Appointment with Cardiac Rehab Physio... - British Heart Fou...

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Appointment with Cardiac Rehab Physio tomorrow pm

Heather1957 profile image

This will be the first appointment with anyone instigated by them since 19th June (op on 2nd June) when the Cardiac nurse visited.

I am going to say that I think this is a poor service from them and I am not going to accept NHS cut backs as an excuse as it doesn't seem to happen elsewhere, then I am going to get on with it.

I have my legging, t shirt and trainers all ready as they will test my current fitness (Oh dear) I am dreading the scales but hopefully this will kick start my diet again as I have put on a stone (and a bit) of the 3 stone I had lost up to January. I have to admit I deserved to have put on more, but the stroke and operation kind of killed off my enthusiasm but I know if I don't get back to it, it could kill off me.

Onward and upward!! LOL!

95 Replies
skid112 profile image
skid112Heart Star

It will do you the world of good, have a good time

Hi Heather, I am pleased to hear you finally have your rehab pre-assessment. I had mine last Friday, which was possibly a little too soon. I now have a further wait until there is room on the course :-(

I know courses vary and I only had a stent but I saw nurse specialist and then physio who put me on a bike to test my tolerance. I also had an ECG - presumably for baseline.

I hope it goes well for you.............

Thanks for the info. Because I have had so many set backs with muscular and nerve problems maybe it would have been a problem but I really needed to be given some exercises to do at home.

I have already been given a date to attend at a leisure centre next month although I may have to change it. They talk about 3 sessions re diet etc so hopefully that will get me started on a fitness regime.

I'll make sure I don't put on any oil before I go now I know they will probably do an ECG as it stops the suckers from sticking as I discovered when I was discharged!! LOL!

my tolerance was tested using an incremental bleep test (no running in this bleep test :) ). I was not weighed or my height taken. had assessment friday first exercise class today.

I have 2 leaflets that I have read cover to cover - didn't take long but it doesn't say exactly what I am going to do. The letter says wear comfortable clothing and flat shoes or trainers and it will take about an hour.

The letter also says part of the test will involve a simple walk test on the flat to determine my level of fitness.

Yep the bleep test was just that a simple walk test between two points but time allowed got shorter and shorter. Alternatively I have heard (and this is about rehab in Cardiff) of something called the 6 minute walk test being used. This is what it says on the tin- how far one can walk in six minutes. Here is a video of the assessment at University Hospital South Wales c.2015:

That was very interesting although I fast forwarded him doing the laps. The Physio was the same as the woman who I met in the hospital and who had me walking up the stairs so they could discharge me - small world!

He was very full of himself but I suppose he was used to doing far more exercise than a lot of people and he looked in his 30's so still young. It was interesting to see that they advised that his HR should not be more than 115 initially I had better keep checking my fitbit!

Yes he was in his 30's. He had congenital heart disease treated for endocarditis at Bristol.

Obviously a fit young man too!

Twobells profile image
Twobells in reply to Heather1957

Like me Heather lol, I was a fit woman before all this. Walked yesterday got breathless very quickly, stuck what to do now.

Heather1957 profile image
Heather1957 in reply to Twobells

I was never THAT fit but need to up my game - I played 10 pin bowling tonight as my great nephew always has a birthday game followed by a pub meal - it all went great I just hope I don't regret it tomorrow.

My Auntie and her friend are going swimming on Monday at 7.30 am so I have booked, Monday, Tuesday and Thursday all at 7.30 am and outdoors!!! The pool is heated though so hopefully I will get some exercise done.

My fitbit says not to go swimming with it on so I don't know how I am going to check my heart rate.

Twobells profile image
Twobells in reply to Heather1957

Be careful not to over stretch your arms when you swim as you can still pull on the muscle tissues . I remember you having nerve pain post surgery. I wasn't super fit, if only. it's just some days I am extremely fatigued. Hopefully you get rehab sorted. Don't risk getting shingles though it can make you very ill.

Heather1957 profile image
Heather1957 in reply to Twobells

Oh I have had my share of nerve and muscle pain. First 6 weeks fine, then discharged and told I can drive then for another 5 weeks I was in such pain, I would drive for a mile or 2 then not be able to drive for a week and even lying in bed was agony - hard to imagine now as I have had 2 very good weeks, if it wasn't for the scar I would be pain free. I do expect there to be set backs, I had a fair share but at the moment (dare I say it) I fee so much better, probably why I was so disappointed when they cancelled this appointment.

Twobells profile image
Twobells in reply to Heather1957

I stopped my rehab after 3rd session, I just couldn't get on with the programme. saw cardiologist and he was amazed at how well I was doing. But I walk most days at least a couple of miles, but I am hoping to just increase my walking at my own pace if my body says stop I stop. I don't want to worry about how fast or slow my heart rate is so I am not going to focus on the numbers. Enjoy your swim.

Heather1957 profile image
Heather1957 in reply to Twobells

Thanks - I suppose I want the chance to mix (in person) with others who have had similar ops to me.

