More on My Aneurism

The written report of my cardiologist, Dr. Michael Kelemen, says that I have an "aneurysmal dilatation of the aortic root," beside the printing of which is handwritten, "sinus of Valsalva aneurysm." This is from an echocardiogram done very recently, on 9/26/05.

I have a radiologist's report from a 2/22/05 CT scan of my chest, made due to a "fullness in the mediastinum [shown up] by plain chest radiograph [X-ray]." This was an "evaluation for mediastinal mass" — i.e., they were looking for a tumor or cyst in the space between the lungs, which thankfully did not show up. The CT scan findings included, "Mediastinal window shows normal enhancement of the aorta. Pulmonary artery. No aneurysm. There is no filling defect in the enhancing vascular system."

If both these findings are correct, it looks as if I may have developed a sinus of Valsalva aneurysm in the aortic root between February and September of this year.

I will be taking the CT scan films/report (and also the echocardiogram tape/report, along witha 2003 chest X-ray) to my appointment with cardiac surgeon Dr. Laschinger this coming Monday. If he confirms that I had no aneurysm before February and I do have one now, it seems likely that my taking up running as aerobic exercise during the intervening period might have had a lot to do with it.


A sinus of Valsalva aneurysm (see this Wikipedia article) is fairly rare and is typically congenital, i.e., present at birth. The congenital version of the aneurysm is discussed in this e-Medicine article.

If my aneurysm wasn't there in February, then it was acquired, not congenital. "Acquired aneurysmal dilatation of the sinuses of Valsalva may occur because of Marfan Syndrome, syphilitic aortitis, or as a function of aging," the e-Medicine article says. I apparently don't have Marfan Syndrome or syphilitic aortitis, so if my aneurysm is an acquired one, it's presumably related to aging.

I assume that, whether congenital or acquired, a sinus of Valsalva aneurysm will tend to have certain common characteristics. The e-Medicine article says, "Aneurysm of a sinus of Valsalva is a rare ... cardiac defect that can rupture, causing heart failure or other catastrophic cardiac events. If the aneurysm remains unruptured, it occasionally causes obstruction of cardiac flow resulting from compression of normal structures. Dissection of the aneurysm into the cardiac tissues may occur, causing obstruction or destruction of local structures."

"Dissection" seems to be what happens when the various layers of the aortic wall and/or associated tissue separate catastrophically from one another, once an aneurysm has formed. Dissection is not the same as "rupture," but apparently is equally fatal.

I am not at all sure, but the propensity for aneurysm and dissection may be related to what the Wikipedia article says is a possible cause of a sinus of Valsalva aneurysm: cystial media necrosis: "a focal degeneration of the elastic tissue and the muscle in the tunica media (the middle layer of the artery), with the presence of mucoid material in the media. It is more frequent after 40 years of age and is twice as common in males as in females. In the aorta, this condition may lead to weakening of the artery, resulting in the formation of a fusiform [i.e., spindle-shaped] aneurysm."

My primary care physician, Dr. Moore, says he thinks the aneurysm to be related to problems in "connective tissue." The "elastic tissue and the muscle in the ... middle layer of the artery" would seem to qualify as connective tissue.

The part about "obstruction of cardiac flow resulting from compression of normal structures" might go along with another finding from the echocardiogram: "moderate aortic insufficiency." I interpret that as meaning that not enough blood actually gets passed through the aorta on each heartbeat.

Perhaps Dr. Kelemen's third echocardiogram conclusion, "mild left ventricular dilatation with normal left ventricular systolic function," is also related: my left ventricle, which connects to the aorta, is larger than normal when the heart muscle is relaxed, implying perhaps an attempt by the heart to fill with more blood in compensation for my "moderate aortic insufficiency."


So there would seem to be three possibilities. One, the diagnosis of an aortic root aneurysm of the sinus of Valsalva, based on an echocardiogram reading, is just wrong. I think that possibility unlikely.

Two, I have a congential aneurysm that was missed on the CT scan. I think that to be a real possibility ... one which can most likely be checked, and checked conclusively. As I say, Dr. Laschinger will review the CT scan films.

Three, I have an aneurysm I just acquired this year, at age 57/58. Since I took up aerobic running just this year, the possible connection seems obvious.

It is this connection which may interest middle-aged folks who start doing aerobic exercise for the first time. The lesson here is that it might be a good idea to have a cardiologist's staff give you an echocardiogram before starting the exercise and then another one after undergoing the exercise regime for a month or two.


An echocardiogram is a diagnostic method that is non-invasive and basically not at all uncomfortable. You don't have to fast. You don't have to swallow anything. You don't have to have dye, or anything else, introduced into your body. You don't have to lie claustrophobially in a noisy tunnel. You don't have to hold your breath. You don't have to mash your chest into a machine, as with a mammogram.

You simply remove your shirt or blouse and lie on your side on an examining table. The technician attaches a few stick-on electrodes to the skin around the area of your heart. Then she puts a gob of jelly on a wand that she slides along the front of your chest, while looking at a monitor to view the image it is producing of your heart's actions.

The images that are picked up are being recorded on a magnetic tape cassette which can be played back, copied, and reviewed by the cardiologist or cardiac surgeon.

The whole thing takes about 20 minutes. The wand and jelly may feel a bit cold at first. But the only moments of minor discomfort come if the technician asks you to lean your shoulder away from her temporarily, a position that feels a bit unnatural. After she is done manipulating the wand to generate the images, you simply sit up, peel off and discard the stick-on electrodes, wipe your chest off with a paper towel, get dressed, and leave.

An echocardiogram can show up abnormalities that don't reveal themselves on a "heart scan," which I also had one of recently. It's basically a CT scan, I believe ... and it's also a good idea to get one, since it can show whether you have too much calcium clogging up the arteries of your heart. In my case, my health insurance didn't pick up the cost of the heart scan; be advised.

