By Wendi Miller, RN
Breaking our hearts
Since a large majority (75%) of Americans report activity levels that are not high enough to strengthen both heart and skeletal muscle groups, the high rates of hypertension (elevated blood pressure) and the prevalence of diseases that follow it are understandable. Many patients take medication, such as a beta blocker, to control their blood pressure and reduce hypertension’s life-limiting and life-threatening effects.
Heart diseases linked to high blood pressure are in a large and unwelcome class by themselves. They are also known as cardiovascular diseases because they impact the blood vessels throughout the body in addition to the heart. A who’s who of cardiovascular disease includes coronary artery disease, arrhythmias like atrial fibrillation (AFib), congestive heart failure, heart valve disease, cardiomyopathy and peripheral vascular disease. Other diseases related to high blood pressure are kidney disease, stroke, and even cognitive decline. Any one of these can take life from your years as they’re taking years from your life.
Training your heart to beat more efficiently and powerfully by regularly exercising and challenging it pays off in spades, unlocking benefits on top of reduced disease risk such as improved energy and mood, increased enjoyment in everything including social interaction, improved weight control, better sleep - even better sex!
Now that you’re convinced…
How does the right amount of moderate and vigorous activity look and feel? Starting an exercise program, with all its benefits, needs to be cleared with your health practitioner first. He or she can guide you to a safe start that’s least likely to cause injury.
For many, something is better than nothing! Starting at the beginning is often the best way to build a daily exercise habit that will last, rather than hitting hard and quickly fizzling out, back onto the sidelines and sedentary living. The ability to keep doing what you need and want to do as you age can hinge on staying active. While you may still be able to power through as you get older, improving your health now and in the future can mean completing your tasks, living independently and moving through life more safely and comfortably in the coming years.
The latest research indicates at least 150 minutes of moderate activity or 75 minutes of vigorous activity each week is ideal. Moderate activity looks like brisk walking (about 4 miles an hour), push mowing the grass, swimming or going for a bike ride. Even these can seem daunting if you’ve been doing none of the above up until now!
Once you have your doctor’s permission, start slow and you’ll be amazed how your ability improves and out of nowhere, the energy “appears,” to squeeze in activity! Vigorous exercise could be heavier outside work - think digging the garden, hauling brush - or perhaps running, laps in the pool, even dancing the night away (maybe just until midnight!).
Know to grow
Strengthening your heart gradually to handle its work more efficiently can keep you in it for the long haul. There are two main ways to monitor how it’s going in there: being mindful of your heart rate and its target ranges for your age, and the Borg perceived exertion scale.
Both of these methods are impacted by beta blockers you may be taking to control high blood pressure! By knowing how beta blockers change your heart’s experience during exercise and adjusting as needed, the chances of building a successful exercise habit increase.
On target
Calculating target heart range is one way of getting to know your body and monitoring your progress as you get fitter and healthier. It can be found by subtracting your age from 220, then using that number to see what your heart rate should be at its fastest during exercise. Subtract your age from 220 to find your maximum heart rate. For example, if you are 63, your maximum heart rate would be 220 - 63 = 157. The heart rate goal of moderate exercise would be 50 to 70% of your maximum heart rate. For example, a goal of 50% would be calculated by dividing your maximum heart rate in half; in this case 157 ÷ 2 = 78.5 (round up or down to 78 or 79). This number is the beats per minute you’d be shooting for while exercising at moderate intensity.
Perception is everything
Since this method is very math-y, the Perceived Exertion scale can be helpful. Also known as the Borg scale, it serves as a measure of how hard you’re working during exercise, and also serves as a measure of progress. As your heart health improves, it may be possible to handle more of an increase in heart rate without feeling winded or tired.
The modified Borg CR10 RPE scale starts at 0, or no exertion whatsoever, like lying in bed when you wake. Level 1, very light exertion, may look like nothing more than getting out of bed and heading to the bathroom or coffee pot. Level 2-3, light exertion, might feel like cooking breakfast or washing dishes. As the intensity of movement increases, it is likely to raise the RPE (rate of perceived exertion).
Level 4-5, moderate intensity, may be similar to jumping in the shower, taking the dog for a walk, or going up and down stairs a few times as you ready for the day. Level 6-7 is felt with high intensity, vigorous activity like running to catch your bus, spring cleaning with lots of reaching and bending or a HIIT (high-intensity interval training) workout. It makes sense that not many daily activities fall into this category for most people. As we have culturally phased out most manual labor outside of some jobs, training at this level is quite intentional for most.
At levels 8-9, very hard exertion and 10, maximum effort, it’s not necessary and can be detrimental to sustain these levels for any length of time. Since perceived exertion is based on one’s perception, someone else’s level 1 could be your level 4, and vice versa. What someone else may feel is a level 7 may only feel like a 3 to you. What’s important is working in the level 4-5 or 6-7 zones to train your heart to be its best.
Beta blocked
If you’re on beta blockers, it’s critical to know how they can impact both your heart rate and RPE. Without accounting for their effects, you may feel like you’re not doing enough, doing it “right,” or making enough progress.
While taking a beta blocker can prevent your heart from reaching its calculated targets, your heart receives the benefits nonetheless. This can be hard to understand, but beta blockers affect everyone differently, and a stress test is the only scientific way to know what your target heart rate truly should be while on a beta blocker.
The RPE scale may be your best ally when evaluating how your heart is being strengthened by the exercise you’re doing for it. If you feel short of breath or can’t finish a sentence during your workout, it’s time to ease off and return to a more moderate intensity. Keep the lines of communication open between you and your healthcare provider before you start an exercise program, and during, so any questions you have about exercising for a healthier heart can be addressed right away.
Keep ‘er movin’
While it’s important to understand and appreciate how beta blockers can impact your heart’s response to exercise, the risks of doing nothing often prove far greater than those of moving even a little more. The health professionals in your life can help you sort out the risks vs benefits of each type and intensity of exercise for your individual needs.
References
Elgaddal N, Kramarow EA, Reuben C. Physical activity among adults aged 18 and over: United States, 2020. NCHS Data Brief, no 443. Hyattsville, MD: National Center for Health Statistics. 2022. DOI: https://dx.doi.org/10.15620/cdc:120213
Mitchell, Braden & Davison, Kade & Parfitt, Gaynor & Spedding, Simon & Eston, Roger. (2018). Physiological and Perceived Exertion Responses during Exercise: Effect of β-blockade. Medicine & Science in Sports & Exercise. 51. 1. 10.1249/MSS.0000000000001845.
Tudor-Locke, Catrine et al. Frequently Reported Activities by Intensity for U.S. AdultsAmerican Journal of Preventive Medicine 39, Issue 4, e13 - e20 (2010).
https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=Very%20high%20blood%20pressures%20can,disease%2C%20heart%20disease%20and%20stroke. Assessed and Endorsed by the MedReport Medical Review Board