Should You Do Cardiovascular Workouts With a Diagnosed Heart Problem or Past Event?

And, how TV and Peloton figure in the scheme of things.

Exercising after experiencing a heart attack can be a scary experience. But, before you decide to swear off your cardio routine, for fear of exacerbating a previously-diagnosed heart issue, it's important to look at the facts surrounding exercise—particularly cardiovascular exercise—and heart health.

TV Portrayal of Cardiovascular Workout and Cardiac Event

The HBO Max reboot of Sex And The City—formally titled And Just Like That—premiered on December 9, 2021. And, within the first two episodes, there's already been a major plot twist that's got people talking. Before we dive in, you should know that this is a big spoiler alert, so if you're set on watching the series spoiler-free, you might want to come back and read this later.

At the end of the first episode, "Hello It's Me," Carrie Bradshaw's on-screen husband—and former on-again, off-again on-screen boyfriend—Mr. Big dies after a particularly grueling Peloton class. The cause? Seemingly, a heart attack.

After getting off the bike after his workout, Big appears to have discomfort in his left arm. The pain apparently gets worse and he drops to the floor. Bradshaw finds him on the shower floor when she gets home, but it's too late—Big dies in her arms.

Courtesy of HBO Max

Peloton's Response

Peloton was quick to respond: The company's cardiologist Suzanne Steinbaum, MD, released a statement to the ENews Online about the TV incident:

"Mr. Big lived what many would call an extravagant lifestyle — including cocktails, cigars, and big steaks — and was at serious risk as he had a previous cardiac event in Season 6," she said—Dr. Steinbaum is referring to an incident in which Big had surgery to open a blocked artery. "These lifestyle choices and perhaps even his family history, which often is a significant factor, were the likely cause of his death. Riding his Peloton Bike may have even helped delay his cardiac event."

And a Follow-up Commercial

But that wasn't it. The company shared a commercial on Sunday, showing Big alive and well—seemingly having faked his own death. "To new beginnings," he says to fake Peloton instructor Allegra—played by real-life Peloton instructor Jess King.

The two agree to "take another ride" (as in, another Peloton class) before a voiceover comes in: "And just like that, the world was reminded that regular cycling stimulates and improves your heart, lungs, and circulation, reducing your risk of cardiovascular diseases. Cycling strengthens your heart muscles, lowers the resting pulse, and reduced blood fat levels. He's alive."

The initial scene, though, was upsetting—not just for Carrie and Big supporters, but for anyone who has heart disease or knows someone who has.

Working Out With Heart Disease

First and foremost, cardiovascular exercise is a major part of maintaining heart health—even (and sometimes especially) if you've dealt with issues in the past. Overall, it is recommended all adults get at least 150 minutes of moderate-intensity aerobic activity per week or 75 minutes of vigorous aerobic activity. You can "gain even more benefits" by simply being active for at least 300 minutes per week.

Sadiya Khan, MD, assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician, tells Health, there are loads of reasons why cardiovascular exercise specifically is good for you:

  • It can lower your blood pressure and cholesterol levels
  • Help control your blood sugar
  • Prevents diabetes
  • Can protect you against heart disease

Even if you've already been diagnosed with heart disease or had a previous cardiac event, your doctor will still probably recommend that you exercise on a regular basis. "Once you have heart disease, exercise is especially important because you're at higher risk for having another problem again," says Dr. Khan.

Exercise can make your heart muscle stronger if you have heart disease, and it can help you be more active without chest pain or other symptoms.

That said, you shouldn't jump right into a new workout routine after a cardiac event or diagnosis without first consulting your healthcare provider—you'll want to get their okay to make sure the exercise you'd like to do is safe for you.

MedlinePlus says that's especially important if you have:

  • Recently had a heart attack
  • Have been having chest pain or pressure
  • Have shortness of breath
  • Have diabetes
  • Recently had a heart procedure or surgery

Safety During Exercising

Once you've gotten the okay from your doctor to start an exercise, program, there are additional steps you can take to make sure you're keeping your heart safe while making it healthy.

Start Slow

The first major tip? Start slowly. "Don't try to run a marathon if you haven't been exercising and training for it," says Dr. Khan. "Ease your way into different types of aerobic and strengthening exercises." Lighter exercise options that give your heart a workout—but not too much of a workout—include swimming, walking, biking, or light jogging.

Warm Up and Cool Down

Making sure you take time to warm up and cool down after a workout is important too—five minutes is a good amount of time to aim for. And you'll also want to take enough rest periods—with water—and stop exercising immediately if you begin feeling any heart symptoms.

Watch Your Heart Rate

You'll also want to keep a close eye on your heart rate during exercise—and the best way to do that is to know both your resting pulse rate and a safe exercising pulse rate for your body. Slow down if it gets too high.

A normal resting heart rate for adults is between 60 and 100 beats per minute (bpm), while a safe target heart rate zone for exercise depends on your age, and which type of exercise you're doing. For example: Though it's unclear how old Big was, Bradshaw mentioned that she's 55 in the show. In that case, the AHA says her safe target heart rate zone for exercise is 83–140 bpm.

Get a Trainer

In some situations, those with heart disease may also benefit from a physical therapist or trainer, to help determine a helpful exercise program. Some people may also be eligible for a formal cardiac rehabilitation program, which is a structured exercise program geared toward people with heart disease.

When To Seek Medical Care

If you were yelling at your TV for Big or Bradshaw to call 9-1-1 when you saw him lying on the ground, you're not alone. There are some very specific signs that you should get to the emergency department or call your doctor—whether you're exercising at the time or not:

  • Pain, pressure, tightness, or heaviness in the chest, arm, neck, or jaw
  • Shortness of breath
  • Gas pains or indigestion
  • Numbness in your arms
  • Sweaty, or losing color
  • Lightheadedness

The Bottom Line

While it can certainly be scary to see heart issues on screen—even on a fictional TV show with fictional characters—it's important to remember that physical activity is a huge boon to your health. "We definitely want people to feel safe exercising," says Dr. Khan. But, she adds, "it's important to speak with your doctor if you have any concerns."

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  1. E! Online. Peloton responds to the role their bikes played in the and just like that death.

  2. Graham JP and M. The Wall Street Journal (WSJ). Peloton: don’t blame us for what happened in ‘and just like that…’(Spoilers ahead).

  3. Amreican Heart Association (AHA). American heart association recommendations for physical activity in adults and kids.

  4. MedlinePlus Medical Encyclopedia. Being active when you have heart disease.

  5. American Heart Association (AHA). Target heart rates chart.

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