Chronotropic Incompetence

[PeterJemmett]

On 9th Feb I set myself the target to run parkrun in under 35 minutes by my 250th parkrun.

My best ever parkrun time is 26:32 and around that time I was regularly finishing in 27-28 minutes.

Those heady days are long gone of which some is down to aging and my evolving heart condition developing persistent AFib (ablation Dec 2023, A/F free since Jan 2024) and then CI (exercise intolerance), but I was hoping some of it was also due to a lack of self-discipline and will-power that I might be able to improve upon.

Since setting the challenge I have achieved the following times:

• Run 228 – 36:37

• Run 229 – 36:43

• Run 230 – 37:11

• Run 231 – 36:41

• Run 232 – 37:12 (yesterday)

If nothing else I am proving very consistent but I am starting to think this is about as good as it can get and maybe the target is out of reach. I believe my problem is caused by CI (Chronotropic Incompetence).

When first diagnosed via a stress exercise test in June 2023 (61% of predicted age heart rate) it seem to align with the start of my poorer parkrun times but it is difficult to find out what it really means and what to expect, whether it is progressive or if I could work to improve the condition through exercise? Whenever I have asked healthcare professionals about it they seem fairly vague.

Does anyone know anything about this condition and whether I can expect to improve my performance levels?

My parkrun records - PB remains 26:32, post Covid PB 30:31, CI PB 35:40, AFib PB 36:45

Heart attack to 10K photo collection, nice to get a few more running pictures instead of hospital visits in this album ... flickr.com/photos/93491398@...

Latest blog in my heart attack to 10K series - Life changes ... peterjemmett.blogspot.com/2...

[DWizza]

Hi Peter , I’m new to Parkrun but ran a couple of marathons ( and all the training that went with them 👍🏻) in a previous life. Just getting back into running and swimming. I say running but it is more jogging . I had nstemi and quadruple bypass July 2023 , had a great rehab bar some issues that seemed to relate to statin , during actual stop I felt fantastic and started Parkrun , changed statins 2 more times and settled in Rosuvastatin 10mg . Then discovered that I needed a new left hip .. had hip replacement October 2024 .. just completed couch to 5k with B2R ( Beginners to runners) via invite from my GP surgery . I found that my times are also around the 36 min mark. I managed nearer 30mins previously but I’m more focused on keeping my heart rate out of the 160s for the time being , I have low resting HR in the 40s and can get it up to to 170s and above with b hard efforts. Not sure I want to push hard any more . Like you, I find that there isn’t enough knowledge specifically about training, one cardiac coach says if you feel ok carry on , whereas most err on the side of caution. My consultant is absolutely vague , I have written and asked specific questions and all she has replied is “ I think you’re doing really rather well “ 🤣🤣🤣.. true but it doesn’t answer anything.

I’ve bumped into a few triathlon coaches whilst swim training and they offer me to join them , it all sounds like a great idea for about half an hour then I I think I’ll have add another training session ( bike) and ontop of my looking after our small holding and riding my motorbikes I think I really don’t need to do it.

I think you might need to find a knowledgeable coach , if you want to have a go at improving your times with some oversight.

I found the lead physio at rehab classes totally cautious, it was clear that I wasn’t their normal rehab patient , the classes were not tailor made to the individual… I’ll follow your post with interest to see what other runners post . Wishing you well 👊🏻👊🏻👊🏻

[PeterJemmett in reply to DWizza]

Thank you for your reply but it is specifically CI I am looking for advice.

I set myself 'SMART' goals to keep challenging myself and not really looking to break any records so don't want to get too serious with coaching, though it would be nice to achieve a sub 35 again!

We seem to have a fairly simliar cardiac history in I suffered a mild heart attack in Dec 2016 but was stented and then completed the rehab. for a 2nd time. I'm also on Rosuvastatin after trying a few other options first.

I took up running on parkrun the Oct following my HA having previously ran a few half marathons the last in 1993 but have managed a few 10K's another half marathon for charity since returning to running but don't think I would be able now. I wouldn't even call what I'm doing now jogging, it is very stop-start with 5K being about my limit. Prior to my heart attack I had been treated for hypertension and angina (1st angioplasty & stents 2013).