Nor does an aortic root aneurysm necessarily show up in any way on a cardiac stress test — another diagnostic I "heartily" recommend. Stress tests and echocardiograms are, in my experience, things your health insurer will pick up much of the cost of.

Aortic Root Aneurysm

This blog is on hiatus, owing to my being diagnosed with an aortic root aneurysm.

The echocardiogram given to me by my cardiologist Dr. Kelemen — actually, by his technician, Eileen — showed up an enlarged aortic root, where the aorta joins the left ventricle of the heart. The normal diameter is roughly 3.7 cm. Mine is 6.3 cm.

My general practitioner Dr. Moore has referred me to a cardiac surgeon who specializes in such aneurysms, Dr. Laschinger. My appointment with him is on Oct. 18.

For now, Dr. Moore doesn't want me to do any more than casual walking at 3 mph.

Dr. Moore thinks I've probably had the aneurysm for at least a year, if not longer, and that it's associated with some predisposition toward problems with connective tissue such as that found in the aorta. Aortic aneurysms are typical with Marfan's Syndrome, a connective-tissue disorder. Dr. Moore doesn't think I look like I have that ... Abraham Lincoln probably had it, and it produces some extremely tall, extremely gangly specimens.

It is not clear whether my aneurysm has anything at all to do with my premature atrial contractions (probably not) or my seemingly high heart rates while exercising (again, most likely not).

Dr. Moore thinks Dr. Laschinger will almost certainly want to operate to repair the aneurysm. So it'll be awhile before I expect to "run for fun" again.

Premature Atrial Contractions

Dr. Michael Kemelmen, a cardiologist, gave me a stress test today.

He cleared up what it is that I remember, from my last stress test some years ago, as being "odd" about my heart rhythm: I have "premature atrial contractions," or PACs. They're not to be confused with "premature ventricular contractions," PVCs. Neither PACs nor PVCs are particularly worrisome, but there's a small chance that PACs may be associated with valve problems, so I have to go back next week for an echocardiogram.

Dr. K says my "extra heartbeats" may be confusing my simple heart rate monitor, causing it to read high. That sounds like as good an explanation as any for why my measured heart rates seem too high for the amount of effort I'm expending when I jog. When I was hooked up to close to a dozen electrodes for purposes of the stress test, the final phase had me subjectively working much harder than I seem to be doing when I run, say, a 14-minute mile. Yet my measured heart rate was the same: about 165 beats per minute.

I imagine Dr. K's ultra-sophisticated BPM counter factors out my "extra heartbeats" from PACs. So when my cheap monitor says 165, the real number is lower, and I'm actually in the proper aerobic zone which books on exercise recommend.

Assuming my echocardiogram comes out normal, all this doesn't explain why I can't yet beat a roughly 13-minute mile, after two months of working out.

Nor does it explain why I have needed these last four days to recover from my prior near-daily workouts over the period of two months. After going to Basic Fitness class last Thursday — this is Monday — Friday I was near-comatose, and each day since then has seen me gradually get closer to a normal level of energy.

So I'm thinking that I simply can't sustain workouts more often than every other day. My recovery time is apparently too slow.

Failing to honor that constraint may be what keeps my jogging times too high. I've noticed that the improvements I actually have made in my jogging pace, recently getting down to a mile in just over 13 minutes, have tended to come after a day off.

So I'm thinking of cutting back to Tuesday and Thursday mornings at the Basic Fitness venue, plus one weekend morning jogging. That makes sure I don't work out on back-to-back days ... unless I decide to walk on the other weekend day. Then we'll see.

Making Some Progress ...

Today I did the 2-mile loop at Lake Elkhorn in Columbia, Maryland, in what I imagine to be record time for me ... a personal best of 26:16. That computes to 13:08 per mile. I don't think I've ever run a mile that fast. Looking back at times I kept track of in 2000 for running various routes, I find the fastest I recorded then was 1.4 miles at 13:55 per mile.

My heart rate today was in the 150s for the first mile, roughly, and ascended into the 160s for the second, which has many uphill stretches but few if any downhills. It got up to 168 beats per minute at the end. That is still, strictly speaking, "too high," by comparison with my maximum rate of 170. But I wasn't laboring; I wasn't winded. I didn't feel like I was working any harder that I did in making previous, slower circuits of the lake. It felt good.

This came after a Sunday of rest following a Saturday on which I limited my fitness efforts to a brisk half-hour walk.

I'm still experiencing a little bit of lower back pain as a result of Doing Lake Centennial on a Saturday Morn a couple of weeks ago, and putting out too much effort after I had taken too few days off in the immediately preceding time frame. The effort I put out today was on a par with that effort, so I'm waiting to see if the "other shoe drops" in the next day or so, and I develop symptoms of having overdone it.

But the backache isn't as bad, or as constant, as it was. Tentatively, knock on wood, whatever injury I sustained is healing.

Next week, on my doctor's advice, I'm having a cardiologist give me a stress test. I had told Dr. Moore that I consider my heart rates to be too high for the amount of effort I'm expending and for the relatively slow per-mile times I'd been recording. Today's run shows that at least the latter anomaly may be abating.

And that's very, very encouraging. It looks like even "high beaters" like me can increase their aerobic capacity, slowly and steadily, by keeping up the conditioning effort ... even if they are working in a heart-rate zone that is above what the textbooks "officially" recommend.

Tomorrow, I begin the twice-weekly "Basic Fitness" course given by the Department of Recreation & Parks of nearby Howard County.

Interesting note: I read recently in a newspaper article about Chronic Fatigue Syndrome that some but by no means all CFS sufferers can increase their energy levels and reduce their fatigue by means of "very gradual increases in aerobic exercise." I don't suffer from CFS, but it looks as if the slender margins between my maximum heart rate and the rates I'm undergoing when I run (say) a 13:08 mile are allowing me to make no more than "very gradual increases" as well.

