Cardiac rehab with TR?

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Hi all, greetings – I’m a 3-decade serious road cyclist recovering from a stenting procedure last summer, after 90% LAD blockage (the “widowmaker” artery…). It’s been slow going; I’ve finished supervised rehab (or “reeducation” as the therapists put it), so now I’m ready to continue based on 75% of max HR. Unfortunately a power test is out as I’m not comfortable pushing max watts outside of a clinical setting.

But, no problem. I’ve committed this year to Zone 2 HR, so for my age, 53, it’s about 130 bpm, which my therapists have convinced me will help. And I’ve seen my V02 max increase after 2 months of rehab focusing on Z2, so I"m all in.

My TR newbie questions: First – is it possible to use TR effectively solely on HR?
I’ve looked through the endurance workouts, and they all look appropriate for what I’m looking for (1-2 hrs at Zone 2-ish). Should I just jump on the trainer and keep an eye on HR? Basically what I’ve been doing is zoning out, as it were, and watching Netflix. A Z2 workout is kinda…boring, but I know it’s what I need to do. How does cadence fit in? Is there any benefit from varying high/low cadence (muscular?)

Any other suggestions, especially from anyone who’s come back from heart issues?

It’s a little odd to be limited after decades of just whaling away when I needed to, but so be it. (and, obligatory get your cholesterol checked PSA)

Thanks for any help!

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I could be wrong but I think @Captain_Doughnutman went through some sort of cardiac rehab that required a HR cap for workouts. So, if I’m correct, he may be able to give some insight.

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@mwglow15 – thanks for the shout out/alert.

Quick run-down of my experience:
Couple “failed” tread mill stress tests due to very high BP;
“Weird” ECG reading, indicating possible scarring due to previous “heart attack”;
Prescribed statins and beta blockers (did not take either);
Rode around for a long time doing MAF/low HR rides;
Final heart check showed heart & BP to be in perfect working order (aka misdiagnosed).

However, while I lived in freak-out mode for 12 months, I read a bajillion cardiac related studies and papers and research etc etc etc. I’ll try to answer as best I can.

First – don’t ask the internet!!! Gah! Consult your doc or have him refer you to a sports doc, get a 2nd and 3rd opinion, research things for yourself, etc etc etc. No one is going to care more about your body than you…except maybe your insurance co.

Ok…now to your First…yeah, totally use TR w/ HR only. I mean, it’s going to look kind of weird cuz it’s giving you power targets and you’re only using a HRM…do you have a power meter? Whatever, that doesn’t matter. When I did my year of Z2* I had only HR and time showing on my head unit, power was kind of irrelevant at that point.

*(when I use ‘Z2’ I mean power, but when I did my Z2-only year, both power and HR zones matched up. Now I can finally do long Z2 power @ Z1 HR.)

I understand this 100%. Again, what do your docs say? In my cardiac reading travels, there is a “modern” school of heart rehab which prescribes HIIT workouts to patients instead of more traditional Z2 sessions. There seems to be great success and w/ very similar negative events as low intensity exercise. Ask your medical team.

Not really. Just do whatever keeps you entertained and keeps your HR in zone.

I hear you on that one. It messed me up for a while and took a really long time for me to appreciate and enjoy the long endurance ride. Couple of points regarding this, it was most definitely all the “just whaling away” which caused my heart to be an unhealthy healthy heart, and in turn, misdiagnosed as diseased. After a year of rest and recuperation w/ tons of Z2, my heart was as healthy and strong as ever. I’m now a very firm believer in tons of Z2, to support both performance and general health. Unfortunately…you’ll probably see your VO2max and fitness plateau due to lack of intensity, unless you keep pumping up the volume (ah, 1990!). I started with 2-3hr rides and only saw fitness increases when I started doing 5hr rides. You might not want to ride slow for that long.

As well, there is research which has shown that “decades of just whaling away” can have a negative impact on cholesterol et al.

