Caring for your heart
Just because you can’t physically see your heart muscle and mostly can’t really feel it, we sometimes neglect caring for one of the most important muscles in our bodies.
The heart is actually a very simple organ which functions almost like a normal muscle; it is one of three types of muscles in the body; cardiac muscle, smooth muscle, and skeletal muscle. The heart muscle shape is different and an involuntary muscle which is controlled by the autonomic nervous system, which means it contracts and release all day without you consciously knowing it.
All the above I always knew as I studied BSc Human Movement Studies and have always loved the physiology of the heart, but then I am also a stubborn athlete who thinks because we are healthy and do sport and eat healthily, we are exempt from any serious heart failure. I have always been training my whole life and seldom get intensely sick. If I do become sick it would be a mild flu and I would rest for the first 2 days and then start training again. So, in general I am a very healthy person.
Realising I may have a heart problem
I started racing as a professional athlete in 2017 and in 2018 I was really struggling with my races. During that time, I was only doing the half Ironman distances (1,9km swim - 90km bike - 21km run). Not having good races and not feeling great - as an athlete this leaves you thinking that you are not working hard enough. So, after each race I came back working harder and harder. At the end of 2018, on my way to Cape Town for a Triathlon race, my coach arranged for me to see a Cardiologist so we can have a clearer picture and better idea of the different aerobic and anaerobic zones to train in. Thinking back now he must have noticed something is not quite right and realised we needed to investigate further.
Undergoing an echocardiogram and tests
I went to the Cardiologist and did a series of diagnostic tests including an exercise stress test, Echocardiogram and VO2 max run test with ECG scanning. I was excited to show off my fitness levels thinking of how impressed the team will be with my overall health and level of commitment (I know this sounds vain!). But what to come was the opposite in fact. The Cardiologist told me that my main pumping chamber, the left ventricle is not doing the job it is supposed to and that the power of the muscle to contract and fully get the blood pumping out of the heart is not sufficient. This causes an increase in pressure in the lungs and puts my heart under severe risk when exceeding higher heart rates. Also an electrical imbalance was noted, I had several high electric impulses spiking my heart rate in seconds to 180 bpm then down to 45 bpm; these spikes occurred 4-7 times directly after each other.
Luckily no permanent damage was done, and I could fix it by avoiding anaerobic training and training at lower heart rates. The turning point for when my heart was still functioning normally was at 120 bpm. This meant I could train as much as I wanted but at a heart rate of 120 bpm or less. Most people would know this is a fast-walking effort and not at all any professional level of training.
Getting a heart scan diagnosis
As I mentioned I was in Cape Town for a triathlon race on the Sunday, and my appointment was the Friday before the race. In my mind I was just stopping by the doctors to get more accurate training data not life changing news. He then told me if I raced on Sunday that I would basically put my life at risk. Suddenly the numbing feeling in my hands and arms during the swim leg started to make sense, it wasn’t me not being fit or strong enough, it was actually my heart trying to get more blood and oxygen to the muscle but struggled to meet the demand! During my races I felt horrible by the time I got to the running leg; everything felt heavy, I also had this warm feeling over my head ever so often while running. Thinking back now, I can only imagine how hard my heart tried to work for 4+ hours to keep up with the demand that I am asking from it.
Training my way back to peak heart fitness
To get back to the sub-120 bpm training phase. I am not even going to lie telling you I was motivated here. I felt down and really struggled to deal with this, because this is not something you can see. And I am not in pain or feel poorly or demotivated daily. It is different to recover from an injury where you tore a ligament or broke something, but to fix a problem you can’t see was mentally very difficult for me. The most difficult part was to keep going slow, I didn’t feel like an athlete any longer. How can a professional athlete train at sub-120 bpm? I did not even sweat or feel slightly out of breath during these training sessions. It felt like no happy hormones were secreted in my body anymore.
During this time, I could only do indoor stationary work as any external influence made my heart rate raise. So, I was then stuck to turbo bike, gym work and the treadmill. Side note, this was during the South African summer where all you want to do is be in the sun outside.
Diet and nutrition
I realised I need to start thinking differently about this otherwise I will never be able to recover or be a better athlete. I started to give myself small goals, trying to do everything possible correctly to make sure I could move slightly in that heart rate zone. That meant fuelling myself on a low carb diet as I was only utilising fat for energy. I started picking up exactly when my body was shifting from a carb metabolic phase to fat metabolic phase. I started to be as precise as I can be thinking of my diet & fuelling strategy during training, my environment, meaning how hot or cold it is so I can always train on a stable core body temperature and I don’t need to waste energy to cool my body down, I also avoided any stimulus for the heart like caffeine etc. So, my coach then - Niel du Plessis & PVM nutritional science helped me immensely to get the biomechanics, metabolic and physiological training right.
Back on the treadmill
I started by walking on the treadmill for 45 min and sometimes I could get a run in at 7 km/h which is almost a walk. My cycling was at such low wattages that I almost had to not put resistance on the turbo trainer. But I trained sub-120 bpm for 2 months with as much volume as I could, and 1-week got to do a 40-hour training week. Because everything is at a very low intensity, if you fuel correctly you can keep going as long as you can, because there is not a lot of risk for the heart to function on such a low effort. In fact, this was the only way I could get my heart healthy and strong to function like a normal muscle again. After 2-months I could do training for running to 135 bpm and cycling 130 bpm. This was the best news ever and I could start running outside on flat surfaces. By the end of month 3 I was able to do 90 min runs on 12km/h without my heart giving any spikes or any issues.
I was cleared by the cardiology team since February 2019 and allowed to start racing again, but I regularly need to do check-ups to make sure everything is in order, and I still need to do a lot of low heart rate training in between the harder efforts. My low heart rate training is still sub-135 bpm. This meant that I could go full speed without elevating my heart rate. Nowadays I run 60-90 min runs on a sub-135 bpm at speeds of 13-14 km/h.
This brings me to my point - caring for your heart.
Your heart muscle can be trained to be better. Like any other muscle in the body, it needs to be stimulated with exercise so it can build to be stronger, it needs to be rested sufficiently that there is no added stress on the heart muscle. And it needs to be fuelled correctly so that you don’t over stimulate or add unnecessary inflammation around the heart muscle. You can care for your heart and like you have read, you don’t need to do any crazy form of exercise. The best way to achieve this is your sub-maximal low heart rate running or walking 30-45min daily, so that you stimulate growth in your heart muscle which will improve the heart muscles functionality. An improved heart muscle draws oxygen better from circulating blood which reduces the need for the heart to work as hard and helps generate more blood to the muscle.
Take note of small signs, symptoms, trust your instincts and regularly make sure your heart is healthy.
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