The moral here seems to be: patience, patience, patience. This is to be a permanent lifestyle change, after all. I want to jog for the rest of my (hopefully, long) life. It doesn't really matter how gradual the buildup is, of necessity, going to be. What matters is that it does seem to be (slowly) having the desired effect. I can run fairly long distances faster than I could before, at the same rate of effort.

Am I a "High Beater"?

Today (Wed., Aug. 31, '05) I've taken an unaccustomed day off from all exercise because of my aching back, whose onset was last Sat. after pushing myself too hard. It hasn't gotten any better as I've tried to "run through the injury." I may take tomorrow off as well.

Meanwhile, I comtinue to be concerned because I think my heart rates are too high for the speeds and levels of effort I'm engaging in. So I Googled running "heart rate" "too high" and found this page in which an expert named Joe Beer discusses a similar problem someone else wrote in about.

The question being asked was:

Following your advice, I did a treadmill test using a heart rate monitor to work out my maximum heart rate. The result was 177bpm. However, during 40-minute steady runs my pulse easily reaches 165bpm, about 94 per cent of max! Am I training too hard? (It doesn’t feel like it.)

Joe Beer answered (in part):

While heart rate monitors are all pretty similar, runners aren’t, and that can lead to some anomalies.

I suspect that you are a ‘high beater’. This simply means that your heart muscles beat at a faster rate across the various levels of exercise and training than your peers’ do. This isn’t a ‘bad’ thing, merely a personal idiosyncrasy that needs to be taken into account when planning and assessing your training.

So I suspect that I, too, am a high beater: my heart contracts more times per minute than most others do under the stress of exercise. And this condition obtains "across the various levels of exercise and training."

Beer says to his questioner that 40-minute exercise stints at 165 bpm, 94 per cent of the maximum of 177, can be expected to be "incredibly debilitating, if not near impossible."

Beer continues:

In fact, it’s best to get away from the idea at working at a percentage of your MHR anyway, and think instead about your working heart rate (WHR). You still need to find your maximum, but once you’ve got that, subtract from it your resting heart rate. To find the rate to run at – for example 75 per cent effort – simply multiply your WHR by 0.75 and add the resulting figure to your resting heart rate – that’s the rate to aim for.

My max HR is 170 bpm and at rest I do about 60 bpm. The difference is 110. For a 75% WHR, I'd use

(110 X 0.75) + 60 = 82.5 + 60 = 142.5 (or, rounded, 143)

where 75% of 170 is roughly 128. So figuring in my resting HR raises my 75% target level by some 15 beats per minute.

Beer also suggests that heart rate monitors don't always accurately log one's true maximum heart rate, which can be higher than indicated ... which only increases the actual 75% level (and all the others) even more.

Finally, says Beer:

You could also try only breathing in through your nose and out through your mouth when running. This will automatically set you to an appropriate moderate intensity. Note your heart rate at this comfortable level, and use it as the basis for the majority of your running training.

I may or may not try that.

But the main thing I'm getting from this is that high beaters like myself need to take their resting heart rate into account in computing training ranges, which will increase any given target level, such as 75%, but which will also guard against training at too high an intensity.

Paying the Piper

Well, it's finally happened: muscle injuries, plural. Minor ones, but not fun.

In Doing Lake Centennial on a Saturday Morn I told of running the 2.4-mi. loop around a nearby lake at a previously unapproached rate of over 164 — and up to 168 — beats per minute on my heart rate monitor. Never before had I sustained an average HR above the vicinity of 154, ten beats fewer per minute.

Later on that same day, my lower back began to hurt. That was a first since I began my fitness program about five weeks ago.

Then, a few hours after a walk-only outing the next morning, the insides of my calves began to ache. Another first.

Most of the pain in both cases is/was on my body's right side, but there are/were echoes in corresponding places on the left side.

I began taking Aleve, assiduously resting, and icing the affected areas. This morning I was able to do a laid back walk-jog around the same lake with little distress. I took care to stretch my lower back much more carefully than I had been doing in the past.

So I appear to have started to recover already. Although I'm still sore, using ice and Aleve, and resting a lot, I'm better off than I was yesterday.

But I realized yesterday evening that (duhhhh!) I was finally paying the piper for pushing myself well above my actual exercise capacity. I can do 154-bpm jogs without repercussions; I can't sustain 164-bpm jogs. I've learned my limit.

Notice I say "jogs." Not "runs." They're not even "jogs," per se; they're "slow jogs." Grandma Moses would pass me by, if she were still around.

My slow jogs which produce such high heart rates, quite near my measured maximum of 170 bpm, do not make me winded or overly sweaty. They make me feel great, both during and after. The only thing is, my heart rate goes up real high: into the 90%- or 95%-of-maximum range. 90% (153 bpm), I find I can hack. 95% (161 bpm) and above trigger repercussions.

And the literature confirms my experience: exercising above one's 90% level is supposed to involve an increased threat of injury. That's one reason why exercisers are supposed to stay below 90%.

So the question is, why do I get such high heart rates with slow (by the standards of 99% of the other joggers I encounter) exercise that doesn't leave me anywhere near being doubled over, trying to suck in more air?

Doing Lake Centennial on a Saturday Morn

Last night I experienced a middle-of-the-night spell of insomnia, and as I was lying there hoping to fall back asleep my thoughts turned to running, jogging, walking, and exercising in general. It occurred to me that there are a whole complex of reasons for which we engage in such activities, and the reasons we start out with are not necessarily the ones we stay with.

The reason I started walking on a daily basis some five weeks ago was that I needed an activity for the after-dinner hour which would keep me from doing what I would otherwise crave to do: get myself prone and watch TV. That aggravates what I presume to be my hiatal hernia/gastroesophageal reflux disease (GERD) syndrome. It gives me a stomachache.

