Heart to Hartman

Health Guide for Congenital Heart Disease

How to calculate the best working heart rate for you and your goals

How hard should you be working when you are working out? There are many ways to measure your intensity, but the most common way is by measuring your hear rate. You can do this with various apps or watches or simply by palpating your pulse on our writs or necks. In general, people usually try to keep their hear rate in a specific range based off their maximum heart rate. The most common way to estimate heart rate intensity is to take 220 and subtract your age to get your maximum heart rate, and then take a percentage of that number to get the best intensity for your workout. This method is ok- not great. Everyone’s resting heart rate is variable, usually anywhere between 60-80 beats per minute (bpm). Thus, it makes sense to factor in your resting heart rate to the calculation.

The Karvonen formula, or heart rate reserve (HRR), takes into account your resting heart rate. This makes more sense because if your resting heart rate is usually higher than the average of 60-80 bpm, then it will not take much increase in effort to get to your working intensity. Conversely, if your resting heart rate is typically lower than 60 bpm, it will be harder to get to your appropriate intensity.

Here’s how it works: Start with 220 again but subtract your age, then subtract your resting heart rate. Multiply that number by the desired percentage of work intensity. Finally, add your resting heart rate back to get your heart rate range.

Formula Target Heart Rate (THR) = [(max HR − resting HR) × %Intensity] + resting HR See the example

Say you are 40 years old and you want to work at 60% of your maximum heart rate and your resting heart rate is 55 beats per minute.

THR = 220-40=180, thus [(180-55)] x 0.60 + 55 = 130 bpm

60% is a relatively hard intensity- above a walk but closer to a jog.

Of course if you are taking any medication that affects your resting heart rate, like a beta blocker, then it will affect your exercising heart rate as well. In that case, you can use a rating of perceived exertion scale. In the clinic and in research you may have heard of the Borg scale as a way to rate exertion. This scale is from 6-20. See the image below. This scale closely correlates with exercise heart rate intensity, with “6” correlating to a resting heart rate of 60 bpm and “20” correlating with a max heart rate of 220 bpm. Just add a zero to the number on the chart to get an estimate of a working heart rate. I find this visual to be helpful.

Borg scale image taken from irondaughterirondad.com

However you choose to measure your intensity, the important thing is to just move and stay consistent. The intensity you work at is determined by your fitness goals. In general however, and to meet the recommendations for health set forth by the American College of Sports Medicine and the US Department of Health and Human Services, you need moderate activity, which typically is an RPE of around 13 or a heart rate intensity of 40-85 %HHR; keeping in mind that any intensity over 60% HRR is considered vigorous, for 150 minutes each week.

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Empowering you or your child

If you are a parent of a child with a congenital heart defect, or maybe you are the one with the defect, the best thing you can do to keep yourself or your child healthy concerning the defect is to know what the defect is! Not only the name of it, but also structurally and functionally what is wrong with the heart!

The reasons you need to know what is going on with you include knowing how to care for yourself, knowing what questions to ask your practitioner, knowing what signs and symptoms are normal, minor or possibly severe.

Just like people without a defect, knowing how the heart normally functions is critical. A few years back, I was at a round table discussion on exercise and CHD. Some of the participants stated that whenever they had to do a stress test, they were fine when the treadmill was flat, but as soon as the incline started, they got short of breath. I was a bit stunned and not sure how to respond at first. Increase demand for oxygen and thus increased breathing rate is a typical response of the cardiovascular system to increases in intensity. It is normal and healthy. If you do not understand that, how can you know what to expect when you start exercising?

Before a surgery , during a pre-op meeting, I was speaking with the PA. She answered all my questions and then said, “I’m amazed that parents only ever ask me, how big the scar will be.” I told her, they probably do not even understand enough about what is going on to even ask a question.” If you don’t know anything about the defect, how can you ask a question?

Ever felt a run of a fib, SVT or vtach? Probably. By now, you probably know what is normal and not for you. What is causing those runs? Is there anything you can do to impact them? Meditate, breathe, drink decaf, take your meds? Is it safe to exercise with those kinds of symptoms? Do they ever cause you anxiety? What resources are available to you to help you with these symptoms? Ever been short of breath while at rest? Had lips that turn blue or hands that get cold? Why does that happen? Electrical and “plumbing” issues are two things that result from your defect. Which is more prominent in your defect and in your stage of life?

There are many resources available to you to learn more. Start with the Adult Congenital Heart Association. Here is a video that explains blood flow in Tetralogy of Fallot. You can find other videos on defects at this website.

What types of questions do you have about your defect?

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Heart to Hartman

Health Guide for Congenital Heart Disease


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