by Steve S. Ryan, PhD
When you develop A-Fib, you have to think seriously about changing your exercising routine. In general, you want to do whatever you can to stay active and exercise normally. Review these articles to help you determine the right choices for you.
1. Exercising During an Episode: “When I’m having A-Fib symptoms, should I go ahead and exercise as I would normally?
2. Returning to “Normal” Exercise Level: “I love to exercise and I’m having a catheter ablation. Can I return to what’s ‘normal’ exercise for me?“
3. Exercise to Improve Circulation: “Is there any way I can improve my circulation, without having to undergo a Catheter Ablation or Surgery?”
Do Whatever You Can to Stay Active
Having Atrial Fibrillation doesn’t mean you have to stop exercising, but you have to be smart about it. (In some people, light exercise helps get them out of an A-Fib attack. In others, like me when I had A-Fib, exercise makes it worse.) Do whatever you can to stay active even though you have A-Fib.
Intense athletes have to face the fact that they’re more at risk of developing A-Fib and conditions like small heart injuries and fibrosis, and need to monitor their heart health more carefully.
That doesn’t mean you have to stop running or working out, but you have to be smart about it. Did you give yourself enough time to recover after the last race? What did the EP tell you about your overall heart health? Are you taking time to rest, sleep, and decrease other stressors in life? Is your diet a healthy one, centered on whole foods?
‘Knowing your heart’ is the best tool in prevention. Understand your heart rate: your normal rate at rest, early in exercise, during peak exercise, and in recovery. For more, read my article, Intense Exercise and A-Fib: Lessons from Elite Athletes.
18. “I love to exercise and I’m having a catheter ablation. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?”
Caution would say to start off slow, then work your way up. You could get a Polar (or other) heart rate monitor to keep track of your heart rate.
Your heart is considered healed from the scarring of the ablation after three months (possibly sooner). Often you feel so good being in sinus rhythm after an ablation, that you can’t wait to exercise, to do something physical.
But even though you feel great, it’s better to be prudent and rein yourself in for a short while.
Ed Webb, a very active exerciser, shares his experiences and insights. Ed writes:
“It seems the prevailing opinions seem to lean toward resuming normal activities a week to two weeks after the procedure. In fact that’s what my EP had recommended for me (the first time around). I started light walking and cycling, but unrelated to these activities I also was doing some outside work on my boat (during the fall here in Florida where it can be putrid).
On two separate occasions–I happened to be wearing a heart rate monitor–my heart was a comfortable 85 BPM and then WHAM back into A-Fib!
As I am one of those persistent A-Fibbers, I had to be cardioverted both times. This all happened within a span of 3 weeks after the procedure. Needless to say, I was somewhat discouraged thinking the ablation had been a failure.
My EP wasn’t too concerned and just advised me to hang in there. After the second cardioversion, I finally got the hint and took it really easy for the next month, after which I started a walking regimen where I allowed my heart rate to increase from 80 BPM on the first day up to 100BPM at an increase of 1 beat per day.
Once I hit the magic 100, I got back on the bike and picked it up from there and was fine after that (until 2 years later when I had another onset!). The bottom line is I think this all had to do with not allowing enough time for the scar tissue to heal.
My second time around (which was 2 years ago) I pretty much stuck to the same routine. First two weeks, absolutely nothing. Then easy walks allowing my heart rate to increase a little each day. I walked for a month (starting at 80 and finishing at 105).
After 6 weeks or so, I was back on the bike and doing maximum efforts by the end of 3 months. I have been in sinus rhythm ever since (that sound you hear is me knocking on my desk!)
Anyway, I hope this gives you at least one perspective for your recovery. All the best for your procedure.”—Ed Webb
Thanks to Monique Van Zeebroeck for this question and to Ed Webb for sharing his experiences and insight.
Return to FAQ Catheter Ablations
Frequently Asked Questions by Newly Diagnosed Patients
Newly diagnosed Atrial Fibrillation patients have many questions about living with A-Fib. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)
Last updated: Monday, July 13, 2015
FAQs Coping With Your Atrial Fibrillation: Day-to-Day Issues
Coping with your Atrial Fibrillation means a patient and their family have many and varied questions. Here are answers to the most frequently asked questions about dealing with the day-to-day issues of having Atrial Fibrillation. (Click on the question to jump to the answer.)
2. “Is there any way to predict when I’m going to have an A-Fib attack?”
