Hey all, need help from lifters on how to approach a new routine, due to advice from my cardiologist to not strain too much on the weights, which is due to a defect which causes a tiny leak in the valve. This is NOT a request for medical advice, but rather a request for advice or suggestions on how to lift within the confines I've been given, and make progress without straining the body.

 I told my doctor that I usually gauge whether I want to progress to more reps or heavier weight by seeing when the last rep becomes challenging, and if I get used to the extra 1/2 reps which are a little more challenging after a few workouts, then I will continue doing them, and continuing making progress with more reps or weight. I think this is a very common approach, but he says, "just don't do that last rep." I actually am not sure on how to make progress by never doing any challenging reps. And since it's not the doctor's job to tell me what options I have nor does it seem like he can, it's led me here.

 Wondering what other's thoughts or approach would be? Is it possible to gain strength without at least slightly increasing the challenge at a steady rate?