I had the same HR cap. Your therapists are right, a year of Z2 HR will be great for your heart, body, and brain. Exercising in that zone creates very little acute and/or chronic stress, it’s good stuff.

No idea if this helps or hinders you. Any questions, just ask!
Good luck and happy you’re still riding!

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Thanks, good stuff. I am indeed exceptionally happy to still be riding. To jinx myself I had just bought a new bike before my heart issues started and still haven’t had a proper outdoor ride on it. Last summer/fall was basically a washout, pandemic aside, involving like you many tests, 3 procedures including angioplasty etc etc…

And good to know re bpm. 130 is an interesting level for me.

One quick follow up: Were there any TR rides (1-2 hours) that you preferred? Were you able to measure gains in any way? One idea I have is to average speed vs. time, overlaid with average HR. I.E., if I can do 20 kmh in one hour at 125 bpm, then improvement would be noticeable when I can go for 21 kmh etc…

My therapists are fine but they don’t quite understand some of the subtleties of training apps and stuff like threshold power.

They’re cool with me using a smart trainer + app to continue, and basically said I have no real limits on activity other than trying to avoid spending too much time beyond Z2.

I have trained with both HR (the 1990s) and power, and like most would prefer power. But if HR it is, then I’ll make the best of it.

Regarding heart, it’s interesting for committed athletes – my cardiologist said that it was strong enough to create alternate pathways for the blood to flow despite major blockages, which explains why, in hindsight, I did not have any real symptoms and could train for 10-15 hours a week. (I was able to do the Etape du Tour in 2019, for example). But on the other hand, he did say my heart needs to “relearn” a few things wrt arterial pathways.

Once the weather gets better I’ll be able to do longer rides but for now 2 hrs is max on weekend mornings and thanks to remote work i can sneak in an hour ride during the week. I have no problem doing 5 hr z2 rides once it starts getting light at 630 a.m. – my wife and teenage kids are late risers on weekends so can be home before lunch.

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You could estimate your FTP by riding at a level that gets you up to your max-allowed heart rate, i. e. 130 bpm. Make sure this is your ceiling, i. e. you should spend about 20 minutes at 130 bpm so that your heart has enough time to catch up. If you want, you an also add a margin of error and shoot for 120 bpm.

Then select a few easier workouts such as Whorl where you scale the FTP so that the max effort (typically 70 % FTP) corresponds to your max-allowed heart rate power level. Other, similar workouts are Taku, Pettit, Andrews and West Vidette.

Depending on your taste, trainer type and all, you have the choice between exercises that have a relatively flat, constant power profile (Pettit) or have the same TSS and IF, but more variety (West Vidette). I’m on a dumb trainer, so I usually prefer simpler power profiles. But that’s also more boring. I listen to podcasts then, though.

It goes without saying that you should be in constant consultation with your doctors. If something feels funny, take it seriously.

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Thanks for that, and for flagging some specific workouts.

Regarding estmated FTP, my concern is that HR tends to go up with effort, so at the end of a workout it might take a higher HR to produce similar power numbers. But that was my initial thought, too – I might start at 120 with an estimated FTP and see how power/HR correspond – if it pushes my HR up too much, it might not work.

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Hi there and welcome to TrainerRoad! I have had exactly the same heart issue as you, except I had a totally blocked LAD artery which required drilling out before stenting. Background:

I have been cycling since 2006, and joined TrainerRoad in the winter of 2016, did a good winter’s training and bumped up my FTP by 20% (beginner’s gains). I had a good summer of 2017, doing lots of hard rides with some pretty fast groups, pushing myself harder and harder. I was on a pretty steady ride in Sept 2017 with 2 friends when I started to get chest pain. Thinking it was just heartburn I carried on and the pain came back a few more times till eventually I couldn’t turn the pedals. Still thinking nothing of it I called the broom wagon to pick me up, got home and as I climbed the stairs I had what turned out to be a pretty big heart attack. Still refusing to believe this was happening, I had a call with the NHS 111 helpline (I’m in the UK), played it down and told them I was ok now but a bit worried. They sent me for an appointment later that day at the local hospital. Basically the nurse mis-diagnosed me as my BP etc was fine, and advised me to get an ECG at my local doctor’s surgery. Did this 2 days’ later and it turned out I’d had a pretty bad heart attack and went straight into hospital. I spent 11 days waiting for my procedure as it was no longer an emergency (the downside to the NHS!) and was a specialist procedure to drill through the blocked artery.