Actually, it worsened the chronic stomachache I'd been fighting for several months, and my eat-much-less-at-any-one-meal strategy had stopped paying off — except that it probably contributed to what was really an unanticipated weight loss of some 20 lbs. during 2005.

So "eat, then walk" became my new strategy. That evolved into mixing in some slow jogging ... doing it after breakfast instead of dinner ... and then before breakfast, as a way to start the day.

My stomach symptoms quickly began to diminish, not just while exercising or immediately thereafter, but all day long. They're now only about 10-20% of what they were. This may be due to the direct effects of exercise — or of deeper breathing during exercise — on the diaphragm, the muscle that separates the lungs from the stomach cavity. It may have to do with lowering my stress, producing more beta-endorphins, and triggering other biochemical changes in mybody and brain. Who knows what the full explanation is? All I can say is that for me, regular aerobic exercise has helped me minimize my symptoms of GERD.

With that, my reasons for running changed in their relative priorities. I hardly ever think about GERD relief any more. Mostly what I think about is getting that runner's high.


This morning I got high along with countless other folks who were doing the lovely 2.4-mi. circuit around Lake Centennial in Columbia, Maryland. And it was all legal.

Though I often go to Centennial during the week — I've walked around the lake hundreds of times over the years — today may have been the first time I've showed up on a Saturday morning in the summertime. I couldn't believe how many people were doing the same thing I was doing ... except that most of them were running, ahem, noticeably faster than I.

At one point, hearing an unusual amount of loud gabble approaching me from behind, I turned to see what seemed to be the entire student body of one of the local high schools gaining rapidly on me.

As I continued my ultra-slo-o-o-o-w jogging — exchanging greetings with a few of the bushy-tailed kids who were breezing by me like I was road tar — I managed to gain some information about the group from a pair of women joggers coming toward me from the opposite direction: this was just the track-team-wannabes from River Hill High School! But there must have been 200 of them!

Boy, did I feel old and out of shape. Not only were the teenagers making me look bad; the only other people who weren't passing me were walkers and those running in the other direction. At one point, I think I was lapped by a butterfly!

I even started inwardly chanting 'He who runs the slowed-down way, lives to run another day' to soothe my injured pride.


Why am I so slow? A lot has to do with the fact that, says my heart rate monitor, I'm ticking along at well over 90% of my measured maximum of 170 beats per minute, even when I run Centennial at my snail-like pace. My typical HR was between 157 and 164 today, and my final burst took me up to 168. I'm not dogging it, not by a long shot.

This confuses me. I ought to be really huffing and puffing, exercising in the ninth decile of my performance capacity. But that isn't what happens. Oh, I need to breathe fairly rapidly and deeply, true, to support 160+ bpm. But I'm not winded, I'm not gasping for breath, and I can talk easily enough. Nor am I sweating copiously, on these unusually cool August morns.

Only time will tell whether I'll ever be able to run any faster ... but I really don't care. After all, I'm getting just as much of a runner's high as any of those young whippersnappers from River Hill!

High on Running

Today, Monday, I felt I made quite a bit of progress. This morning I did the loop around Lake Elkhorn in Columbia, Maryland, not far from my home. I have found a web page which shows it to be a 2-mile circuit. The terrain is basically level but with a few downhills and uphills. The path on what I consider the "far side" of the lake has several shallow uphills in succession, when you go around counterclockwise.

I walked counterclockwise slightly more than halfway around the lake for a warmup, then jogged the full circuit in 30 minutes — for a 15-min./mi. pace, or, put otherwise, 4 miles per hour.

I closed with nearly a half-circuit of cool-down walking.

At the end of the jog portion, before the cool-down, my heart rate was 158 beats per minute, well into my supposed ninth decile based on a measured top HR of 170 bpm. But I was not breathing hard, nor was I sweating profusely on this relatively cool, non-humid August morning.

In fact, I did not lose enough fluid to keep me from having to duck into the shrubbery behind a pump house to make weewee at the end of my workout, in this public park whose main pavilion and restrooms are inexplicably kept locked behind a metal barrier, except when the kiddies' summer camp is in session!

At any rate, I felt like I had crossed a barrier of my own, now being able to run (OK, jog slowly) relatively effortlessly for two miles and not feel overly tired as a result.

I still can't quite figure out why my heart rate is so high — much higher than I would expect for my pace, rate of respiration, and rate of sweat production. I think I could do two miles at a clip somewhat faster than 4 mph, if my heart rate gave me more "headroom" and didn't top out at 170.

Nonetheless, I really am starting to feel like a run-for-funner.


And it seems like the regular exercise elevates my mood, at least while I'm exercising and for a couple of hours after. This certainly has to do with endorphins, morphine-like chemicals the body releases naturally which have been linked with the subjective feeling called "runner's high."

In addition to accounting for "the blissful feelings one experiences after sex," these chemicals "are naturally produced by a wide range of activities like meditation, deep breathing, ribald laughter, eating spicy food, or receiving acupuncture treatments or chiropractic adjustments." They reduce stress. They postpone the aging process (yessssss!). They also block pain, explaining one's increased comfort of running after perhaps the first 20 minutes have elapsed — the endurance athlete's so-called "second wind."

I especially like the part above about "ribald laughter," by the way. I recall reading some years ago of a book by Norman Cousins — Anatomy of an Illness as Seen by the Patient, I think it was — in which Cousins described how he recovered from a hopeless, nominally fatal illness by laughing, regularly and hard. Cousins would schedule a session watching old Marx Brothers movies and stuff like that on a daily basis, just to tickle his funnybone and get him laughing out loud, and after a period of time his illness vanished. He wrote (see this web page), "Hearty laughter is a good way to jog internally without having to go outdoors."

For all you chocaholics: eating chocolate is another great way to release endorphins!

Flirting with 90%

Today I threw caution to the wind and decided to run at a pace higher than Brian Sharkey says I ought to in Fitness & Health.

