by Carolyn Thomas ♥ @HeartSisters
After being discharged from hospital following my heart attack, I was utterly gobsmacked by how exhausting even the most basic of daily activities now felt. Taking a shower was a memorable example. It left me feeling surprisingly weak, shaky and gasping for breath.
In fact, a routine shower usually meant a 20-minute lie down afterwards just to recover. That’s when I first read about METS*.
METS stands for “metabolic equivalents.” Different daily activities are assigned different MET levels depending on how much physical energy they take to do (see the list below).
The higher the MET level, the more energy the activity takes.
Your doctor may ask you to avoid activities that take more than three METS in the early days following a cardiac event.
Taking a shower scores a 3.5. Well, no wonder it’s so tiring! Showering also includes raising the arms to shampoo our hair – and any activity that requires raising both arms above the head puts an extra workload on the heart known as the pressor response.
Here are some other common daily activities and their MET scores:
- Sitting in a chair 1.0
- Watching television 1.0
- Sweeping the floor 1.5
- Driving a car 2.0
- Bicycling, stationary, very light effort 3.0
- Walking 3 mph 3.0
- Ironing 3.5
- Showering 3.5
- Bowling 3.5
- Sex 3.7-5.0
- Golfing 4.0
- Gardening 4.5
- Playing tennis 6.0
- Lawn mowing 6.5
- Shoveling 7.0
- Downhill skiing 8.0
- Jumping rope 10.0
*MORE on METS: One MET is the amount of energy required at rest, equal to approximately 70 calories per hour; three METs represent an exercise intensity equivalent to three times the metabolic rate at rest. Using the MET concept, according to the journal Clinical Cardiology, can provide “a convenient method to describe the functional capacity or exercise tolerance of an individual.” Please consult your own physician before determining which exercises are appropriate for your cardiac health.
♥
NOTE from CAROLYN: I wrote about post-diagnosis issues like fatigue in my book “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press, 2017). You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 30% off the list price).
See also:
Still too tired to put away the Halloween costume…
Exhaustion: the ‘leaky emotion’ of chronic illness
When routine tasks trigger heart symptoms
Why your heart needs work – not rest! – after a heart attack
Are you reading this sitting down? Don’t!
Women’s heart health advice: “Walk often, walk far!”
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Heart Sisters 
Brilliant article! Thanks a ton. I had an MI and stent – LAD – in June. I have been very active with dancing and Gym/ exercise workouts. Recovery using medicines is a complex thing. Although I am self motivated a lot to fight this fatigue and unexplained tiredness, the mind takes over at times causing distress.
The article is precise in capturing the essence of what the body goes through and extremely useful
Staged recovery. Fear is not an option as much as Rest has never been an option
Thanks again
Cheers stay healthy
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So glad you liked this. I believe that rest is ALWAYS an option – and a very important option!
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Like you, not one doctor, after my heart attack asked me if I’d ever had any problems with pregnancy complications (which I did, two TWO!! x low-birth-weight-full-term babies. I had no idea I was at risk.
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I had multiple idiopathic pulmonary emboli a couple of years ago at age 36 and remember vividly how exhausting showering was. The thought of it was awful. But I scored 12 METs on the stress test before been diagnosed.
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Who would imagine that simply taking a shower could be so exhausting? Thanks for sharing your perspective here, Raquel.
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Interesting that you make the “sissies” comment, Dr. Parker. It’s fairly well known that as estrogen in females decline, men’s testosterone also declines (with age) allowing men a greater amount of estrogen. Of course many feel this rebalancing allows men a deeper appreciation and experience of emotion as they age.
The classic “Type A (anger, driven)” presumed of males, let’s say in younger ages, is presumed to be translated to women, with the same prescription (meditation, letting go, etc). With women, of course this could be called “Type E (emotional)”, but I have to say, it has come as a shock to me that this does not just apply to weepy moments, sadness, etc.
I experience shortness of breath when I become excited, happy and riled up. Very happy if you will. So what this says to me is that all range of emotions (at least in me, maybe for many women) are clipped short. My entire radius of emotional life is crimped in, smaller and smaller, particularly as my little micro vessels progress over time. This results in a shrinking of the foundation of the person, the expression of the person and certainly, their ability to cope with and enjoy life.
I am not sure that the routing of emotional stressors and feelings travel the same brain routing as men. I am currently looking for some research on this. I would welcome any information on brain-emotion routing showing gender comparisons. There is new information coming out daily, particularly demonstrating heart-brain receptors that respond to each other. I would just like to see some gender comparisons on that subject. Please let me know if you see some!
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Great piece Carolyn. How true, still. It’s one of the things that I always think twice about and plan my day around.
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METS seem to be uniquely designed for the PHYSICAL side of the stimulation equation. It would be fantastic to devise an anginal equivalent structure for EMOTIONS. How would you rate these?