A bit like yourself, the cardiologist told me that he thought my artery had been totally blocked for a long time, at least 3 months and maybe a year or 2! My heart had grown capilleries across from the right side to help take up the slack and was also backfilling from the rear artery - absolutely amazing! I had done a whole summer of really pushing my limits with a blocked LAD artery - I am lucky to still be here!

My advice - ever heart issue is different, so all advice needs to be taken and assessed against your own situation. I was very lucky in that I had zero dead heart tissue - I have a cycling acquaintance who had a slightly less severe heart attack but lost a few % of his heart muscle.

He did give me a lot of advice and I learnt from his mistakes - he pushed himself too hard too soon and had further issues, but he was and still is a very strong cyclist and doesn’t seem to be human!

What did I learn? Firstly, your heart won’t recover unless you use it! i started off my recovery with diagnosed heart failure, my ejection fraction was around 45% - it recovered to 55% within maybe 6 weeks though. I started off just walking - the first day I managed maybe 300 yards, had massive chest pains and had to stop. I then managed a mile, again had massive chest pain and ended up back in A&E - the chest pains turned out to be anxiety and I was having zero issues! A lot of your recovery is going to be mental - I would say it took at least 6 months for the chest pains to stop (like fake angina I guess).

I ended up having CBT because I was coping very badly with what had happened. I was 47 at the time, I’m now 51. this helped me massively, also my cardiologist gave me a treadmill ramp test which I passed with flying colours (it’s just brisk walking!) and helped me a lot.

i started back on the bike once I was walking 5 miles a day. I set up my FTP on TrainerRoad at a level I felt would keep my heart rate in the safe zone (I knocked my FTP back by 10%) and I started doing the Traditional Base workouts (60-70% FTP) ensuring that my heart rate matched my power zones. By then it was November so I also started riding outside doing Z2 stuff. I did join some friends for a group ride, they promised me they’d stick to Z2 but on the first hill my heart went into Z4, and I stopped, totally demoralised and considered going home - they convinced me to stay, I stuck out the ride and felt really wasted the rest of that day - big mistake!

What I did - 3 months of Z2, when that gave me no issues, I started venturing into Z3 (mostly!) for another 3 months. All on my own, at my own pace. After that went quite well I re-joined friends for group rides. The main thing I remember is feeling really tired after a ride! I would often get dropped, that was demoralising but I had zero need that year to push myself! I even had to walk my bike up a hill for the first time ever, but I preferred to do that than have my heart in Z4 for too long!

So 2018 was basically a year of slowly recovering physically, getting myself mentally recovered as well. I ended 2018 with my FTP roughly 10% down on 2017, and 5% up from where I started after the heart attack. I dived back into full training that winter, it was a bit up and down and I found it hard to push myself mentally, but I maybe improved by another few % power-wise, but my endurance improved massively. I then had a year of trying to enjoy my riding, backing off when I needed to, pushing it when I could.

i went into 2019 winter with an FTP as high as I was prior to my heart attack. I didn’t really improve much beyond that in 2020 due to Covid and having to shield etc. I had a crash at the end of summer 2020 and then took a month off, so lost fitness again and went back to 2018 numbers - I’m now just back to winter 2019 power numbers.

I would say - give yourself a year to recover and just enjoy your cycling. Your heart is a muscle and it’s been stunned and had a bad injury! Allow it to recover, allow yourself to mentally recover and slowly start to trust it again. I am now training to higher numbers than I was prior to my heart attack and can push myself on workouts without freaking out what my heart rate is doing - that wasn’t the case for a few years!