I feel very isolated in many ways as I haven't seen anyone apart from the cardiac nurse on 19th June and surgical registrar on 17th July for discharge.

Maybe I won't want to go after a few sessions but I do need a kick up the backside to exercise so the chances are I will take all they offer.

Twobells profile image
Twobells in reply to Heather1957

That was the only positive thing I got out of rehab. Like you I have diabetes which was diagnosed when I was a 14 I They say the heart attack was caused by diabetes or it certainly a risk factor. I just never realised it could affect me. I was one of the younger ones there and no-one had a bypass. I think partly I was really struggling mentally at the time. I was so shell shocked at what happened I couldn't deal with anything medical to do with hearts. The help I could have done with was some kind of counselling, but none was ever offered, so I just didn't go back.

Heather1957 profile image
Heather1957 in reply to Twobells

I agree counselling (IMHO) is a must and I amazed that this doesn't seem to be offered, I am still not sure it has completely sunk in yet and I was told in Jan it was going to happen.

As I mentioned on another thread I am pretty sure I am going to take advantage of the cognitive therapy that is free with the insurance I pay as I really am concerned that it is going to come back and bite me on the bum!!

Twobells profile image
Twobells in reply to Heather1957

Definitely take it up if you can. It can't do any harm. I am on a waiting list to see someone,but I needed the help earlier, but I will go for it as I feel I need to talk it through. It seems to be hit and miss. But I still struggle at night to sleep. Let's hope you get another appointment quickly. There is a GP referral you can get to go directly to a local gym. They offer six free sessions of rehab. Phone your gym ask if they have anything like that. They are run by qualified physio but it may bridge the gap until your rehab starts and you can do both at the same time.

Good luck today Heather. The exercise is just how she was doing it in yhe vidio.

After your warm up you go on all the gym equipment. Also they lay out a few exercise with weights etc.

The best bit is the chil out at the end. Ten to fifteen minutes.

Then in our one they always did a talk on different things like diet one wk, then meds the next etc

Have fun now 😊

I think today is just the assessment and I start at the gym (leisure centre) after they have assessed me - I am actually looking forward to it, I do need a kick up the behind to get me going.

They didn't do that test with me. I went twice 2014 then 2016.

I think our gym was too sml at Bristol.

I do remember people being tested walking around the bars sometimes.

I gusss it may have been because I walked about five to six miles to get there each time ☺

Yeah the Guy was treated at Bristol and did rehab at Cardiff.

Hi Heather. There are various ways they assess your fitness level, which they then factor in to determine your exercising heart rate. I had a step test where you step up and down in time with a metronome. The pace is picked up at intervals and they ask you to give an indication of how tired you're feeling, based on 1-10.

However they do it, it's nothing to worry about. I found the assessment was the point where I started thinking I was finally going to start on the mend. Up until then I was sort of in limbo.

Rehab is also nothing to worry about.. 10 minute warm up, mostly walking/walking on the spot, and stretching. You then use the equipment for a couple of minutes each for 20-30 minutes, then a 10 minute cooldown. That's then followed by a chill out session, and they then measure your heart rate.. if it hasn't slowed down enough you might have to sit there a bit longer until it does but that's it really.

The three classes I had were done separately to the exercise classes, and in a lecture theatre. You probably already know most of it by now anyway. It gives you chance to ask general questions on diet, exercise, wellbeing etc so go prepared if you have anything you want to know. Questions specific to you can be discussed with the rehab nurses.

It's important to keep going with the rehab classes and as you near the end it pays to start thinking about how you want to carry on after it finishes. If you get to the end with no plan, it's easy to let it slip and you might find it hard to get started again when you have no-one pushing you. That's the worst thing you can do. You'll feel much fitter at the end of rehab, and much stronger in your head about what you can and can't do.

Good luck and enjoy!

Heather1957 profile image
Heather1957 in reply to Marc68

Hi Marc I think you have more or less described how it is done here (I think) The classes are separate from the exercises and yes, as I am a diabetic I have had input on most of this. I am looking forward to it all starting now as I feel ready and am feeling good today, in fact for the last week I have been been feeling as good as pre op, it is just the scar that is the reminder, but I also need to remember that I have had major surgery and have had knock backs before so trying not to get too enthusiastic.

My assessment appointment is at 13.30 and in an old hospital which is only 10 mins from me, although the actual activities are about 30 mins away in a leisure centre, still not too bad especially now I am driving again (without pain.)

I'm home, chilling now but will report back after the assessment.

Thanks again Marc.

Marc68 profile image
Marc68 in reply to Heather1957

Hi Heather. The rehab nurses will keep track of you and will most take your heart rate when you are on one of the exercise machines. They'll then tell you if you are working fine, not hard enough, or too hard. One of the aims, by the end of rehab, is for you to be able to tell when your heart is going too fast without actually measuring it, so when you are out and about in everyday life you can feel if your heart is pounding for any reason and take action.

