Ask the Doctors September 2016 Issue

Too Much Exercise; Slow Heart Beats

I want to be healthy and exercise regularly, but can too much exercise cause harm?

A large body of information supports the benefits of regular physical exercise and an active lifestyle on heart health. However, intensive exercise above a certain level may not offer additional benefit compared to moderate activity and may be harmful. Muscle or skeletal injury or cardiac events may be more likely with high-intensity exercise, particularly if started abruptly. If you are an occasional weekend warrior and decide to suddenly run a 5K or start a high-intensity Cross Fit program, injury risk is as much as 5- to 10-fold compared to someone who trains regularly.

Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic.

The most appropriate type and degree of exercise is dependent on the goals trying to be achieved (training for competition, weight loss, heart disease prevention), level of health and activity when starting a program, and other associated illnesses. Cardiovascular disorders such as heart failure, rhythm abnormalities, heart attack, chest pain with exercise, prior stroke, or muscle/joint related disorders would impact type and intensity of exercise.

Fortunately, you don’t have to run marathons to gain benefit from exercise. The American Heart Association advises that 150 minutes of moderate-intensity exercise or 75 minutes of high-intensity exercise a week is optimal.

One way to minimize heart-related events or injury is to increase activity gradually and with the guidance of an expert. An exercise program would be entirely different for a competitive athlete versus a heart attack survivor. Soon after a heart attack, heart surgery or coronary stents, individualized monitored exercise in a cardiac rehabilitation program is a good way to start at an appropriate level and progress to optimal levels. If you are sedentary and interested in starting an exercise program, a formal exercise prescription based on your current level of fitness assessed with an exercise test is a safe way to get started.

There are times when I notice my heart beating, not fast or irregular but more like a “thud, thud, thud,” almost like it’s too slow or heavy. My pulse and blood pressure are fine. My doctor did an EKG and found no problem. Why might I notice these “slow palpitations?” Is it all in my head?

Normally the activity of the heart, like breathing, is not felt. However, an alteration in the steady background beating or force of the heart beat may be perceived. This may be normal or physiological, such as when you have a sensation of a forceful heartbeat due to a stronger contraction of the heart when suddenly stressed or frightened. Some people are just more sensitive to their heart beating and may notice it, particularly when quiet or lying on one’s left side. At other times this may be the result of an abnormal rate or rhythm. When you have a premature or early heartbeat the next beat to occur after the early beat has had a longer time for the heart to fill with blood and the resultant beat is more vigorous. If these premature beats occur regularly, such as every other beat, the early beats are often not felt but the more forceful beats are, resulting in a slow, steady but more prominent beating. A more pronounced heartbeat may be present with a thickened or dynamic left ventricle of the heart due to an inherited condition or high blood pressure or secondary to valve disease such as a leaky aortic valve.

It is important to determine if the sensation is normal physiological beating or due to an abnormal condition. An EKG may not be helpful if obtained at a time when there are no symptoms. For symptoms occurring frequently a continuous monitor for 24 to 48 hours may help to identify an abnormal rhythm. For less frequent symptoms there are monitors that can be worn or implanted for weeks to months. A physical exam and echocardiogram (ultrasound of the heart) may help to identify a structural problem in the heart muscle or valves.

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