Rushing to get somewhere:
Pressures of living:
Bad news (small):
Bad news (medium):
Bad news (large):
Arguments:
Surprise:
Excitement:
Happiness:
Sadness (a movie):
Sadness, trauma:
Despair:
Anxiety:
Financial Upheaval:
Losing your Home:
Losing your Insurance:
Travel (small or large):
Deaths (actual or fear about):
Well, you get the idea. Emotions are just as powerful in a form of unmeasured METS for most women as exercise. They’re harder to rate, though. Consider a miniscule study which did not get much airplay in the medical realm:
A very small older, 2008 study (that is a bit hokey) done in the psychology field speaks to this.
What this means to me is that IF all female “stress” response (and in this, it’s counting back in increments) perhaps filters FIRST via the amygdala vs male response filtering first via right pre-frontal cortex, it might offer some wide explanations.
In my personal experience and opinion, this is why:
1) The perception of emotional “stressors” in females is so much greater and perhaps speaks to the greater mortality rate in females from first MIs – the patient is diagnosed later, is sicker, and often under-treated.
2) Doctors tend to dismiss women’s heart symptoms as anxiety, and also feel that women are just worse at managing emotions (vs men).
3) Cardiac meds work on the “plumbing regulation” aspect of heart management, (although beta and alpha blockers are directed to the sympathetic/parasympathetic balancing aspect of hemodynamic regulation, but DON’T address the PRIMARY issue of heart-brain routing and regulation differences, particularly in females). Brain science only recently realized that Coreg’s primary mode of action is in the brain, not the heart!
4) The implications of this pharmaceutically are significant, as there is a 5% ischemic risk in the most current generation of psych meds (SSRIs and SNRIs), no ischemic notations in tri-cyclics or benzodiazepines (although addiction and CNS risk are significant). Nonetheless, outcomes from psych meds in this population are marginally worse in women. Perhaps they are sicker, the meds add complications, or the population who requires these medications have some higher component of mental health co-morbidities.
So, although the subject is physical METS, I would argue that equally or more significantly, in females, the METS presentation is emotional.
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Thanks Mary for your thoughtful response. Even “little things” like just running late can feel surprisingly exhausting. I’d add “misplacing one’s keys” or “having company for dinner” to this list of events that can result in me collapsing in a frazzled heap afterwards.
While we’re at it, let’s also add “being misdiagnosed in mid-heart attack” to our new METs emotional stressor list? Fantastic stuff here.
Cheers,
C.
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Mary,
I’ve printed your extraordinary response to Carolyn’s METS post. Thanks to both of you today!
I’ve been looking into the world of female brain injury from heart events for years, contending that women get slammed with far more intensity via amygdal wounding that is irreparable…during heart attacks that involve significant O2 deprivation.
I’ve seen the fMRI data on differences in male/female brain processing of emotion, and males do indeed have that protective filter. Women experience emotions at about 8 times the intensity of males too. All this may explain why there are so many ‘walking wounded’ females out there long after the males have finished rehab.
A profoundly impacted amygdala is going to keep pumping out those fear/despair neurochems and hormones no matter how much the damaged heart manages to repair. For these reasons, I would like to see an MI intervention protocol instituted that deeply sedates women during heart attacks to buffer the amygdal damage. If amygdal excitation can be kept low, maybe mortality prognosis and quality of life would vastly improve. Do you have a blog too?
Jaynie
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Thanks, Jaynie,
No blog at present, but working on a website. My interest in brain filtering was due to what I felt were obvious differences; they have not been quantified yet. I have sent off some inquiry into research, but have not found much on my own.
To your comments about the amygdala, you have the wounding trauma, and you have the day to day filtering. I believe the primary filtering of “life” needs more brain study. It also explains why the male model and the female model of this experience are so vastly different. Now, we just need some good data.
Once that were ascertained, then pharma can address this in more effective ways. I think it would offer an entirely new focus for pharma direction, where you have emotion-dampening meds with negative side effects and impact contained. There is a compound that essentially strips emotion out of a person, in a sense, anesthetizing their amygdala, but then I would imagine they are left in a Mr. Spock-ish frame of mind.
The military IS working on medications that can be given to a soldier to innoculate them from trauma on the battlefield. They are working on it. Till now, one of the most efficient ways to (naturally) neutralize this is through EMDR, which the military is utilizing more and more.
Unfortunately, it does not suppress emotional reactivity. One of the best approaches for that kind of training is http://www.heartmath.com and/or meditation.
Neuro-cardiac regulation – a thought or perceived stressor (running late) should have no impact on us. Our bodies do a seamless job of responding: bringing blood to the muscles, vaso-dilating us for the hurrying, adrenaline for the rushing.
All these responses though, have an impact on the heart – it has to regulate, too. IF and when a female’s very daily functions and interactions are as magnified as a man’s going quickly up a flight of stairs, it goes a long way to explaining why women feel so debilitated, why the fatigue is so great, why women are mis-percieved as “anxiety” or “stress cases”, and why the mortality rates are higher. I look forward to finding more research to piece this together.
Mary
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Mary —
I really like the idea of emotional METS — and part of the problem after a heart attack is that like exercise, emotions are more difficult to endure…
I am not sure that emotional stressors are less for men though; I think the emotions are just suppressed more. We have been trained that emotions are for sissies.
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