You can get surprisingly accurate. I went for a walk last night but beforehand I could feel my heart rate was a bit higher than normal (no idea why). When my fitness tracker was on it confirmed it was about 10-15bpm above what it usually is, so I tempered down my walk accordingly. Rehab taught me to "feel" the difference. If I hadn't got a HR monitor on or felt the difference I'd have pushed myself as I have been and my HR could have reached dangerous levels.

Sounds obvious, I know, but be honest when you tell them how you're feeling in the assessment.. you might do yourself some harm if you indicate you're fitter than you are, or conversely, not exercise hard enough if you underestimate it.

Keep us posted. :-)

Well you couldn't make this up!! I had showered and changed into something more comfortable and the phone goes and it is the physio to say she has shingles, she is practically in tears and said I can still go and see if her if I need to. I was not a happy bunny especially in light of the fact I have already waited 13 weeks for this appointment! I voiced my unhappiness but what could I do. I felt that I could not take the appointment as I don't know very much about shingles other than it is very unpleasant and being 1 of 5 children I suspect I have had chicken pox but my mother can't remember although I believe you can still get shingles if you have had chickenpox?

I have asked to go onto a cancellation waiting list as I live so close to the old hospital, I will put my leggings, tshirt and trainers in my car so if I get a call I can be there very quickly.

I asked a few questions about HR and she said based on my age and that I am on beta blockers 116 is the maximum my heart rate should be (without seeing me)

I am really disappointed as I so wanted to get started - as I said you just couldn't make this up!!

Marc68 profile image
Marc68 in reply to Heather1957

It never rains, but it pours Heather! How disappointing for you.

Heather1957 profile image
Heather1957 in reply to Marc68

I can't believe it!! I was so ready! No point in dwelling now, I'll have to keep up the walking and dancing!! ;-)

skid112 profile image
skid112Heart Star in reply to Heather1957

what a shame, I do hope they manage to get you a spot quickly but as Marc says its all exercise and it all helps

anke123 profile image
anke123 in reply to Heather1957

Hi Heather, only just read your post and all the answers, it takes a while reading it all. what a dissappointmnet for you after waiting so long to get on the program.

I went to cardio rehab after having 1 stent fitted, but it sounds different from the others. It was 13 weeks, the first few sessions I was fitted with a ecg monitor to check heart rate. We only did walking round for 30 minutes one sessions then the next one cycling. After the first few I then also did a bit of weights 2 kg ones in each hand and using a bar 8 kg. The heart rate has never been mentioned at all, the assessment at the end did say it had improved. I still go to an after care program and next time will ask about heart rates.

Keep up the good work with your walking and dancing, all the best

It's all exercise Heather, whether you do it at rehab or not. Keep smiling. :-)

Heather1957 profile image
Heather1957 in reply to Marc68

Absolutely! I did ask about heart rate maximums and she said that without an assessment she would work it out on age and that I am on beta blockers. She gave me a maximum of 116 but at this stage should aim for between 98 - 103. At the time she asked my resting HR was 72 so at least I have something to look out for.

I was 'peeked', so long may it continue! :-)

My given rate was 110bpm, which I stuck to religiously, but now think that's too low for me. It limits me to walking and that's it! I'm currently waiting for a response from the consultant cardiologist about it.

At least you have a HR you can work to while you wait for rehab. Hope it happens soon for you.

Absolutely Marc I just wanted to have a little something to work with.

Do you still go to rehab? I wondered if someone there could give you some information re the heart rate.

I had my HA last November 5th, had stents fitted on 7th, and started rehab on 7th December (my birthday of all days!). Rehab finished on Feb 6th. At the end of rehab you have another assessment. Mine was by the same fella who gave me the 110bpm at the pre-assessment. I spoke to him in detail about what I wanted to do, ie. shark fishing, but he didn't want to change the 110bpm figure, despite him saying I was fairly fit beforehand and had made "significant improvement to my fitness" during rehab. That's what I can't get my head around. I was/am fairly fit, not that old, yet my exercise heart rate is as low as it gets. No-one wants to change it (or GP's even discuss it) despite me being told it was a minor HA, with minimal heart muscle damage, and I'm classed as low risk... all these things don't stack up. Either my heart rate is wrong, or I haven't been told the full story.

As I say, I'm waiting for a response from the cardiologist as he's my very last hope. I've tried everyone else but no-one wants to stick their head above the parapet. I can only think that a treadmill stress test, which I've never been offered, will be the only way to get to the bottom of it. We'll see.

Heather1957 profile image
Heather1957 in reply to Marc68

I am not an expert (far from it) but doesn't your heart rate get lower the fitter you become? Say at the start you walk at the same pace for a mile and your heart rate is 110 at the peak. If you continue to do the same as you become fitter then I suspect the peak of your heart rate on the same mile would drop to say 100 and continue to drop.

So the fitter you become you shouldn't need to up the heart rate as the things you do should not exert you as they do when you are unfit.

