Safe Rehabilitation And Subsequent Exercise Following Aortic Surgery Depend Upon Base, Pace, And Your Dreams For The Future

Click image for link to my new Aortic Patient website – learning to build websites turns out to be very interesting, and working out how to train safely even more so.

Welcome!

Only you can really decide the best exercise plan for your mind, heart and body, when dealing with the rigors of aortic disease – but deal with it you will, one way or another.

Increasingly, people ask for my advice on appropriate levels of exercise following aortic surgery, ranging from endovascular abdominal aortic aneurysm stent placement (my case) to major aortic dissection repairs, including open heart surgery. I’ve also been told by cardiologists that no one is qualified to give such advice. How odd! The aortic patient, who often knows little about their condition (I didn’t research mine until I joined the group), is left to work it out for themselves! Not good!

Benjamin Carey, of Heartosaurus, ran the NYC Marathon with his surgeon only one year after his open heart surgery for an ascending aortic aneurysm.

Here are some interesting questions I’ve received:

1. Can I lift 10 lbs or 50 lbs (4 days) after my AAA stent surgery? The surgeon said there would be no restrictions.
   

   With Marfan’s Syndrome? Depends on your level of risk averseness, not just whether it is safe.

2. Can I ride a mechanical bull with Marfan’s Syndrome?
3. Can I play golf with a 4.2 cm. ascending aortic aneurysm?
4. Could you provide guidance for someone who is two years post-surgery, for correction of an aortic dissection?
5. When will it be safe to return to marathon training after correction of my ascending aortic aneurysm?

These are non-trivial questions, and a systematic approach to patient education is what is really is needed, preferably provided as detailed guidelines, with links to helpful services and forums, to be handed to the patients when they leave the hospital (if not before).

Highly recommended by FitOldDog.

I attempted a semi-quantitative approach to the issue in a previous post, entitled “Rediscovering Your Sport And Your Life After Life-Saving Surgery Using Semi-Quantitative Benefit/Risk Assessment v1.“

My approach takes in all the key variables that I could think of, including:

What do your doctors/surgeons/cardiologists say? (Information Base)

What does your family say? (Emotional base)

What does your research say? (Knowledge base)

What do your feelings say? (Emotional base)

What can you do to reduce the risks? (Knowledge base)

FitOldDog proudly stands with his son Nigel, who captured a Kona Slot at the Louisville Ironman, August 2013 – 9:52 at age 40, can you believe it. I was slower, but I finished third in my age group – my training base is pretty solid – what’s yours?

I’ve learned a few things since then, and it occurred to me, as a direct result of my daily training diary (made on request from my biking partner, Sue) that there are two really important variables to consider as you come out of rehabilitation and start a training or exercise plan – training base and pace.

Training base: If you follow my diary, you’ll notice that I jumped to 5,000 yard swims and a 60-mile bike ride after only a couple of months out of surgery. This didn’t come from nowhere. It was preceded by some fairly tough shorter swims and cord work, and multiple indoor trainer rides. I planned a 3-mile run after the 60-mile bike ride, but my body said, “Not a good idea,” so I dropped it. This would be a no-no with a coach, but which coach can tell us what to do with a wonky aorta? – no coach I know of, so we have to listen to our bodies.

Then you might say, “Well, I’m not an Ironman triathlete, so what should I do?”

FitOldDog interviews his surgeon, Tara, at the Cleveland Clinic – stay in touch with your medical professionals, especially the surgeon. Click image for link to the interview.

The same thing, but with exercise loads appropriate for your pre-surgery training base – I don’t care what your goal is, I care that you approach it wisely and safely.

Say you want to walk a mile with friends in the mall – just work up slowly to the distance, and after each walk note how you feel, especially the next morning, and check your morning pulse and blood pressure regularly. If you’re really sore or your pulse or blood pressure are off, back off. If you feel fine, apply the 10% rule, except maybe we should make it the 5% rule. You could have a coach write you a training plan, but you would have to interpret it – no one can tell you exactly what to do, they can only advise – aortic patients have to learn to listen to their bodies.

Two of FitOldDog’s triathlete heroes, Joe Friel and Bob Scott (right), know all about pacing for Ironman races.

The answer – slowly return to your pre-surgery activity or training base, before attempting any kind of increase in load, and study body awareness, such as Feldenkrais, for heaven’s sake.

Pace: As an older endurance athlete, I’m pretty familiar with the critical role of pace in Ironman training and racing. Go too slow and you make sub-optimal progress. Go too fast and you risk injury or burnout.

You have to learn to pace yourself, and the only things that work are experience and the study of body and mind awareness, and in our case regular aortic checkups, so keep your coach, surgeon and other health advisors in the loop.

At the end of the day it’s your life and your call.

-k @FitOldDog