Stress has been a constant companion in my life. Two years ago, despite being a fitness fanatic (via strength and cardio training), vegetarian, consumer of almost every anti-oxidant known, a person with no family history of heart disease and one with absolutely no cardiac risk factors or elevated cholesterol, I experienced a near-fatal heart attack while lecturing to about 100 of my engineering students back inS Africa.
I 'flatlined' for about 7 minutes and miraculously survived without brain damage, then later had a quadruple bypass. I give constant thanks for this incredible second chance at life. BC (Before Coronary), my sports science lectures on cardio phenomena and exercise were just theoretical exercises, but my recent experience really taught me in a highly practical way about so many of the myths and facts about cardiac rehab and aerobic exercise.
For one thing, don't ever believe that years of fitness training is going to prevent a heart attack - there are so many other factors involved that it is vain and naive to think that any of us are even vaguely close to having all of the answers.
It's because of this, that I sometimes post information on cardiac disease to make fitness instructors more aware of how subtle and insidious heart disease can be. Just look around and every one of you will have at least a quarter
of your family, friends or clients in the USA afflicted or killed by heart disease - maybe even yourself.
Nobody is immune and it is vital that we be as educated as possible about cardiac health and disease. Even if you know CPR, something like 30% of those whom you try to save will die if you do not get them to an intensive care unit or good paramedics within minutes - and I mean minutes! - one minute I was lecturing animatedly, when, totally without warning, I went through a brief phase of dizziness and nausea and was soon flat on my back in total agony, rapidly expiring in front of all my students!
Chest pains? Radiating pain down the arms? None! One minute fine, the next minute, well on my way to the beyond!
Anyway, despite the extensive left ventricular damage resulting from that 7 minute deprivation of oxygen to heart and brain, I decided to apply the principles of our "Supertraining" book (Siff M C & Verkhoshansky Y V 1999 to cardiac rehabilitation, because I just could not find a single book on how to return a cardiac survivor to serious lifting or heavy sport again. I documented what I did, including all nutritional means and medical tests, to allow me to advise other serious athletes who may also suffer from heart disease.
In fact, modified martial arts regimes formed an important part of my early rehabilitation. Back, side back kicks or any form of kicking? What a joke! - after having those veins stripped surgically from your legs as bypass grafts? The leg surgery alone is one of the more persisently painful side-effects of coronary bypass surgery - this is very useful to know if you are trying to devise group classes for cardiac survivors.
The sawn-in-half sternum means that push ups or any arm adduction-adduction, arm swings and so forth are extremely painful, so one has to be very creativeif one wishes to devise a useable cardiac rehab program!
Interestingly, cardiac monitoring while I was working on a treadmill showed that blood pressure increased more with sustained periods of endurance exercise than with shorter series of interval training with regular rests. I had always believed that aerobic training did not place that sort of loading on the heart. If you really think that aerobics classes are not
just as likely to precipitate a heart attack as a weights session, think again! Jim Fixx, the great running guru, sadly discovered this when he died on a run.
This discovery spurred me onto use a special regime of smaller modules of resistance and aerobic training that was much shorter than the average aerobics class, something like those used in Bulgarian weightlifting training. Exactly a year after my quadruple bypass, I competed in an Olympic weightliftingevent, which I believe is very unique in the annals of cardiac survival.
Other principles adapted from "Supertraining" for cardiac rehab included:
1. Breaking up all aerobic training into 5-10 minute modules of walking, and modified martial arts movements throughout the day
2. Progressing from an initial state of specific limitations (limitations of range of movement, planes of movement, speed, resistance, complexity, duration etc) to a progressively advancing state.
3. Use of progressively undulating overload, not constant overload, as is traditionally taught
4. Application of 'Cybernetic Periodisation' in which one uses Ratings of Perceived Effort to constantly modulate each type of periodisation or cycled loading
5. Control of intrathoracic pressure to an even greater extent than intra-abdominal pressure to minimise compressive pressure on the heart
6. Regular use of formal methods of restoration, such as massage, specialised nutrition, electrostimulation, hydrotherapy, meditation, music therapy, autogenic training and rhythmic movement
7. Use of intermittent sets or cluster methods of loading with brief rests (1-10 seconds) between single repetitions of strength exercises.
8. Use of sets with no more than 3-5 repetitions for many months
9. Walking and rhythmic movement between each repetition and set; no sitting down during a workout to minimise sudden changes in stress level and blood pressure
10. Use of the conjugate sequence principle in which one type of fitness training overlaps with the rest and lays the foundation for what is to follow
11. Never working to an emotional all-out maximum, but choosing to work to a relatively easy 3 RM which does not encourage too great a rise in intrathoracic pressure.
12. Avoidance of any prolonged loading, slow tempo training, heavy eccentrics, endurance training, HIT (Highly Intensive Training) or 'superslow' methods, because these all tend to cause large or sustained increase in intrathoracic and blood pressure.
13. Alternating easy and more strenuous days of training.
14. Implementing the delayed after-effects principle (performance improvements may be stimulated as long as 5 weeks later by current loading)
15. Prolific use of quicker Olympic weightlifting and powerlifting training variations over partial and full range, especially "hybrids" (aerobic, martial and strength types of combined movements) - over 250 examples are listed in "Supertraining".
16. Regular use of mental rehearsal, visualisation, loadless training and reflex conditioning (a la Pavlov)
17. Gradual introduction of more ballistic and 'plyometric' (powermetric) action in the form of very small sets over a limited range of action, with aqua-powermetrics indifferent depths of water.
18. Modification of loading according to the differential adaptation of each different part of the body to training.
19. Use of punctuated informal training throughout the day, using free standing squats, pull ups, pressups, good mornings etc, for a few minutes at a time
20. Use of undemanding aerobic training such as walking and gentle swimming as a means of restoration, mental relaxation and joint mobilisation
21. Periodic use of PNF or Functional Neuromuscular Training methods of patterned, three dimensional movement to increase structural and functional capabilities.
In many ways, I am most grateful for the incredible learning experience that my cardiac event provided. It taught me even more strongly about what is really important in life and how to apply sports science in a far more practical way than ever before.