So there shouldn't be a need to increase the heart rate it should be up to us to get fitter.

Am I totally off the mark?

You're bang on the money Heather. I can now walk 5 miles without even breathing very hard and I only get near the 110bpm as I get into the 4th mile. Most of the time I don't reach it. As my fitness has improved my actual rate when walking has lowered by 5-10bpm since I bought my fitness tacker. I now jog short distances during walks when my HR drops to 100 just to get it back up.

Exercising isn't the issue for me and it wouldn't bother me if I had to stay at 110bpm for it... I've got zero plans to take up running or anything like that. You may remember my long post about shark fishing a while back... I need to be clear on my true max HR because of the adrenaline rush that will undoubtedly push my HR up, despite how fit I get. There's a lot riding on me getting accurate info... I'm thinking of eventually moving to the coast if I buy a boat to do it.

Heather1957 profile image
Heather1957 in reply to Marc68

I see what you mean but not sure how you can prepare for that as I guess each experience would increase the HR in different ways. Is there anyone you know who is of about the same ability as you who is prepared to wear a fitbit or monitor and record their HR during the experience? I know it is unlikely to be the same as you but at least you will have a ball park figure at what you may reach if you go back to the shark fishing!

I have a fear of sharks (great white especially) Crocodiles and alligators - I have lots of other fears but they are top of my list so I suspect my HR would be off the scales!!

Every time would be different but my HR would always be highest at the end of the fight when you get the shark boatside. There's too much happening that you have to concentrate on at that point so trying to control your HR in those minutes would go out of the window. It's not a normal situation for sure and I wouldn't expect anyone to give me specific advice relating to it but other patients must have to deal with adrenaline spikes... skydiving for instance.

I don't have anyone who I can really ask about their HR at the critical point but I do know other heart patients go shark fishing. The secretary of the Shark Club of GB has told me there are members with heart issues. Trouble is, you have to catch a big shark to be eligible to join the club, and without joining you can't access the members to speak to them! Catch 22.

A great white was at the very top of my fish wishlist for a long time. It came off when they were classed as an endangered species and most places in the world banned fishing for them. Since the ban, their numbers have increased dramatically and the ban is being lifted in a lot of places.. typical, now I could do it, I physically can't! Not even I'm dumb enough to think I can fight a 15ft, 2000lb shark.. not now anyway! lol

Heather1957 profile image
Heather1957 in reply to Marc68

Still grappling with 'sky diving'.

I have had several holidays in Australia and swam on the Great Barrier Reef and at all times am humming the Jaws song to myself.

Last time we did 10 days on the beach in a place called Rockingham nr Perth and I was petrified that a great white would come in as apparently Perth has a fair few,

Not for me with or without heart troubles!!! :-D

Marc68 profile image
Marc68 in reply to Heather1957

lol. They can smell fear you know! :-D

This is as active as I am going to get (for now)

skid112 profile image
skid112Heart Star

Hi, interrupting here, I was told not to exceed 120 at my rehab, but now routinely hit 135/140 hill walking and cross trainer. I wasn't given any post rehab targets have generally relied on my GP, my sense of I am feeling OK (yes i do stop). I would consider Marc to be massively fitter than I was pre and post am stunned you are only allowed 110

Heather1957 profile image
Heather1957 in reply to skid112

When I spoke to the cardio physio she has based my HR on age and the fact I am on beta blockers, so maybe this is the difference between the 2 of you.

I was given 120 also at rehab. But I think that was purely for the rehab exercises. Like skid112, I wasn't told that was the rate I had to consider gor future exertion.

I could be wrong, but I would see it as, build up, buildup. There is no one T/shirt fits all with fitness or beta blockers. I am on them & as far as I am concerned. I just have to you my head & listen to my body.

I really don't think any cardiologist will be able to give you the awnser you are looking for.

As we all handle adrenaline differently.

I have had many things due to security work & St John Ambulance over the years, that cause my adrenaline to go through the roof.

Mind management is the key.

I believe when you posted about it before I was saying you can find strategies on how to use mindfulness or controlling your heart rate when it could be under extreme pressure.

This would then prepare you on how to cope with that sudden adrenaline rush when it happens.

Fight or flight ☺

As long as you get yourself to the fittest you can & you work on your mind. Then there should be no reason you can do it.

Of course I am just a fellow patient like you, with no medical experience at all.

I'm just a mum 😊

Marc68 profile image
Marc68 in reply to Sina-6491

Hi Jo,

I agree with you and I've done everything I can to enable me to keep my HR down but there's no getting round the fact that adrenaline is going to make it rise, and quickly. I've been building my rate up but there must come a point where it becomes dangerous. That's the point I'm trying to figure out. If I have to do it by trial and error with no professional guidance it becomes very risky.

I don't think any/many people are given a rate to follow after rehab, but as my situation was out of the ordinary I spoke to the assessor in detail about it. That's when he advised to keep it at 110bpm but I honestly think he was just erring on the side of caution. I can understand that but it doesn't help me progress at all.