Given that I test out as having "low" fitness, I'm supposed to stay in a training zone between 60 and 75 percent of my maximum heart rate, 170 beats per minute.

But my heart rate monitor tells me there's no way I can do that if I run instead of walk. My HR simply wants to go up over the 75% level, 128 bpm, and that's a fact. I can't run slowly enough, even downhill, to keep that from happening for long. After about 50-100 paces on level ground, it's bye-bye 75%. Going downhill only postpones it a bit.

So today I picked out a course which is roughly 4 km (2.5 mi.) long, what with going three times around a certain 800-meter (0.5-mi.) circle and another 1600 meters (1 mi.) thrown in for good measure. It's fairly easy, starting off downhill, leveling off, and never really going uphill for long — though there is as good, long uphill warmup walk involved in getting to it. I ran that course.

Or I should say I jogged it. The first, downhill part was easy. Then came the long, mostly level stretch including the repeated 800-m loop. When I got to that, at first I begain to feel pooped. Then, about 1,500-2,000 meters into the run, I got my second wind. I felt fine from there on out.

My heart rate was flirting with the 90% mark, 153 beats per minute, most of this time! On the brief uphills I encountered along the route, it would go slightly over that mark. When I put on a burst of speed at the end, it shot up to 168 bpm, just shy of my measured maximum.

Yet once I had gotten my second wind, I never felt winded. I never gasped for breath or felt like I couldn't talk if I had occasion to. My legs felt OK, with no significant burning ... though I did try to vary my stride length and mechanics from time to time to keep them comfortable. There was plenty of gas left in the tank for that final burst of speed at the end.

I may pay for my ambitiousness later today or possibly tomorrow, my scheduled day off, but right now I am about five hours into my post-run recuperation and I feel great.

So I really don't know what to say. I'm not supposed to touch 90% until I make it to the "high" fitness level, but it seems to be impossible for me to jog for any appreciable distance without bumping up against it. Until further notice, I intend to keep doing runs like the one I did today and scratch my head over why my fitness program doesn't jibe with what I read.

My Walking Test

Brian J. Sharkey's Fitness & Health has a formula on page 83 which lets me estimate my VO₂max, a measure of how much oxygen my muscles are able to use, at the extreme of aerobic intensity or effort.

Though this figure is often called an individual's "aerobic fitness" score, it doesn't really measure endurance, only the highest intensity of aerobic exercise one can sustain for spans of 5 to 15 minutes at most. The figure is expressed in milliliters of O₂ per kilogram of body weight per minute (ml/kg/min).

The formula is:

VO2max =	132.853
	- (0.0769 x weight in lbs.)
	- (0.3877 x age in years)
	+ (6.315 x 0 for female, 1 for male)
	- (3.2649 x time in mins., to nearest hundredth)
	- (0.1565 x heart rate in beats/min at end of test)

Today I speed-walked a 1.0-mi. (1.6-km) course (2 laps x 0.5 mi./lap). I did it in 15:40, which in decimal form is 15.67 minutes. My heart rate at the end was 154 beats per minute. Given that my weight is 165 lbs., my age is 58 (or will be in less than a week), and I am male, my VO₂max computes to 29 ml/kg/min, rounded to the nearest whole number.

For good measure, I did a third lap, which gave me a total walking time of 23:30 for 1.5 mi. (All three laps had exactly the same time: 7:50!) At the end of the third lap, after I had put on a final burst of speed which put me just on the edge of a run, my HR was up to 163 bpm — quite close to my measured maximum, 170 bpm.

An aerobic fitness score of 29 puts me in the low fitness group, the one for scores under 35. Scores of 35 to 45 are of medium fitness. Scores over 45 are of high fitness.

It's probably a fallacious extrapolation, but if my same aerobic fitness score could be carried over from walking to running, Fig. 4.4 on page 84 of Sharkey's book suggests I ought to be able to run 1.5 miles (2.4 km) in less than 15:30. Yesterday, the best running time I could manage for that distance was 22:10, only 1:20 faster than I can walk the same course. Of course, I didn't pace myself aright and had to walk part of the way anyway.

Based on my experience, I'd have to say that Sharkey is corrrect in claiming that aerobic fitness is dependent on the specific activity and muscle group being exercised. I assume it will take me quite a while to get my running fitness score up to 29.


In fact, there seems to be a catch-22 operating here. Since I'm of low fitness, page 102 tells me not to exceed 75% of my maximum heart rate: nominally, my anaerobic (lactate) threshold. Exercise over that threshold does not qualify as aerobic.

With an HRmax of 170, my 75% level is 128 bpm ... and I find it impossible to jog on level ground for more than 50-75 paces without putting my HR above that!

But if I stop jogging and just walk, although my HR goes back down nicely, then I'm not training my muscles for the specific activity of jogging or running! Catch-22!

I'm considering finding a fairly long downhill stretch in my area — luckily, there are some — and jogging easily down it at < 128 bpm. Then I'd walk (as slowly as possible) back up the hill and do it again, and maybe again.

My VO2max

I've been reading parts of Brian J. Sharkey's tome on Fitness & Health. Now in its fifth edition, dated 2002, it presents the science of fitness and exercise physiology so a lay person can grasp it.

Sharkey tells me things which surprise me about aerobic fitness (he also covers muscular fitness and many other related topics). The main one is that aerobic training does not have all that great an effect on the heart.

There seem to be two schools of thought. The first (the one that Sharkey pooh-poohs) is that aerobic exercise equals cardiovascular exercise equals cardiorespiratory exercise. What is being "trained," according to this school, is primarily the heart, lungs, circulatory system, volume of blood in the body, etc.

Sharkey goes with the second school of thought: what is being "trained" is mainly the specific muscles and muscle fibers used in the training exercise (as leg muscles for running). Also responding to the "training effect" are the nerves and nerve endings which feed those specific muscles.


