I read the book “The Haywire Heart” and would like to know how much rest is enough rest. Based on your experience and your age, which I assume is about 60, what is your rest formula?
I am 74 and started running when I was 39, completing 10 marathons, including Boston. I have been cycling for the last eight years and racing five of those years, with the exception of the Senior Games, where I have raced for seven years.
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Most of the information and the symptoms described in the book point to me. I had a pacemaker (slow heart) put in about seven years ago, and it was replaced (battery life) this past February. In August, I was told I have AF (atrial fibrillation). I had an Electrocardiogram (EKG), which was not good. That was followed by a stress test which, was “OK,” and I have a follow-up visit to my cardiologists in March.
After reading your book, I have reduced my workout sessions. Now, I do jogging (treadmill, 30/40 minutes), weightlifting/maintenance for 1:15 and ride the trainer for one hour. I do each twice a week and rest one day a week. My cycling on a trainer was 1:30/1:45, three to four times a week unless I rode outside (30 to 50 miles, three or four times a week). Jogging twice a week and weights once a week. Some of the information in the book scares me and is the reason for my question.
My cardiologist probably does not know about an athletic heart or its symptoms. So, I hope to ask the right questions and hope that he will pursue the answers. On the stress test I did, the treadmill went fine, no abnormal heart rhythms, but I do not know what the pictures revealed (several 360-degree pictures were taken). I was told they were “OK,” whatever that means. Rest is something I had not paid attention to until I read your book. If you have any suggestions or recommendations, I would appreciate your input.
This is not a question with a definitive answer, at least not yet in the world’s relatively recent understanding of the relationship between endurance training and racing and the incidence of heart arrhythmia. And you are right to ask your cardiologist; he knows you and is knowledgeable about your heart and what it needs.
Regarding my age, you are right; I am about 60 (I’ll hit that number in June), and I cannot know from personal experience what it is like to be 74 and wanting to train hard. My personal rest formula for dealing with arrhythmia is to have rest be the default, rather than more training. When in doubt, rest; you can’t hurt yourself much by resting, whereas the reverse may not be true.
Lots of research has focused on the amount of rest and recovery needed in order to optimize training loads (and avoid overtraining). There are many methods to detect recovery states, one of the primary ones being heart rate variability. When I was on the national cycling team back in the early 1980s, this was our main tool for determining overtraining or not — checking the resting heart rate (and body weight) first thing in the morning every day. This is a smartphone app I had for monitoring this five years ago when I still cared about optimizing my training before I developed my heart arrhythmia. In the face of your mind coming up with rationalizations for training hard anyway, you might listen to your little handheld computer telling you to back off if needed, rather than you telling yourself to do so based on an elevated morning resting heart rate and a drop in morning weight (indicating dehydration).
You can also take self-assessment questionnaires, which assess mood and other psychological factors, like the Profile of Mood States (POMS); these have been shown to be effective at detecting one’s recovery status. VeloNews will have a podcast on this topic soon with Trevor Connor, who knows a lot about it, hosted by Chris Case (one of my co-authors on “The Haywire Heart”).
While recovery from training is well-studied, it is not necessarily the same thing as the amount of rest required to avoid developing an arrhythmia, which I have never heard of being studied. Still, I believe that the above methods would be useful for optimizing your training without overcooking yourself, and they may also be beneficial for avoiding arrhythmias.
You didn’t say whether you are always in AFib, or whether you have paroxysmal AFib (meaning episodes of AFib that occur occasionally) or persistent AFib. Paroxysmal AFib episodes can last for a few seconds or a few days before the heart’s pacing returns to normal sinus rhythm, often on its own. This condition is fairly common among masters endurance athletes. Paroxysmal AFib and persistent AFib may be treated by “conversion” (cardioversion) back to sinus rhythm with an electric shock delivered via a pair of paddles while under anesthesia (or with drug therapy) if it goes on for many days or longer.
Since you said you were in sinus rhythm on the treadmill stress test, I imagine you are not in permanent AFib. Also, if you were always in AFib, your doctor probably would have put you on blood anticoagulants to prevent stroke, and I imagine you would have mentioned that. Since the heart is not functioning at optimal efficiency when the upper chambers (the atria) are fibrillating (disorganized, chaotic contractions over 300 bpm), AFib certainly decreases your cycling power output.
Sleep is the most important component of rest. If you have any doubt, I recommend you investigate whether you have sleep apnea, which can be done with a sleep test organized by a pulmonologist. Sleep apnea greatly increases the probability of an individual developing AFib, and it largely does that by straining your heart at night while reducing the amount of rest you get. If you are waking up without realizing it due to gasping for air to survive (waking this way 20,000 or more times per night is common in sleep apnea), you aren’t spending much, if any, time in REM sleep and thus aren’t getting good rest when you sleep.