I'd be more than happy for a professional to simply say I can safely work at a higher rate as my fitness improves, even if I don't get an actual figure, but I do need medical advice about any impact of my other issues.

Hopefully I'll get a response from the cardiologist soon.

Sina-6491 profile image
Sina-6491 in reply to Marc68

Yes I sent that message before I read you had other issues.

So I think you are not really in the recovery stage I thought you was.

I agree, you do need to be careful due to the outstanding issues.

I think you m a y have to wait a while yet before you can take on th a t kind of physical or mental presure.

Sorry to sound negative after my possitive. But you really need to be clear on your other heart issues begore you can really move forward on the shark fishing 😐

Marc68 profile image
Marc68 in reply to Sina-6491

I'm fitter now than I have been for many years Jo and I don't think I have either physical or mental issues that would stop me doing it but like all of us, i'm no medical expert. I don't know if my other issues are sufficient reason not to do it. I only found out about the RV branch a few weeks ago, and that was purely by accident.

Sina-6491 profile image
Sina-6491 in reply to Marc68

Hahaaa, I didn't mean mental in the way you are probably thinking.

I meant the making your mind stronger at coping with adrenaline rush, haha, bless ya.

Now my mind however, well that's a different matter????

I think that is a bit crazy, ha, well never a dull moment so to speak. It always seems to be on overload with my over thinking everything hahaa.

Yeah you need to talk direct to your cardiologist team I recon.

They are the only ones who will be able to sus out how you different issues would come together in the event of that kind of both physical & adrenaline rush.

I don't think you will be happy until you do.

Trouble is, I don't think they will want to commit themselves to say you will probs be ok.

You needbto find out exactly how each of these issues effect the heart under stress.

Keep us updated now 😊

Marc68 profile image
Marc68 in reply to Sina-6491

Don't worry Jo. I didn't think you were calling me a nutter. Even if you were, it wouldn't be the first time anyway. :-D

I know what you're saying about mentally coping with adrenaline but there is a point where you have to concentrate 100% on what's going on. If you don't you might get seriously injured, or pulled over the side and drown. There's nothing, mentally or physically, that I can do at that point to keep my adrenaline in check and my HR down.

It's not a matter of being happy.. I just want a straight answer so I can get on with my life... that's not too much to ask is it?

I haven't even mentioned the fact that this RV branch problem hasn't ever been mentioned to me by a cardiologist, a consultant cardiologist or three GP's! I won't bore you all, and me, with that! ;-)

As i've mentioned, it's with the consultant cardiologist now so we'll see if he comes back with anything. I hope so as I'm fast running out of options.

Sina-6491 profile image
Sina-6491 in reply to Marc68

Mmmm, soinds like me with my own heart issues. I never really feel like I am getting any clear answers.

And like you, I really haven't been able to move on right from where I had my HA.

Because I can't get the work side sorted, it has got in the way of the social side of things ☺

Marc68 profile image
Marc68 in reply to skid112

You're not interrupting at all Mark. I welcome your thoughts.

I noticed recently that you went upto 150bpm when out hill walking and was wondering how you settled on that figure. To be honest, over the last month i've been pushing my rate a bit when out walking. I started off jogging until I got to 120 then slowed down to keep it around that rate, the week after upto 130, and the week after that upto 140. Only for a few minutes each time but a few times each session, and I had no issues from it. To anyone reading, I wouldn't recommend doing this without medical approval.

I'm not sure how fit you think I was before, or am now, but I'm not sure I'd call myself any fitter than you mate... and certainly not massively.

I have a couple of other issues with my heart that might be why my rate is so low but I wasn't told about either of them. I've got mild to moderate aortic valve regurgitation (no LV expansion and a yearly follow up ECG planned for November) and I have a "massive RV branch with moderate to severe disease at it's ostium" which has "slow flow". That bit worries me as I asked, and was told, at the time the stents were fitted that they'd only found a very minor blockage in another artery that was so small it would sort itself out with lifestyle changes. I sort of knew there was a discrepancy after the word "severe" was mentioned by the nurse in my rehab pre-assessment but didn't know to what it referred. How something can be called both "minor" and "severe" is beyond me. That's the second thing I've asked the cardiologist this week in an email.

Sina-6491 profile image
Sina-6491 in reply to Marc68

Yes you need to get that clarified 😊

skid112 profile image
skid112Heart Star

57 on beta blockers as well, Marc I think is ten years younger

I am 59 (60 next month) and on beta blockers and she gave me a max of 116 so I suppose that's about right.

Hopefully one of the medical people on here can give us a better idea how this is all calculated.

I have to say even with my walks I have not exceeded 100 so I need to up my game a bit - hopefully the line dancing will push it up.

Even in my fittest days running was not for me - I am just not built for it!

Just because yours hasn't gone up as much doesn't mean you are not working as hard.

Once at rehab, I worked harder than ever, felt like I would pass out.