So when training lowers the heart rate and increases the "stroke volume" for any given level of work effort, what's really happening is that the small nerve endings in the muscle tissue that is being worked learn to

... sense conditions in the muscle and modify the heart rate response to exercise via connections to the cardiac control center in the brain. ... [T]he reduced heart rate can be traced to the improved metabolic condition in trained muscle. When the heart beats more slowly, it has more time to fill, allowing an improved stroke volume. (p. 92)

"Improved metabolic condition" means that the muscle fibers and cells become more proficient at acquiring and using oxygen to burn fat and/or carbohydrate (CHO, from the symbols for carbon-hydrogen-oxygen). In so doing, they produce energy in the chemical form of adenosine triphosphate (ATP).

VO₂max is a measure of how much oxygen the muscles are able to use, at the extreme of intensity or effort. This, the maximum volume of oxygen (O₂) the body can use to produce energy aerobically, is measured in ml/kg/min. That's milliliters of O₂, per kilogram of body weight, per minute. VO₂max is also called the "oxygen cost" or "maximal oxygen intake."

VO₂max goes up as aerobic fitness does. But it's really a measure of how much intensity you are capable of for short periods of 5-15 minutes, not your endurance for sustained efforts of over 15 minutes (see p. 77). To measure endurance, two thresholds below VO₂max are used.

The aerobic threshold is the minimum level of exercise intensity, for a particular individual, which can produce significant changes in that person's fitness (see p. 101). It is also called the "minimum training threshold." It can be stated in terms of VO₂, the volume of oxygen being used. It is, of course, less than VO₂max.

The anaerobic threshold or lactate threshold is the maximum level of exercise intensity, for a particular individual, that avoids crossing into anaerobic exercise (see p. 102). In anaerobic exercise, oxygen is not used by the muscles in energy production. Energy is instead produced by means of chemical reactions based on glycogen, with lactic acid (lactate) as a byproduct. The anaerobic (lactate) threshold is also called the "minimum training threshold." Like the aerobic threshold, it can be stated in terms of VO₂, the volume of oxygen being used. The anaerobic threshold is greater than the aerobic threshold, but less than VO₂max.

Given that VO₂ and VO₂max are not easy to gauge, heart rate is used instead to define a training zone for the individual. In theory, HRmax, a person's maximum heart rate, is attained just when the person's oxygen intake is maximal, at VO₂max. At the anaerobic threshold, which may be 70% of VO₂max for that person (see Fig. 6.1, p. 102), the heart rate may be 80% of HRmax. At the person's aerobic threshold, VO₂ may be at 55% of the VO₂max maximum and heart rate at 70% of its maximum, HRmax.

These two thresholds change with training and consequent improved fitness. The more dutifully the person trains within his/her proper zone of exercise intensity — the training zone — the more the zone slides (gradually) upward.

Especially the lower boundary. This boundary, the aerobic threshold, rises with a sustained aerobic exercise regimen. High-fitness individuals get no benefit from the relatively low intensities which do benefit low-fit individuals, for this reason (see p. 101).


How does this apply to me? Well, today I decided to try to find my aerobic fitness score by timing a run of 1.5 miles (2.4 km) and using Figure 4.4 on p. 84. The good news was that my score was off the chart. The bad news was that it was off the chart in the wrong direction.

If you can run 1.5 miles in 9:35, your aerobic fitness score, VO₂max, is 55 (measured in ml/kg/min). A time of 11:40 corresponds to a 45 score. You get a 35 score if you run 1.5 miles in 14 minutes.

I took 22:10 to run 1.5 miles.

Actually, to run and walk the distance.

I thought I was going to need — and would be able — to run faster than my usual jogging pace. So I started out too fast and had to subside into a walk after the first of the three 0.5-mi. circuits, which total 1.5 miles.

Bad strategy.

After I walked for a while, I began to run again, intermittently, with walking interspersed. Toward the end of the third and final lap, I ran as hard as I could for maybe a quarter mile, until I petered out a bit short of the finish line. I wound up with an abysmal time of 22:10.

Afterward, I realized I could have done better if I had jogged at my usual slow pace, using my heart rate monitor to position my intensity of effort in the low end of my accustomed zone at the beginning and then letting it rise gradually toward the high end of the zone as I continued to jog.

That would have been better because, as Sharkey emphasizes, I have been training specific muscle fibers in my legs to work efficiently at specific intensities. To change to a faster pace uses the muscles differently, in ways they're not accustomed to.

I think I could have run 1.5 miles in 20 minutes, that way. I've done it before, albeit five years ago, before I went back to being a couch potato.

20 minutes is still off the chart, though, in the wrong direction.

That means I have to increase my (as yet undeterminable) fitness/VO₂max score quite a bit by continuing to work out aerobically.

Specifically, I have to raise my aerobic threshold and maybe my anaerobic (lactate) threshold.

Which means I need to do work at both ends of my training zone, since, as Sharkey points out, exercise at the low end has different capacity, endurance, and performance benefits than exercise at the high end.


So what is my training zone? One thing I did manage to find out today is that my maximum heart rate, HRmax, is actually 170, not 160. 170 was as high as I could push my HR with what seemed to be my absolutely maximal effort.

So, based on HRmax = 170 beats per minute, here's a table I can use to figure my zone:

% of Hrmax	Rate (bpm)
100	170
95	162
90	153
85	145
80	136
75	128
70	119
65	111
60	102
55	94
50	85

Sharkey (p. 102) says a person of low fitness (VO₂max under 35 ml/kg/min) should adopt a training zone of 60 to 75 percent of HRmax. Medium fitness (VO₂max between 35 and 45), 70 to 85 percent. High fitness (VO₂max over 45), 75 to 90 percent.

Since my fitness is super-low, maybe I ought to use 102 bpm (60%) to 128 (75%) as my training zone.

Up to now, I've been targeting a high-end heart rate of 136 (80%) and allowing overshoots to go over 140 — as if my fitness were "medium." (I was basing that on an assumed HRmax of 160, not 170).

