Body Language More about lifting's hazards to the heart

An expert applauds Roger Schwab's ideas for lessening cardiovascular stress.

By Art Carey, Inquirer Columnist

Earlier this year, John Elefteriades, chief of cardiothoracic surgery at Yale-New Haven Hospital, shook up the Brotherhood of the Barbell when he warned that weightlifting can blow out your aorta, the body's largest blood vessel, the water main of the cardiovascular system.

Certain kinds of resistance exercise - specifically, bench presses and push-ups - can compound stress on your heart and blood pipes, causing blood pressure to spike. During heavy weightlifting, systolic blood pressure (when your heart is contracting) can soar from a normal level of about 120 to as high as 300, said Elefteriades henceforth, Dr. E.

This can trigger a disaster called aortic dissection. What happens is that the internal layer of the aorta ruptures and the blood-vessel wall delaminates. Blood under pressure invades the split layers, producing knifelike pain that is beyond what most mortals can bear.

Dr. E, an avid weightlifter himself, emphasized that the number of aortic dissections is minuscule compared to the millions who pump iron. Nevertheless, he recommended that strength-training enthusiasts cut back their bench press to about half their body weight, especially those over age 40.

When I wrote about Dr. E's warning, concerned lifters and bodybuilders (and the women who love them) deluged me with questions: Does this mean I should stop lifting? Is it safe for me to do push-ups? Do I really have to cut my bench press to half my body weight? And if I do, how will I fully develop my pecs?

The bad news: Since last summer, Dr. E has found fresh evidence of a link between heavy lifting and aortic dissection. Earlier this month, in the Journal of the American Medical Association, he and his Yale colleagues reported the results of a study of five victims of aortic dissection.

When pain ripped through their chests, all five were engaged in strenuous exertion. Two were lifting weights, two were doing push-ups, and the fifth was trying to move a structure made of granite.

One victim died before diagnosis. Another died shortly after diagnosis and before being transferred to another hospital. Three of the five had emergency surgery and survived.

"There is a very real health danger for people who lift heavy weight because of the increased stress that it places on the aorta," Dr. E says. "There's no doubt in my mind about the link."

The five victims ranged in age from 19 to 53. None had a previously diagnosed aneurysm (ballooning of a blood vessel) or a history of high blood pressure or vascular disease. On the other hand, all had some mild dilation or swelling of the aorta.

"There might have been a predisposition," Dr. E says, "but if they hadn't been weightlifters, they probably wouldn't have had trouble for many years, if ever."

His recommendation: If you have an aneurysm or connective-tissue disease, if you have a family history of aneurysm, dissection or high blood pressure, ease up on the barbells and dumbbells.

Ditto for those over 40. Reason: Your aorta and other blood vessels are less elastic, hence less able to handle the strain of a sudden pressure spike. (If you're a serious lifter heaving hundreds of pounds, get your aorta checked out via echocardiograph, Dr. E urges.)

The good news: You can still lift, do push-ups, and pump up your pecs.
Among those weighing in last summer was Roger Schwab of Main Line Health & Fitness in Bryn Mawr. A longtime lifter and bodybuilder, Schwab, 58, has never seen or heard of anyone keeling over from a ruptured aorta. But since safety is the watchword of his approach to strength training, Dr. E's warning caught his attention.

Schwab's solution: pre-exhaustion.

Example: By doing a set of dumbbell flyes before moving quickly to the bench press, you'll fatigue your pecs. Thus, you can still work your muscles hard, still push them to the point of surrender, with a lower weight.

"You can still achieve intensity but with less destructive force on your body," Schwab says. "Your muscles don't know how much weight you're lifting. All they know is that they're tired, and that it's going to take a mighty effort to complete the tenth rep with perfect form."

The idea is to isolate smaller muscles and work them to exhaustion before undertaking compound exercises - with no rest - that involve groups of larger muscles. To wit: Do a set of lateral raises with dumbbells, Schwab advises, before the overhead press. Or a set of triceps extensions before push-ups.

When I chatted with Dr. E the other day, I briefed him on Schwab's method. "It sounds like a great idea," he says, "a perfect solution."

Two other ways to reduce stress on your cardiovascular system: Breathe during exertion, Schwab suggests; and don't squeeze or grip the bar hard.

"Another good suggestion," Dr. E. says. "When you contract a muscle hard, you actually turn off the blood vessels that feed it. The more muscles you contract simultaneously, the more of your circulatory system you close, and the higher your blood pressure rises.

"Picture a street where all the houses get water from one main. If the faucets in half the houses are shut, the water pressure in the houses with open faucets is higher. Blood pressure works the same way in the body's vascular system."