My rate hardly moved at all.

They told me it isn't always the case that it goes up a lot when you have exerted yourself. Especially if you normally have a slow heart rate ☺☺

This is why I would like to try something different to walking so the line dancing will start tomorrow Ya ha!!

Oh, sounds great fun. Go girl😀

I'm 48 and on beta blockers.

For men, the calculation of the target heart rate is 220 minus age, and for women it's 206 minus age. That gives a target heart rate but I assume the figures are for someone who doesn't have heart problems. From what I gather, the reduction in bpm that the beta blockers provide is taken off the target rate, although this should ideally be measured before and after bb's are taken to determine the actual reduction (very difficult to do when you are put on a drugs quickly, for the right reasons).

Heather, your calculation could have been 206 - 60 = 146, minus an arbitrary 30bpm for bb's = 116.

If I applied that to myself it would be 220 - 48 = 172, minus 30 = 142bpm.... which doesn't tie up with the 110 rate given.

Marks calculation based on the same principle is closer but also doesn't quite work out and would have been 133, not 120.

This leads me to believe, all things being equal, that adjustments are made for different heart issues. How/if this is done I've no idea. I wish I did know so I could work it out myself.

You might have guessed, I've spent an inordinate amount of time, over the last 6 months, trying to get this sorted and so far I'm none the wiser! Hopefully the top man will get back to me soon.

Heather1957 profile image
Heather1957 in reply to Marc68

I totally get why you need to understand how this is all calculated. I am a theorist by nature and am more likely to accept something if I understand why.

There must be details of how calculations are made somewhere, where I don't know though.

The physio was talking about 3 different figures but I couldn't quite understand what she was talking about which was when she told me that for now I should aim for between 98 - 103 but my max was 116.

When I eventually get to see someone I will try and get more info.

Hi heather do you mind me asking what the physio is for? Was it something we were all meant to have after surgery☺

I don't mind at all - yes I believe we are all supposed to have cardio rehab physio. I will eventually attend a gym and do various monitored exercises which should help the rehab.

Before this starts you have to be assessed but I have been cancelled twice and am now week 13 of post op and would have benefited from some kind of rehab and assessment before now.

I am looking forward to meeting others who have gone through the same as me as well as the exercises themselves but at this rate I am not sure how much good they will help my recovery.

I will still go though as I don't want to intentionally miss out on anything available to me.

Yes I think it is obviously different depending on where you live.

At Bristol you go to first rehab, they ask questions & go from there. No phsyo first :)))

I have just found the following but it does not include the rates for those taking medication.

Heart Rate

You can measure how hard your heart is working by taking your heart rate (counting your pulse). Everyone has a peak heart rate and a target heart rate. Your peak heart rate is how fast your heart can beat during an exercise test. You will not be exercising at this rate. Your target heart rate is 70-85% of your peak heart rate. To get the best cardiovascular results with minimal risk of injury, you will need to exercise at your target heart rate for 30-45 minutes four to five times a week.

A simple (but not exact) way of finding your target heart rate (THR) is to subtract your age from 220 and then take 65-80% of that number. This method does not work if you are taking medicine that slows down your heart rate.

Target Heart Rate (THR) Example

AGE 30 35 40 45 50 55 60 65 70 75 80

THR (75 %) 145 143 142140 138 136 135 133 132 130 125

Sorry the format doesn't work but the top figure relates to age and the relevant HR is below. For me without medication it is 135

If you have not had an exercise stress test since starting the medication, the adjustment the Physio made to the max heart rate might be fairly out. I know my beta blocker reduced maximum heart rate 2x more than my cardio had expected. So take the value with a pinch of salt. If you feel you are working at 11-13 on the Borg scale and your not near 116- do not try and push 116. It may be the medication is having more of an effect than planned on your mac heart rate.

I was already on BB when I did the stress test so have no idea what my HR was previously.

Marc68 profile image
Marc68 in reply to Heather1957

I think there are 2 or 3 ways they work it out Heather but the 220, or 206, minus age seems the most prevalent. As my post above though, it doesn't tie in with what they advise so even adjusting for beta blockers, which as Midgeymoo points out is very difficult to estimate with any accuracy, there must be more involved.

The variation you get between 65% and 80% is pretty big as well, 112 vs 138 for me, so what determines which % criteria to use? Are the figures adjusted for heart conditions, and how? ie. surely someone with one stent in a single occluded artery who hasn't suffered a HA can't be worked out the same as someone with multiple and/or more serious heart problems.

I came across the same 65-80% equation a while back, which at 65% could explain my low figure, but as I was told I had a fairly minor HA with minimal damage, and was classed as low risk, it wouldn't make sense to use the lowest % to determine my THR? Maybe it is the other issues I have but it'd be good if someone could tell me if that's the case as that would make me more ill than I've been led to believe, and I will need to be a bit more careful on how I exert myself. My quest for a proper HR may seem pedantic to some, but these are big questions.