So I'm going to have to think about dialing down my workouts, or at least some of them.


Aerobic workouts can fall in either of two categories, long-duration (or "long-slow") training or high-intensity training. The former involves staying in the lower part of the training zone for a relatively long time, which at least for me implies walking — not jogging, not running. The latter utilizes the upper portion 0f the training zone for necessarily shorter periods — for me, jogging, or combining jogging with walking, is high-intensity exercise. (Outright running is usually anaerobic for all individuals.)

Long-duration training increases the aerobic threshold. High-intensity training, on the other hand, pushes up the anaerobic (lactate) threshold. (See p. 80.)

Long-slow training "improves the ability of slow oxidative [muscle] fibers to use fat [rather than carbohydrate] as an energy source" (p. 97). That has benefits with respect to the lowering fats (lipids) and "free fatty acids" in the blood, among a number or other benefits. Turning the muscles into more efficient "fat-burning machines," it seems, pays off in many ways.

High-intensity (but still aerobic) training "recruits fast-twitch (fast oxidative glycolytic) [muscle] fibers" (p. 97). That's apparently why the lactate threshold goes up. Boosting the FOG fibers keeps the fast glycolytic (FG) fibers, which operate anaerobically, at bay.

High-intensity aerobic training "may also have more effect on the cardiovascular system" (p. 97).

So it seems to me that I ought to mix, or alternate between, long-slow and high-intensity training modes.

More on My Heart Rate

Today is Monday. Over the weekend, I felt I was possibly about to catch a cold, so I decided to limit my effort this morning to walking rather than running.

I strapped on my heart rate monitor anyhow, and I was a bit surprised. I found that my heart rate, based on an estimated maximum of 160 beats per minute at my age (nearly 58), would easily stay in the 70 percent (112 bpm) to 85 percent (136 bpm) range as I walked.

In fact, for the most part, it was easy to keep it in the 75 percent (120 bpm) to 80 percent (128 bpm) range. All I had to do was step up the effort a wee bit on level or (especially) downhill stretches and then take it real, real easy on uphills.

If I relaxed when I wasn't going uphill, my heart rate would drop to 116-118 (just over 70%), so I'd speed up and/or take longer strides and/or take "springier" strides. My HR would quickly climb well above 120 (75%) again.

If I didn't relax when I was going uphill, my HR would climb well past 128 (80%) to 136 (85%) or even in excess of 140 (approaching 90% of maximum).

This implies I'm getting a perfectly fine "training effect" from walking alone, as long as I move right along when not going uphill. And when walking uphill, even slowly, I'm getting just as much of a cardio workout as when I jog on level ground.

The authorities generally say keeping your HR above 60% of maximum for 30+ minutes qualifies as an aerobic workout. Some even say a 50% HR is enough. I don't exactly buy that, since my HR is almost always at 50% (80 bpm) or higher.

Anyhow ... I wonder if my heart is less efficient than "most" hearts. A few years ago, I had chest pain and was given a stress test. It turned out my chest pain was from something other than heart trouble, but I was told that my heart had something odd about the timing of its beat. As I understood it, either the diastolic or the systolic phase (I forget which) was noticeably late. The doctor said it was not terribly unusual, and nothing to worry about.

Yet I wonder. If my heart rhythm is abnormal, doesn't that imply my heart is not as efficient as most? For if the average heart could be made more efficient by altering its rhythm to be more like mine, wouldn't evolution have arranged for that?

In childhood, I never felt I could run as hard or as long as my playmates. Always too easily winded, and all that.

When I was in school, I used to flunk the running portion of physical fitness tests. Couldn't keep up the pace.

I'm contemplating seeing a cardiologist to find out more.

But I think the bottom line might be: OK, maybe my heart is below average in efficiency. All the more reason for me to work out, since that will improve my heart's efficiency, just as it does for a "normal" heart.

Or, the bottom line might be: My heart's odd beat has little to do with its efficiency. Get out there and get in shape!

Either way, I still have to work out!

It's just that I seem to be able to get a workout at 70-80% of maximum HR without running at all ... which doesn't really thrill me. I want to run!

Monitoring My Heart Rate

After about three weeks of daily running for fun, fitness, and health, I chanced upon an article in The (Baltimore) Sun, my local newspaper, "Work out smart, monitor your heart," which extolled the virtues of using a heart rate monitor. I went out and bought one, a Polar FS1, at the Sports Authority for $50.00. I have used it once. That was yesterday, today being my day off running. I was quite pleased with it.

Non-fitness nuts such as myself — until now — may not be aware that regular "training" exercise such as brisk walking, running, cycling, swimming, rowing, and so forth is going to do two things, over the long haul. It's going to make the large skeletal muscles of your body, such as those in your legs, arms, and shoulders, better able to take up oxygen from the blood. And it's going to strengthen your heart.

Your heart is a pump. It pumps blood through your body. When the blood goes through the lungs, it gives up carbon dioxide (CO2) and takes up oxygen (O2). Returning to the heart, the oxygenated blood is then sent out to the rest of the body, including the skeletal muscles. The muscles, when being worked, take O2 from the blood into their cells. The muscle cells use it to produce energy, with CO2, a waste product, being carried off by the blood. The CO2 goes to the heart and then to the lungs, which expel it with the next exhalation. More O2 is taken in the next time you inhale, and the cycle continues.

For running to be fun, this cycle should be done with a degree of efficiency. Problem One is that the skeletal muscles of a couch potato don't take up oxygen well. Problem Two is that the couch potato's heart, basically made of muscle itself, isn't all that efficient, either.

When large skeletal muscles are not in good condition, they can't use all the oxygen they receive fast enough to keep lactic acid from building up and causing that burning, fatigued feeling. Solution: regular "training" exercise.