You can recover, you can still enjoy your cycling, and TrainerRoad workouts can help you but you may need to tailor your plans and take extra rest etc when you need it.

We’re both lucky to still be here, and cycling can only help to keep our hearts healthy!

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Fascinating thread here. I too have been going through a recent cardiac scare, which started with some fluttery palpitations and devolved into a self-perpetuating mortal terror of impending death. All tests for me so far are normal, but this distracting new obsession and hyper-awareness of my heart has ruined every workout. It’s led me to a month of nothing above tempo, which is both disappointing but also strangely enjoyable. My main takeaway so far is that as endurance athletes, we train ourselves that every feeling of weakness is something to push through, and the sudden fear (whether rooted in truth or not) that this feeling is a potential sign of danger and a reason to slow down is extremely dispiriting. Even when I receive an all-clear, I think it’ll take some mental work to get myself to trust my own abilities again, and to learn not to immediately associate the feeling of a pounding heart with a crippling existential awareness of my own mortality.

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You did the right thing to get it checked! I still get the odd palpitation! I had a nurse check it for me during my rehab - my heart literally missed a beat! She said it was ‘pretty normal’ and she saw it all the time, but it really freaked me out! Nowadays I occasionally feel one and just ignore it!

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Thanks for those encouraging words. I know that a lot of what I am feeling is normal anxiety. I was able to push as hard as I wanted in lots of different sports – cycling, surfing, climbing etc. – and it’s not “normal” to have to slow myself down to what the former me would have considered a “beginner” pace. I’ll play around with power/HR to try to find a good balance between progress and not pushing too hard.

The heart really is an amazing muscle. I was able to sustain a VERY high training load through all of 2019, as I said, culminating in the Etape du Tour with 5,000 meters of climbing on a 35 degree C day, with 90% LAD blockage and 60% in another major artery. But at this point I’d be happy to get out for a three hour Z2 ride on a flat course. Funny how your priorities change…

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I’ve just looked back at what I did during recovery. I lied! Looks like I took it easy for a few months then did an 8 Minute Test in January 2018 (just over 3 months after having the stent!). Eeek! I then did a Low Volume SSB1 and 2, including over/unders and attempted Vo2 workouts, albeit with a much reduced FTP. I totally forgot I did that! To be honest, my cardiologist was a cyclist, and he said to me, “the rehab nurses won’t like me saying this, but just get out and ride your bike! You’re a fit man and you’ve got a strong heart muscle, you’re going to be fine” or words to that effect. He discharged me a year later. The only difference in my life now is I have take take an aspirin, an anti-platelet tablet, a blood pressure tablet and a statin! Oh and crashing wasn’t fun, I landed on my face and yeah, that bled, a lot!

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@Smudger69 — thanks for that great post! Awesome that you’re back at it!

:

Someone posted an FTP estimation protocol in the low HR training thread I started…I’ll try to find it for you.

TBH, I wasn’t worried about FTP etc., I was purely fixated on HR. Like hardcore fixated, I’ve got a few 2hr rides with HR pegged right at 120 for the entire ride. Crazy. Great way to develop focus & control!

My power @ MAF HR (also 130bpm) did increase over the year (+27%; +60% increase since 2019 & doing tons of Z2), but also plateaued. I also saw big decreases in cardiac drift/pwr:hr decoupling, falling from 25% down to <5%. It was very evident my aerobic/cardiac fitness was garbage.

I was also religiously tracking HRV through the whole process. When I started, my numbers across the board were absolute garbage, I had really smashed myself into a hole. The readings improved massively over the first 4-5 months (due mostly to huge reduction in stress to the body).

As the others have mentioned, the mental aspect of overcoming the fear that your heart is going to explode and you’ll die on the side of the road is very real. But, once you regain faith in your physical abilities, it goes a long way in restoring your mental outlook. Even though I can hammer it whenever I want now, I still pay attention to what my heart is telling me, as well as over-all fatigue, two things I greatly ignored pre-cardiac event.

