Hard To Get Hr Up Exercising?

[NMPotsie]

I noticed a lot of you say you have issues exercising because your hr gets high. I kind of have the opposite issue. Since I started beta blockers I have a very hard time getting my hr up during exercise. Just standing up it will go to 130, but I can't get it to go much past 140-145 even after rowing or using the elliptical for 40 minutes.

Anyone else experience this, or know why?

[miajnt]

I am on atenalol and I have not been able to get up past 140 . Usually it around 120-130 with exercise.Im not sure what its supposed to be when on the beta blockerand Iam waiting to ask my doctor. Im not sure if I should push the intensity toget it up more or not?If I pauseeven briefly my heart rate goes down fast also. Maybe someone else has info on what is the correct heart rate?

[peregrine]

Since going onto atenolol and then propranolol this has been my issue too. On the recumbant bike or swimming I can't get above 120 even with 30 minutes of sustained exercise. I can get up to 150 if I am climbing a very steep hill in the neighborhood and not taking it slow, but that's about it. Standing pulse is now around 90-100, which is an improvement, but the rest seems weird.

[Tachy Phlegming]

I think I'm missing something.

This would appear to be a calculator from a reputable source:

http://www.mayoclinic.com/health/target-heart-rate/SM00083/

It doesn't give numbers for below the age of 18. Are you younger than that?

[peregrine]

I'm in my mid-to-late 20s, so according to that calculator I should be in the 140-160 range, which I was able to get to in the pre-POTS days. After the POTS started, without beta blockers I was more at 170-180, and with them I'm in the 100-120 range during exercise.

[Tachy Phlegming]

I was writing about the first post, peregrine, sorry. Do you feel ok on your med dosages or has there been talk about changing those or otherwise tweaking your meds?

[peregrine]

I've had to tweak the propranolol a lot - 30mg 2x daily ended up being too much (dyspnea and bradycardia), so I went down to 15mg twice daily and that seems fine. I do get a little less HR control with it than with 20 or 30, but my breathing's a lot better and my resting heart rate is back to 60.

[NMPotsie]

My doctors have encouraged me to get to 150-155, and I find it next to impossible. I am on propranolol 10mg TID but generally work out in the a.m. and p.m. before I have taken my meds (it seems to wear off in 4 -6 hours). I guess the issue is less that it's not "high enough" and more that it only gets up 10-15 bpm on exertion. I used to go from 60 to 160 when I exercised, before I had POTS.

[Lemons2lemonade]

Why in the 150's? 140 should be sufficient for cardiovascular exercise? Also, isn't the beta blocker supposed to prevent your hr from getting too high by blocking the adrenergic receptors? Also, I feel like the inability of your heart to beat faster to meet the needs of the exercise would make the exercise challenging because you are doing the exercise with essentially an engine that isn't running at 100% due to the beta blocker--i.e less cardiac output. Just my opinion ~ I bet a cardio could give you a good answer

[POTLUCK]

The Beta blocker Inderal tends to block the HR at a higher rate more than at a lower rate. This is why it can be helpful in POTS as the problem for a POTS patient is that the HR increases to much (30 points) or is too high (120 and up) standing. Thus, if the medicine can lower the standing HR without lowering the resting as much one might feel better.

This means you will have trouble getting your exercise HR to as high a level.

I was on Inderal 60 mg BID and later 80mg BID for over 20 years for other reasons, and one theory I have for my POTS is that my body somehow learned to compensate for this blockade. What I mean is when I was doing strenuous exercise over the years, like a 10 mile hike or running, my body was signaling itself it needed more blood, but the B-blocker was slowing the heart rate. So the body learned to adapt. ( Bodies are good at that. ) Maybe by increasing receptors in number or increasing output from the adrenal gland I do not know. Increasing sensitivity of the receptors?

Thus my idea is to taper my Propranolol very slowly while running. I measure a series of Lying and Standing HR's 3 times a week and if I go back into the POTS range ( 30 increase with stand or over 120 stand ) I stay at that dose without taper till normal.