When the heart is out of training, though, its "stroke volume" is too small. That is, the volume of blood it pushes out with each contraction is too low. Even if the muscles have been conditioned to utilize oxygen real fast, the heart can't deliver oxygenated blood to the muscles fast enough.

To compensate as best it can, the heart's rate of contraction, measured in beats per minute, rises.

You have a resting heart rate, which you can measure by taking your pulse for ten seconds just after you wake up in the morning, while you are still lying in bed. Take the number of beats and multiply by six, the number of ten-second intervals in a minute. (If you have a heart rate monitor, you can use it instead.)

That gives you a baseline heart rate. Any physical activity you do, however minor, will raise you heart rate, albeit temporarily. The heart rate (aka pulse rate) will change quite a bit, up and down, as you go about your daily business. But unless you exercise, it won't go high enough to give you a "training" effect.

"Training" in this context means exercising steadily enough for long enough (at least 30 minutes per workout) often enough (at least three or four times a week) to get your heart pumping at a rate high enough to increase its "stroke volume" over the long haul (say, three to six months, to get a major improvement).


What heart rate is high enough? You want to exercise hard enough to keep your heart rate in a range of, say, 60% to 90% of your maximum heart rate, as long as the exercise continues.

Note that the boundaries of this optimal, so-called "submaximal" range are cited differently by different authorities. The article I mentioned recommended a 50%-85% range, based on the book Fitness for Dummies. The important thing is that there is a "training" range, above that range which you usually achieve in your day-to-day activities, and below your maximum heart rate. You need to put your heart in that range for at least 30 minutes at least three or four times a week to boost its stroke volume, and thus its ability to cope with your workouts more efficiently.

How do you know what your maximum heart rate is, though? Short of taking a very rigorous stress test, most people use the formula "220 minus age" to estimate their maximum heart rate.

The idea here is that very young children's hearts can typically beat at up to 220 beats per minute when they, the kids, are maximally active. As we age, that maximum possible rate drops by about one beat a year. So a 57-year-old like me probably has a maximum heart rate (MHR) of 220 - 57, or 163 beats per minute (bpm).

That's a statistical average. If you test 100 individuals of my age, picked at random, their MHR might range from, say, 143 to 183. Your MHR might not be 220 minus your age. But statistically, it is probably very close.


So I bought a heart rate monitor to wear while I'm running and to tell me what my heart rate is from moment to moment, and also whether the rate is in my target range or not.

Basically, it consists of a transmitter which you strap to your chest, beneath the chest muscles/breasts, right next to the skin. It picks up your heartbeats through two flat electrodes that seem to be made of a plastic-like material. It transmits those beats to a wristwatch-like receiver, which displays your instantaneous heart rate and also whether or not it's in the target range, under it, or over it.

I initially started by asssuming my maximum heart rate to be that of a 60-year-old, since the math is easier with 220 - 60 = 160. That makes each 5% of the range equivalent to 8 bpm.

I figured originally on targeting a range of 60% (96 bpm) to 80% (128 bpm). But that proved unrealistic. My heart rate gets up close to the 128-bpm upper limit when I walk up the steep hill that I have to deal with to get to where I run! Then, when I run on level ground, I find that my rate goes up above 128 bpm right off the bat.

In fact, I find that a steady pattern of 50-paces-jogging/50-paces-walking keeps me in the 128-140 range. So I am upping my upper limit to 136 bpm, which is 85% of my estimated maximum, and I allow my heart rate to overshoot as high as 140, which is 87.5%.

Specifically, I run until the monitor reaches 136, which usually happens after 50-to-100 paces at a jog or trot. Then I start walking, and as I do, my heart rate at first overshoots for a few seconds: 137, 138, etc., sometimes going as high as 140 or 141. Then it starts to drop. When it reaches 130, I start running again. There may be a few seconds of "undershoot" — going as low as 128 — and then a steady climb back up to 136, when I again resume walking. And so on.


That seems to produce a "fun run." By that I mean a run (or run/walk) that does not make me feel like I want to stop. There's no thought of "how much longer?" Rather, it's "I know I'd better stop, but I don't really want to."

At the same time, I know from the heart rate monitor that I'm definitely getting a "training" effect. I'm not failing to push myself hard enough to do any good.

As far as I'm concerned, that's really where its at.

Welcome to Run For Fun

Hi! I'm a 57-year-old guy who has begun fitness running, after not being much of an athlete for most of my life. I call this blog, in which I will report on my experiences, "Run For Fun" because one of the things I have learned in life is that if it isn't fun to do, I won't do it.

I didn't start running because it was fun, though.

I started because it seemed a natural thing to do on my fitness walks.

But my fitness walks weren't really motivated by either fun or fitness. (How complicated things can get!) No, I started — actually, resumed, having let them slide — taking regular walks because it helped my stomach woes.

I'd been having symptoms of what seemed to be gastroesophageal reflux disease, or GERD, possibly associated with a hiatal hernia. The medications weren't helping. After months of distress, changes I'd made in my eating habits seemed to have caused too much of a weight loss — that's right, a weight loss. I was getting too skinny, and my new eating habits had stopped offsetting my stomach woes, to boot. What to do?

I reasoned that reclining after meals to read or watch TV, my usual habit, aggravated my symptoms, so I ought to find something else to do — something that would keep me upright for a while. I decided to walk for exercise once more. (I'd walked three or four times a week in the past. Having lost my walking partner, I'd slipped to one or two, then one, then maybe none. Now that I look back on it, my stomach symptoms seem to have increased in step with that exercise decrease.)

Anyway, after finding that regular walking was helping ease my stomach distress, I started mixing in some jogging. That evolved into daily walking/jogging before breakfast. That's where I am right now.

My stomach problems are perhaps 70% better. And I know what I'm doing is making me fitter and healthier for (it is to be hoped) a longer and more problem-free maturity. Still, I have to admit that what gets me out there every morning (except Sunday, when I rest) is that it's fun to run!