Be good to your heart and it’ll be good to you.

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I can’t speak to the specific problems that the OP has had, but as someone who had misdiagnosed heart issues (I am apparently one of 5% of people with a totally harmless genetic abnormality that generates a ‘weird’ ECG; combine that with anxiety-induced PVCs and you get a lot of investigations), I understand some of the stress and anxiety it causes. I hope you make a full recovery and enjoy the bike for years to come.

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Welcome :slight_smile:

Some others that I have done in the past are Collins, Brasstown, Bald Knob, Mokelumne, Beech and Volunteer. You can search for other workouts by filtering — Active Recovery and Endurance are in the right power range. Then you need to pick your workout length. You can also do two workouts back-to-back. So for example, I did a regular workout and then Taku -1 as an extracurricular activity for bonus points. It might be psychologically easier for you to complete a 1-hour workout and then skip your bonus workout as opposed to not finishing a 1:30 workout.

Also, pay attention to some of the workout texts. Sometimes Coach Chad asks you to do high-cadence drills. I’d skip those as they tend to tax your cardio-vascular system more. And perhaps it helps to reduce your cadence a little, or at least, to mix up your cadence.

PS I’m glad you are with us upright and still cycling. It’ll be tough for a while, but we’ll wait for you at the top of the hill :metal:

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If you’re over 40 and have risk factors for heart disease, it’s worth getting a heart scan done every few years. They are cheap, so even if insurance doesn’t cover it, it’s not going to break the bank.

Every year you hear stories of people dying from a blocked LAD - I.e. the widow maker heart attack. A rider in our local big annual MTB race died last year. That prompted me to get a scan, blood work, and led to changes in my diet.

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I like TR and recommend it to people, but honestly don’t see how it helps you with riding at a HR cap of 130bpm. And I’ve done traditional base 1 and 2 several times, which are filled with easy rides. My Garmin 530 does a better job alerting me to exceeding HR targets than TR app. I’d keep it simple and just use my bike computer and some type of resistance mode when on the trainer.

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I’d also be cautious about the type of heart scan. The one listed (calcium scan) has the possibility of showing conditions which are either not present, or not showing existing conditions, with both possibly leading to misdiagnosis and mistreatment.

If at all possible, go for the “gold standard”, a CT angiogram – it’ll show everything.

I was wildly misdiagnosed and mistreated based on basic cardio tests – both the testings and the interpretations were wrong – until I went to an actual heart doc who got me the CTA…and a very clean bill of health.

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Absolutely. I had a range of tests that started with a dye assessment, then an angiogram up through the left wrist. But what triggered it was a cholesterol test. I’d always been in the high-ish end of normal but never enough to trigger statins, and was resolutely normal and healthy otherwise. But last year I had bloodwork that showed I was high (on the French scale, I live in France); and that led to my diagnosis of 90% LAD blockage. I’ve also had various ECGs, including a Holter, but they never showed anything abnormal.

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True, I can do that. I’m thinking TR will give me some structure and variety within Z2. Regarding warnings, I’ll have to play with settings – but I have an iPad bracket on the bars so am always looking right at data…

Normally I would use Rouvy for indoor training, but it’s too easy to blow through HR zones unless you choose a nearly flat ride – all the interesting ones involve “climbing” – so when I’d see the Rouvy road going up at 10% I’d reflexively get out of the saddle and be at 160 bpm.

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Structure for z2 is simply the number of hours you put in. There isn’t a lot of power variation in the different aerobic endurance workouts in the TR catalog because it’s really not possible unless you design workouts with ridiculously low off intervals.

Steady power and heart rate is the name of the game at z2, unless you toss in 5-sec sprints every 6-8 minutes. But if using an app motivates you, then go for it. If I was in your shoes I’d probably set a HR alarm on my bike computer, put on a movie, hop on and pedal at different targets (say 124bpm for mid z2 and 127bpm for upper z2).

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