NMPotsie - obviously this plan cannot work if your resting standing HR is 130 on RX at current dose.

I do not know what is going on with system either just trying to figure it out as well as I can, and see what works for me. It has not eliminated symptoms either.

[NMPotsie]

Thanks Potluck. That makes sense; I'm sure it was the propranolol. I was trying to follow the exercise protocol someone gave my doctor that said that I had to get my hr up pretty high for the exercise to help my pots. I have abandoned said protocol for fear of having a stroke while exercising because my bp was climbing very high but hr wasn't doing a darned thing. My doctors have assured me my heart is normal in size (structurally perfect were their words) so I should just exercise and get up a good sweat and be good with that. I was advised to ignore my hr and just try to get my 30-45 mins a day in.

I am finding more and more that monitoring anything but my bp just drives me crazy. I put my pulse ox in the bottom drawer and haven't taken it out for a couple of months. I am much happier because of it.

[POTLUCK]

If your doctor has OK'd it and you can do it, I recommend the exercise. I believe ( just my own thought) that the body is incredibly complex and if something is not working just running the engine may reset it. May be crazy but the doctors have not figured out the answer.

[handmadebyemy]

I had a similar issue when I was doing Dr Levine's exercise protocol. I could get my HR up (into the 160's as required) on the recumbent bike, upright bike, and rowing machine, but when it came to the treadmill and elliptical machine I couldn't. Sometimes my HR would go down. This ultimately caused me to stop the program because I couldn't proceed pas the treadmill or elliptical machine. I never got an answer from them as to why. Sorry this probably doesn't help you much but at least you know you're not the only one with this issue! It could have to do with the medication you are on, but I'm not on any POTS medications and we seem to have the same issue.

[NMPotsie]

Thanks emy. That helps to know I wasn't the only one who couldn't get going.

[yogini]

Beta blockers stabilize the HR, which is probably why your HR isn't going up. I think there is also a distinction between POTS and NCS. Since I have POTS and my HR tends to keep going up and up (way more thabn it is supposed to). I think those with NCS don't have that reaction - their HR doesn't increase as much as it is supposed to and as as a result they can't maintain enough BP to exercise. The target rates for health persons based on age don't really work for POTS because our HRs are so screwy in the first place

You could talk to your dr about reducing the beta blocker or switching to another medicine that doesn't affect HR - but if you are even able to exercise then you are probably doing OK as is. I am sure Dr Levine's protocol works for many, but not for everyone. There are a lot of benefits to exercises even if your HR doesn't go up too much. You get your muscles moving, blood flowing and building strength. Exercises like pilates and yoga that don't get the HR up still help POTS. Swimming is one of the best exercises for POTS and that is in a flat position and so the HR increase is much less.

I am biased in giving this response. When I do cardio (which I haven't in a few months), I keep my HR in the 130s - or I will get headaches and symptoms for days after. Most of my recovery is from doing yoga, which isn't cardio.

[yogini]

By the way, BP is supposed to go up during exercise. I would talk to your dr to figure out what is a safe BP. As patients we are focused on the numbers, but I think the biggest indiciator is how you feel. If you aren't sick during or after, have headaches, etc. that seems like a good sign that you are not harming yourself.

[peregrine]

As a hopefully humorous example... I do recumbent biking and swimming at the gym at my school. With the bike set on Level 9 (resistance, no clue what that translates to), my RPM is 85 and my HR is 80. The concept of RPM being greater than HR is hilarious to me! When I upped it to Level 10 (I have to keep it low due to my joint wonkiness), my HR got up to 115 and I got the muscle lactic acid mild burn, which is good in my book. The atenolol (and earlier the propranolol) are to blame, but my ANS neuro told me to not pay attention to the numbers and just pay attention to how I feel (though not everyone should use that advice, of course; see what your doc says).