I understand this is never going to be an exact science but there must surely be some common guidelines. The more I think about it, the more I think that only a treadmill ecg stress test is going to give me the answer I need though. That's the only way I can see that will be specific to me.

I'll let you know if the consultant cardiologist sheds any light on it.

skid112 profile image
skid112Heart Star

Doesn't seem to be any correlation at all, which doesn't surprise me.

My recent hill walks in Spain an average of 72 minutes walked, longest 87 minutes (I got lost) shortest 53 minutes, average BPM was 105 to 106 with a peak of 145, around 7000 steps, or three miles according to my weekly Fitbit stats.

My 150 was gained from a personal trainer, who specialises in medical/post heart ops. Don't see him that often but seeing him again Saturday will ask him some questions.

The message from this is obviously we're all very confused!!


The school holidays are nearly over - is there any reason why I can't go swimming? I am 13 weeks down the line and apart from tightness my scar seems to be healing okay - is the chlorine in the water a possible problem?

My Rehabilitation team were happy for swimming to start at 10-12 weeks post operation (after telling me off for swimming week 5 post- op 😏 ) Provided you have had no issues with scar healing the chlorine is not an issue. There are two things to consider though:

1) The way pressure works in water is substantially different to air. Although I am a physicist I am not going to explain the physical principals . You may find swimming on your back more comfortable to start with as the water exerts a large upwards force on your body, if on your front obvious this force would be applied directly to scar and breastbone.

2) Water is 1000x (i think) the density of air this makes its demand on the heart greater than a lot of land based activities and you can not feel any sweating so if you use the Borg scale to monitor exertion you may find it takes a little while to recalibrate your perceived exertion rate.

On memory from rehab, I think it is just the temperature you have to be accurate with. I can't remember what the temp was lol. I would go on the Bhf website if I was you. Just to make sure you can at this stage of recovery, I am sure you can.

I haven't really got anyone to go with atm. Not brave enough to go on my own, silly ha....😕

Will do! I will have to go on my own, we have a relatively new outdoor heated lid here in Pontypridd that I have never used before. It is only £1 per adult so cheap enough. There is a 7.30 am session, I am not a morning person but thought that time would suit me better.

That would definately be my time, I like early starts.

Your far braver than me, so cheap & such a fab way to exercise.

You enjoy girl 😊

The bit about temperature was do not go where it's to cold or too hot. For an ideal temperature range a pool should be between 25-32 degrees. Outdoor pools tend to be a little lower than this. At the lowest 20 degrees below this people(heart condition or not) really should be considering a wet suit.

skid112 profile image
skid112Heart Star

try here,

Heather1957 profile image
Heather1957 in reply to skid112

Thanks! :-)

Sina-6491 profile image
Sina-6491 in reply to skid112

That is a really good link. I forgot about the pressure on the heart stuff. Glad I read through it 😊

I think the best stroke to start with would be the breast stroke Heather. Your arms remain in front of you and don't spread wide apart like all of the other strokes. There's no need to hold your breath with breast stroke either. Breath out when you're head is underwater.. if you go that fast of course. If you keep it slow you don't need to dip your head anyway.

I'd forget butterfly for now! lol.

Heather1957 profile image
Heather1957 in reply to Marc68

I have to admit that while I am an okay swimmer I can really only do the breast stroke properly. Steady Eddy that's me. 40 years ago I got my Bronze medallion life saving award and for the timed swim I had to breast stroke like mad!! :-)

This says something about how long the RLSS did not update there awards as I did my bronze medallion 5 years ago. Although the RLSS changed the award structure 3 years ago.

Lol. As a kid, my parents wouldn't let me go fishing on my own until I learnt how to swim so I swam from an early age. Typical me, ended up getting serious about it and swam competitively until the age of about 15, training 4 nights a week for years. Other swimmers then started sprouting to 6ft+ and I couldn't compete with them in breast stroke or freestyle so ended up having to swim butterfly, and hated it. That was the beginning of the end for me. Still enjoy a good swim though.. I might go myself sometime.

There's a park lake where I used to fish that has/had an outdoor swimming club. All the members were over 60 years old, and some much, much older. Come rain or shine, they'd be out swimming and I even saw them break ice to jump in on more than one occasion! They swore by it for keeping the heart healthy! Perhaps I should have joined them!

skid112 profile image
skid112Heart Star

OK, been to the trainer man, seems I misread, misheard or something, my peak should be 220 minus my age, 57 and only 80% of that until i have got some semblance of fitness, he was pretty shocked at the 145 and asked how long it lasted, how did I feel etc. So my max should be 130 or thereabouts. he did say in a few months (if i carry on) I could look to 140 but it would be a while until i could peak above that. I did tell him at rehab I was allowed 120 but as he pointed out I was monitored the whole time, if I am alone on a hill walk who is looking then.

Oh well no charging up hills for a while and will take more note of the readings

Heather1957 profile image
Heather1957 in reply to skid112

I know it is very frustrating but you have to be very careful. I have been moving some light furniture around while emptying the kitchen ( my spare bedroom will never be the same!!) At the peak my HR only reached 101!!

