEVE
-62 yrs old
-Swam at 1969 NCAA meet
-Elite masters swimmer
-7 national records
-25 national titles
-Oct. 2010 MV Repair + ASD Repair
STEVE’s Training
-Used TM for training in cardiac rehab (walking/running)
-Also, used upper body modalities to condition arms for swimming
-1hr swim in Jan. 2010 as benchmark (85% of prior year)
STEVE Back to Competition
-April 2011, won race at Oregon state masters swimming championships
-August 2011 won lake race
-September 2011 training race (back to 98-100%)
Quote from STEVEabout cardiac rehabilitation
“The thing I liked most about rehab was the calibration of how hard I could push. I had a tendency to protect myself from pushing too hard and rehab helped reset that.”
JEFF
-45 yrs old
-Ran marathon in 1997 (4:50’s)
-Training for both Portland and Seattle Marathons in 2005
-April 2005, 3VCABG
JEFF’s Ambitious Goal
-Still wanted to run Portland Marathon in October 2005.
-Resting and training HR was still relatively high at 3 months post surgery.
-Put him Phase III and set a realistic goal of running Seattle Marathon in late November 2005
JEFF’s Training (All About Compromise)
-Gave him a HR monitor for home and instructed to keep HR <140.
-Gradually increased volume, even in staged runs.
-Use VO2 test to measure anaerobic threshold (HR 152).
-Plan for marathon was run first 20 miles at HR under 152, after that he could do want he wanted (Time 4:20).
JEFF Back to Competition
-Seattle Marathon 2005
(7 months after surgery in a 31-minute PR)
-Coeur d’Alene Ironman 3 times
-Warrior Dash
JEFF Giving Back
-Shares his experience
-Book
-Volunteers
-ACSM Personal Trainer
-Cardiac Athletes
www.cardiacathletes.org
Guidelines for Working with Athletes in Cardiac Rehabilitation
-Still have CAD risk factors
-Still have psychosocial adjustments
-May also have dietary issues that need addressed
Exercise Guidelines for Athletes in Cardiac Rehabilitation
-May start similar to other patients, but progress faster.
-You do not have to be an expert in the athletes sport.
-Can use ECG, HR, BP and RPE similar to other patients.
-May also use advanced tools (VO2max, HR monitors, field tests [eg. Cooper 12min run/walk]).
