As I bounded up the office stairs taking two at a time, I felt an unusual thumping in my chest. I stopped at the top of the stairs but my heart continued to pound. Then my chest began to hurt. While I may be a little slow to catch on to things sometimes, I realized a thumping pain in my chest was not a good sign. I made my way back down the stairs and out to my car. My heart was still pounding. Once in the car, I called my friend Ed Tyson, MD and explained what was happening. He said, "Go to the ER right now! Don't wait! Go now!"
I learned that if you ever go to a crowded emergency room and say, "I have chest pain" you will get a direct entry pass. Everyone else waited and watched as they took me back into the medical wonderland of the E.R. Once there, a flurry of activity followed. Sticky pads applied to my chest, thermometer in my mouth, blood pressure cuff on my arm while no one said as much as "hello". My chest continued to hurt but seemed to be subsiding. I was alone, on a hard gurney staring at a very bright light with all sorts of things attached to me.
About an hour later, a physician came in, picked up a clipboard, scanned it and said, "Well, your EKG is OK right now. We're not sure why you had this event but with your family history you must see a cardiologist very soon. Do you want me to send you to someone or do you already know a good heart guy?"
I had no clue. My mind was still on the word cardiologist as if it lingered in the air like a cartoon bubble. "I'll take care of it. Thank you." And out the good doctor went.
Your heart muscle is simply the most important muscle in your body. Without it, you die. Consequently, determining how well your heart works is serious business. At the hospital two days later, I had a stress echocardiogram test. An EKG machine was attached to my chest and I climbed onto a treadmill. The cardiologist stood on my right and a technician stood on my left. I started walking on the treadmill then jogging. Every few minutes the technician raised the treadmill angle. And then he increased the speed. The entire time, the cardiologist was watching the computer monitor as it displayed numbers and graphs. Finally, after 17 minutes of this mini boot camp, he said, "OK far enough. We're at your maximum. Well done." I then immediately went to a table where the technician told me to lie on my side. I was gasping for air. I couldn't get enough. He placed a cold metal device on my chest and told me to hold my breath. You should try that some time. Hold your breath when you’re gasping for air. It’s really hard to do and exceptionally uncomfortable. The cold metal was the end of an ultrasound machine. The cardiologist wanted to see my heart beating while it was seriously stressed. After what seemed like an hour he said, "Looks good. Your heart looks very good." I had no chest pain. My heart was fine. Whew.
The cardiologist needed to know my maximum heart rate and how well my heart responded to work or exercise. He could not afford to guess. But, people all over the world guess every day when they calculate their maximum heart rate. The formula is on every stair stepper, cycle, treadmill and elliptical trainer in every home or gym. It is a formula to determine your maximum heart rate. The formula is 220 minus YOUR AGE and it is wrong. Here's why.
Bill Haskell, an exercise physiologist at the U.S. Public Health Service had been given an assignment by his boss Sam Fox, MD. Dr. Fox, a cardiologist, was scheduled to talk at a World Health Organization meeting on exercise and heart disease. The year was 1968. Haskell's job was to collect research on maximum heart rate testing. All the experts agreed that exercise was important following a cardiac event or if you had heart disease. At the time, no one knew how hard a person should exercise following a heart attack. Haskell assembled the information and plotted the results on a graph. He and Fox studied the graph and discovered a pattern. By drawing a line through the data points, Haskell found that the maximum heart rate at the intervals of 20 years, 40 years and 60 years, was 220 minus the age. Haskell and Fox presented their finding at scientific meetings in Tel Aviv and Tuxedo Park, New York. In 1971, they published their formula that was to become the gold standard for exercise.
The problem with their discovery was the studies were done only on men all under the age of sixty who did not exercise regularly. Haskell and Fox did not actually perform any research. They compiled data from existing studies. So, their formula was not valid for all people. For a valid study, the results must be true in other places, with other people and at other times. Since Fox and Haskell's work was only on men under the age of sixty, the formula was then only valid for sedentary men under the age of sixty.
Remember, in 1968 there was no heart rate formula. There was no way for a person following a heart attack to know when the heart might be over stressed. Haskell and Fox were interested in predicting a maximum heart rate to allow someone following a heart attack to safely exercise again. They never intended for it to be applied to all ages, genders and conditions. It spread quickly and made its way into every piece of exercise equipment, doctor's office and heart rate monitor in the world because it was simple to understand and easy to use. The formula produced a number that made estimating something very subjective, how hard your body is working, more objective. Numbers are cozy. We feel better when we have numbers to explain, guide or support our decisions.
Haskell and Fox's formula is not accurate though for someone who exercises regularly. If you are a woman, 40 years of age and use the formula to determine your maximum heart rate, you could be off by up to 30 beats per minute. In most cases, you will exercise at an intensity that is too low. The same is true if you are 65 years of age and exercise regularly. The number guiding you is misleading you.
So, what do you do? How do you determine your maximum heart rate? The best and most accurate method is a stress test with a cardiologist standing next to you, but it’s also costly and inconvenient. There is a way to get close though. Much closer than just using the formula. Once you know how, your exercise routines will produce much better results. I'll share those secrets with you next week.
Make today count.
Doug Kelsey
Author. Teacher. Therapist.