I had a late lunch so when that has been digested I shall try a little line dancing. I have looked at one on line that seems quite simple so I'll give that a go. It says you can dance to any country song and as I have plenty of those I will start off with a slow one.

skid you sound quite fit anyway especially with your hill walking but maybe take it a little slower for now - you are doing amazing!

skid112 profile image
skid112Heart Star in reply to Heather1957

Aww thanks Heather, from couch potato to fitness haha, I used to play a lot of sport, used to go to the gym 4/5 times a week, bike rides. All this I used to!! Then kids growing up, more hours at work just all seemed to stop. Second chance aim to grab with both hands

Heather1957 profile image
Heather1957 in reply to skid112

I do some work with a male colleague who had a heart attack about 3 years ago - he has lost 5 stone and runs every night - I will be seeing him in a couple of weeks and no doubt he'll tell me off for putting on some weight. He is a little older than me (60) but says he is fitter now than when he was in his youth. There is nothing they can do for him so it is just medication and keeping healthy.

I don't find pleasure in keep fit per say so I need to find something I know I'll stick at - let's hope the dancing and swimming are the key.

Marc68 profile image
Marc68 in reply to skid112

Hi Mark. I'm sorry, I seem to have dragged you down into my realm of lower rates. :-(

I'm glad that your higher rate exercising hasn't caused you any problems, but it goes to show that your heart is capable of doing it, which can only increase your confidence, even if you (we) have been pushing it.

I wonder what he means when he said only 80% until you get some semblance of fitness. Walking 6 miles as you do every day seems fairly fit to me but is he saying that eventually you might get to 90 or even 100% of your THR?

skid112 profile image
skid112Heart Star

Haha not a problem at least there does seem to be method behind it all. He's looking at 90% doesn't see any reason not to aim for the 100 but it depends on me, the heart and keeping up the regime.

Walking 6 miles is good but the weight loss has stalled, hence the trainer to mix it up, bike, stepper and a few weights all within a controlled environment.

Marc68 profile image
Marc68 in reply to skid112

Looking at everything we've all said on this thread does seem to point to there being a (loose) method to it all although I'm not sure how beta blockers affect what your trainer is saying. He must have considered them in his figures though as I'm sure he knows about them.

With your rehab THR of 120 equating to around 75% of your THR, and my rehab THR being 10% less at 65%, if I assume that eventually you can reach 100%, my max THR could be 90%, which for me would be 220-48=172 x 90% = 154.

If I give myself a bit of room for error and say I'll only ever get to 85% of THR then my max rate would be 146bpm, and for 80% it would be 138. That sort of feels right to me, to be able to reach about 140 or so eventually, and perhaps be able to tolerate short term spikes upto 150 or so.

If I don't get proper advice from the professionals I think I might stick with those numbers as my max rate.

Thanks all for your invaluable posts, I think you've all helped me estimate my own max THR and be able to finally put this to bed after months of agonising over it. Just got to get fitter now and find out how high the adrenaline pushes my HR. Like you Mark, my weight loss has also stalled so I need to kick the exercise up a notch I reckon.

Apologies for hijacking your thread as well Heather. I really hope you get booked in soon. I would urge you to finish the rehab course though if you can.. you can't really get the confidence it gives you from anywhere else imho. :-)

Heather1957 profile image
Heather1957 in reply to Marc68

No problem Marc I suspect your agonising has been helpful to us all!!

Heather1957 profile image
Heather1957 in reply to Marc68

I have become a bit obsessed about my heart rate (not in a silly way) I do a bit of kitchen clearing then check my HR if it is high (which it has tended to be) it is a good excuse/reason to have a sit down.

Marc68 profile image
Marc68 in reply to Heather1957

Information is power Heather. The more you know how your HR reacts to things, the easier everyday life will become as you'll know what you should and shouldn't be doing without monitoring yourself. I now know that I can walk as fast as my legs will take me and I won't reach 110bpm. I also know that jogging for 100m or thereabouts will raise it to 120, and 200m upto 130+.

As Mark has said, by keeping track of such metrics, you can track your fitness levels. Seeing real evidence that your fitness is improving gives you motivation to do more.

skid112 profile image
skid112Heart Star

Not obsessed at all, keep an eye on it when you rest after exercise, if it falls back quickly to normal you're getting fitter!

I know this thread is old, but I was disturbed by how little info, and therefore how much worry there was around cardiac rehab. I'm a level 4 cardiac rehab instructor (so the stage after cardiac rehab phase 3 in the hospital) at a leisure centre. I'm willing to answer any questions, explain it a bit more if anyone would like me to. I've observed phase 3 as part of my training so know a bit about that. It is life changing and you will not regret it at all if you go along. Just ask if you want to know anything how silly it may sound. I've been getting loads of help from the afib part of this website where I am the newbie so I know how it feels.

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