DEAR DR. DONOHUE: I am 71, and I have an enlarged heart. I like to do muscle exercise in the morning, and at night I ride my exercise bike for six to eight miles. I always thought that exercise is good for the heart, but I read that it is not good for an enlarged heart. Is that so? – P.M.

ANSWER: Hearts get bigger for good and bad reasons. Exercise makes the heart enlarge. After all, the heart is basically a muscle, and muscles respond to exercise by growing bigger and stronger. That kind of enlargement – the athlete’s heart – is quite healthy.

High blood pressure stimulates the growth of heart muscle. The heart has to pump out blood in the face of high pressure. That’s a stimulus for growth. However, this kind of growth isn’t healthy. A heart can tolerate high blood pressure by growing larger only for so long, and then it begins to poop out. Furthermore, lifting weights, if that’s the kind of muscle exercise you do, temporarily raises blood pressure to high levels. If a person has a healthy heart, that’s no problem. If a person has uncontrolled high blood pressure, that can be a problem. If pressure is under control, then weightlifting is permitted. Bike riding is an exercise that benefits people with high blood pressure – but the pressure still has to be controlled. People with high blood pressure have to get the OK of their doctor to exercise.

Congestive heart failure also produces a big heart. Here the heart has become so flabby and weak that it cannot empty itself of blood with each beat. Blood pools in the heart, stretches it out of shape and causes it to become big.

At one time, congestive heart failure was considered a contraindication to exercise – all exercise. Now it no longer is. Again, the heart failure must be under treatment, and the doctor has to concur that exercise is safe.

Hearts enlarge for many other reasons. Cardiomyopathy – an inherited heart condition – is another cause.

The point is that only your personal physician can assure you that exercise is safe and beneficial for you. The doctor reaches that decision by identifying the cause of the enlargement and determining if the cause is adequately treated.

DEAR DR. DONOHUE: Exercise instructions usually recommend slow strength exercises. But for high-velocity sports (tennis, basketball, baseball) would moving at sport speed be better? – R.G.

ANSWER: The best way for an athlete to improve the strength and speed of movements in his or her sport is to exercise the involved muscles in exactly the same way those muscles move when playing the sport. That goes for the speed of movement too.

Stereotypical weightlifting exercise doesn’t exactly translate into increased strength and speed of movement in a particular sport. Strength and speed come from mimicking the individual sport movement. That’s exercise specificity.

Admittedly, it isn’t possible to replicate all sports movements with weights, but an approximation of the movement can be duplicated.

DEAR DR. DONOHUE: My teenage daughter is a long-distance runner for her school. Prior to the season, she was supposed to have a doctor examination. She didn’t get it, and the coach allowed her to begin training with the team but wouldn’t let her compete without the exam. One week after starting practice, she saw the doctor and had some blood tests. Her blood tests indicated she was anemic. The doctor said it was nothing of concern. The coach won’t let her participate. What can we do? – R.C.

ANSWER: Get another blood test now. In the early days of endurance training – and long-distance running is endurance training – the body retains fluid. Fluid retention makes it look like there are too few red blood cells. They’re diluted. Anemia is too few red blood cells. However, the deficiency is not for real nor is the anemia. After about three weeks of training, fluid retention goes away and the blood count returns to normal.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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