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Increasing HEARTRATE while doing TREADMILL. Cause?

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This question is to Dr. Mahajan:

Recently, we've had some pretty useful communication about my health.

I have a follow up question concerning an exercise routine subscribed to me by a trainer and a nutritionist at my company.

She says:

1). Do 30 minutes of walking exercise on a threadmil (let's say) every day for 7 days a week.
2). The first 5 minutes my heart rate should be between 100-115 BPM (warm-up session).
3). Next 20 minutes of which, my heart should beat between 125-135 BPM.
4). Last 5 min just a cool down.

Do you think this is good or excessive?

As a reminder, here is a summary of our previous communication and some of my records:

I am 53. I recently visited ER for chest pain, and 10 days prior to that a slightly abnormal EKG.

My latest 7 EKGs within a year showed normal, except one slightly abnormal (as I mentioned). I had a stress test done last week that was borderline. My troponin last week at ER visit was 0.01. All blood tests are normal. Last year in April, I went to another ER and they monitored my heart all night, and all results were normal:

My cholesterol has varied 160-240 over the years.
I take Lipitor (40 mg once every few days).
6 EKGs normal in the last year.
1 recent EKG is abnormal = Minimal ST Depression (0.025 MV ST Depression)
Latest Blood Test (ER visit):
Troponin = 0.01
Myoglobin = 24.0
CK-MB (CK-2) = 1.1

AND, one Borderline Stress Test

I have continuing chest pain, but it feels like it is muscle related, and it is on the surface level. It could be because of the brisk walking exercises that I started in the last two weeks, and sleeping on my left side as well.

Attached, all my results on heart in the last 10 years, with emphasis in the last year.
What do you recommend? How bad (if any) is my condition, you think.

Category: Cardiologist

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Category: Cardiologist
 18 Doctors Online

Thank you for your query.
I think I gave you different advice last time we spoke. Walking on the treadmill is not a good idea. I will rather advise you to walk on the road. Firstly you are 53, and walking besides the heart, puts additional pressure on the knee joint too. So, please avoid. I did ask you to go for brief walk. Try to go to some park and walk.
Regarding your reports, I have reviewed them twice now, and the only issue is cholesterol. I will request you to take Lipitor daily. I am not sure who advised you to take it ' once every few days '. You have to do the basics correctly. Like taking the medicine according to the regimen. Also kindly stick to one opinion. If you listen to the nutritionist, you can follow her regimen, but I am not in favor of treadmill considering your age.
Now, your heart is fine. You should not worry. Work on losing weight maintaining a healthy diet like more of green leafy vegetables, grilled meat, boiled vegetables, soups and salads. Automatically, cholesterol and weight will come down. Walk 30-45 minutes on the road or park. This is all you need to do. And please take Lipitor daily.

Patient replied :

Thanks Dr. Mahajan again for all the care and the expert advice.

1). No, I was in my mind trying to follow your order. Even though I have been using the treadmill, but I was NOT running or jogging on it. I was just briskly walking while keeping my heart rate at 135 BPM for 20 minutes after warming up.
So you are suggesting it is still not good to walk on the treadmill.
2). Do you suggest walking 30-45 min everyday, or 4-5 days a week?
3). Do you suggest for me to take Lipitor all my life? If I go down in weight, and cholesterol also goes down, should I stop Lipitor?
4). I am also taking baby aspirin. Is that OK?
5). Is Oatmeal with water every morning for breakfast good?
6). Can I ever in the future do jogging, playing basketball, or soccer?
7). Can I ever in the future do swimming? Or should I stop that?

Yes, I am still against treadmill considering your age.
2) Yes, 30-45 minutes brisk walking 5 times a week.
3) Yes, Lipitor has to be taken all your life. It is cardio protective too.
4) I have mentioned before also, baby aspirin is fine.
5) Oatmeal is a healthy breakfast, will help in losng weight.
6) If you mamage to bring your BMI down to 20 ( lose 20 kgs ) then it is possible.
7) Can be decided based on your future weight.

Patient replied :

Thanks again for details provided. 1). Is treadmil primarily not good for me because of the stress on the heart, or the knees, or both, considering my age? 2). Can I do some light/moderate bench press with weights? 3). Do you mean to say I should lose 20 kg ~ 45 lbs or 10 kg ~ 20 lbs? I have never even in my best shaped times been that low in weight. I am 5' 7" but have a big structure (wide shoulders and big rib cage).
4). Do you also value the % fat in the body in addition to BMI? I will measure that as well. Which one is more important?

Treadmill is not good for you primarily because of the stress on knees. In fact a lot of studies have been going on where they are advising against treadmill especially incline mode. You can walk on the flat treadmill but not more than 5 kph.
You can do light bench press.
Yes, I meant you should lose 10-15 kgs. Your BMI was over 30, which is bad and that significantly increases your cholesterol levels. So target 10-15 kg weight loss gradually in the next 2 years.

Patient replied :

Do you also value the % fat in the body in addition to BMI? I will measure that as well. Which one is more important?

Definitely fat % is more important.
If you were that well built which was giving you the weight your cholesterol levels would have been normal.
Anyway your fat % should not be more than 15-20 %.
Let me know.

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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