Exercise after aortic valve replacement with mechanical valve

[Spock1189]

Hi all, my first post.

I'm 34 years old and in July 18 I had a mechanical aortic valve fitted, replacing my previous tissue valve replacement (2008) which had expired. I'm taking warfarin. I recently had my outpatient checkup with echo etc, and they said all was well. Next one in 18 months.

I've also completed a cardiac rehab course, which is where my questions started.

I'm no athlete, but I've always enjoyed cycling and racket sports. At cardiac rehab I was taught to exercise at a much lower intensity than I'm used to, and was recording heart rates of 120bpm typically during the classes. I was warned that doing "strenuous" exercise may be counterproductive in terms of cardiac health. This was surprising to me, as I've gone through my entire life thinking that, when it comes to exercise, harder is better (as long as one does proper warm up and cool down, etc).

More recently I've kept this in mind, but I'm finding it really hard to do the types of exercise I enjoy at such a low intensity. I cycle to work some days, 6miles and mostly flat, but it's a real struggle to go slowly enough to keep my heart rate down to the "moderate" levels I was told to aim for. My body naturally wants to work harder than this (nice problem to have, I guess).

I've asked questions of nurses and cardiologists at every opportunity, and the answers have ranged from "stop worrying" to "your valve won't last as long if you work it too hard". Nobody seems to be able to offer clear guidance.

Do others have experience that can help me navigate this? My primary concern is maximising my cardiac health and minimising the chances of needing further surgery. Does this mean ditching my racing bike and getting one with a nice springy saddle?! What have other mechanical AVR replacement patients who want to be active been told?

All the best,

Ashley

[ILowe]

I was 35 when I had an artificial Mitral Valve fitted. Some googling.

"The American Heart Association recommends that a person does exercise that is vigorous enough to raise their heart rate to their target heart-rate zone—50 percent to 85 percent of their maximum heart rate, which is 220 beats per minute (bpm) minus their age for adults—for at least 30 minutes on most days, or about 150 minutes a week in total. " scientificamerican.com/arti... . So, 85% = around 160 for you.

The trouble with this advice is that it assumes we are all standard. It worked for me -- my resting HR is 70-80, but would not apply to someone with a resting HR of 60. Then there is the fact that a fit person and a fit heart means reduced HR for the same activity.

At your age I did lots of walking and tried to keep below 150. Temporary overdrive to 160 was fine. To avoid continually checking my pulse, I switch to the talking test-- can I comfortably hold a conversation.

When swimming, I try to avoid gasping for air -- that really shoots up the heart rate. Unfortunately some youngsters not following the pool rules seem oblivious to the distress they cause other swimmers.

If you do not get replies here, try searching on the sister forum for Atrial Fibrillation. There are many threads there, since hard exercise is a known cause of Atrial Fibrillation.

[Spock1189 in reply to ILowe]

Thanks for your reply ILowe, 150 is where I am trying to stay also. I also worry that the 220-age rule is one-size fits all, so I've been searching for some advice from the cardiology community which takes account of my specific situation. Maybe I will go back to the cardiac rehab team with more questions.

[ILowe in reply to Spock1189]

Good idea, go with questions. I have found them to be more effective than presenting the results of my own research. But, people are human and do not like to admit it when they do not know. I know that many health workers are out of date.

I look for the health worker who is willing to explain, and, crucially, willing to let me come back with more questions. I tell doctors to persuade me, because a persuaded patient is more compliant. [That can touch a nerve, since there is a whole on-going discussion about patient compliance]. So, they persuade me, I get home, and I feel it is not right but do not know why. So I do what is safe for a few days, research and ask others, then take my own decision.