[Chinkoflight]

Hi Peter, a great post with lots of really interesting data questions which I personally think merits a professional answer. Firstly if I have CI I don't know it, I had an SCA on a Parkrun Jan 24. (M 71 then) I did C25K as a personal goal to fitness following a severe stroke in March 22. SCA idiopathic, stroke cryptogenic! I had never run before but really enjoyed C25K, could feel the benefit and over the 20 months to the SCA improved my time from c46 minutes to sub 36 with a target of 35. I ran off the mantra "exercise at conversational pace" so never pushed myself and never gasped for breath. I ran some 10k events too. Jogging had become like walking, I could keep going albeit slowly.

After the stroke because there was no obvious cause I had an ILR fitted, a 24/7/365 implanted ECG with a remote monitoring box. On my SCA this recorded a long LVT hence my syncope. This has never happened before and unlike the start of the stroke the SCA was instant and witnessed as I ran into the ground onto my face. Echocardiogram and angiogram were clear as well as ruling out another stroke and a brain bleed. The Cardiac MRI and subsequent PETscan couldn't confirm any diagnosis other than further tests to look for embolic or non ischaemic causes. Those test options were not offered, the ICD fitted and discharged.

Before this event I had noticed a pattern in my running from my smart watch data that showed a HR sharp spike generally in the first 0.5 - 1 km of running after warm up. This would climb rapidly to around 170-180bpm for about 5 minutes then equally sharply drop back to 140 or so. I was concerned enough to contact the EP and ask whether they had seen anything. The usual answer ensued, " we've not had any red flag reports from the monitor, throw your smartwatch away"! MY SCA has this pattern on my smart watch.

One year on I've come through a somewhat depressed (for me) two months because this pattern has come back. I attach a picture of today's run. I have been running off HR on my watch so immediately it climbs to 130-140 I stop running and walk until it settles back. As I progress in the run/walk mode eventually I can run (jog) and HR stays in acceptable band.

Nobody will offer any guidance on what is or isn't acceptable. I have to work this out for myself. I would like to get on a treadmill test but apparently they are going out of fashion and no longer offered.

I would love to get back to running and to improve back toy previous times but have hit a plateau of circa 41 minutes for 5k running off an HR of 130.

I would happily join a clinical study, I'm just amazed no one is doing this that I can Google for. Regarding explanation I believe adrenalin production may have something to do with it. Whatever , I have to hope my ICD works. I think I read somewhere they are 67% effective. Not the best of odds but life is for living.

A bit long winded

Cheers

Nigel

HR from 30 minute jog.

[Maxbar]

Fascinating stuff. That I am really interested in I have not had a heart attack but do have 70% blockage to my lad that could only be tackled with a balloon stent procedure. Was told I may need a single bypass but as I'm doing so well they have decided to watch and wait to see what happens ( just a bit nervous)Anyway I have always been a runner quite good in my younger days. They only found out about my blockage when I had persistent high BP. And sent me for all the usual tests.

Back to running 2 weeks before being given the angiogram that that found the blockage.

I had run a 10k in 58min which I said to my family was the hardest I've had to run to do a 10k. Now I know why. Back to the present I've had stress test that came back all good and told I can continue to exercise but build up gradually. Also went and had a work out with the rehab team as I told them I didn't know how hard I could push my heart ♥️ rate and stay safe. Advised me with the usual 220 minus your age which means do not go above 150, which I find nearly impossible to achieve unless I'm doing more or less a fast walk. Like you I find it a bit frustrating that nobody seems to want to set up a proper guidance (but is that even possible given everyone is slightly different) so I think you have thrown away the old training idea of no pain no gain.

And adopt a definite do not ever run with any pain in your chest. So now I'm gradually trying to run at heart rate of below 140 and hope that the more I do this the more efficient my heart will become at that level I can manage to do the 5k in around 35 with hr under 145 .

And sometimes I think are we just being greedy and except that if you have a dodgy ticker maybe stick to walking and be glad you can still do that 😉 😂😂

To be continued we hope 👍