3. “Should I exercise when in A-Fib or skip it and rest? Can I damage my heart if I exercise in A-Fib?”
4. “How long do I have before I go into chronic or permanent A-Fib? I know it’s harder to cure. My A-Fib episodes seem to be getting longer and more frequent.”
5. “They want to do an Atrial Flutter-only ablation, will that help if I possibly have A-Fib as well?”
6. “Is smoking medical marijuana or using Marinol going to trigger or cause A-Fib? Will it help my A-Fib?
7. “During an A-Fib episode, when should I call paramedics (911 in the US) and/or take my husband to the hospital? I’m petrified. I need a plan.”
8. “I have a lot of extra beats and palpitations (PVCs or PACs) They seem to proceed an A-Fib attack. What can or should I do about them?”
9. “How do I know which is the best A-Fib treatment option for me?”
10. “When my husband has an Atrial Fibrillation episode, what can I do for him? How can I be supportive?”
11. “How can I tell when I’m in A-Fib or just having something like indigestion?”
12. “What kind of monitors are available for atrial fibrillation? Is there any way to tell how often I get A-Fib or how long the episodes last?”
13. “I’m an athlete with A-Fib and have a naturally slow heart rate. My doctor says I need a pacemaker because my heart rate is too slow.”
14. “Can excess iron in the blood cause Atrial Fibrillation? How do I know? If I have Iron Overload Deficiency (IOD), what can I do about it?”
15. “Can too little iron in the blood (Anemia) cause Atrial Fibrillation? What can I do about iron deficiency?”
16. “Is it possible to have a single A-Fib attack and not have any others? I had a single episode of A-Fib and was successfully converted in the ER with meds.”
17. “My mom is 94 with A-Fib. Are there consumer heart rate monitors she can wear to alert me at work if her heart rate exceeds a certain number?”
18. “Can I have A-Fib when my heart rate stays between 50-60 BPM? My doctor tells me I have A-Fib, but I don’t always have a rapid heart rate.”
19. “I’m in Chronic A-Fib. Can I improve my circulation, without having to undergo a Catheter Ablation or Surgery?”
20. “In one of your articles it said that having an ablation was better than living in A-Fib. I’ve been taking 75 mg of propafenone 3X/day for seven years and have only had 5 A-Fib attacks in 7 years. If your article means all types of A-Fib [including Paroxysmal], then I will consider an ablation.”
21. “Both my uncles and my Dad have Atrial Fibrillation. I’m 50 years old and so far I don’t have A-Fib (yet), but I’m worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes?”
Last updated: Sunday, March 27, 2016
Return to Frequently Asked Questions
8. “Should I cool my sex life? Can I exercise if I have Atrial Fibrillation? Should I exercise?”
You don’t have to worry about dying while making love. A-Fib isn’t like having a heart attack. Episodes of A-Fib are normally not life threatening
Whether or not you should exercise, is really a judgment call for you and your doctor to make. In A-Fib when you first start exercising, your heart rate tends to be very rapid. Also, the A-Fib reduces your overall capacity to exercise, because your heart isn’t pumping properly.
These observations aside, if you can exercise without your heart rate becoming too rapid and you feel like exercising, you probably should. But check with your doctor. (In some types of A-Fib, moderate exercise may actually help you come out of an attack of A-Fib.)
If you want to monitor your heart rate while you exercise, you can wear a consumer or sports heart rate monitor. We like the “Polar” brand. Check out the array of Polar brand heart rate monitors on Amazon.com. Other companies include Timex, Garmin, Acumen, Nike, and Cardiosport. Used by runners and other athletes, they rely on the use of a chest strap to pick up the electrical signals from the heart and transmit to a special wrist watch. You can set it to sound an alarm if your pulse exceeds a certain rate.
Last updated: Tuesday, July 14, 2015
19. “I am in Chronic (all-the-time) A-Fib. I feel tired and a little light-headed, probably because my atria aren’t pumping properly. Is there any way I can improve my circulation, without having to undergo a Catheter Ablation (poor success rate and risky at my age) or Surgery (even more risky)?”
In theory, yes. In Chronic A-Fib it’s not unusual to feel tired and light-headed. Your atria are fibrillating instead of pumping blood into the ventricles. Blood flow to your brain and other organs is reduced by about 15%-30%. But your ventricles still function by suctioning blood from the atria much like a turkey baster sucks up liquid.
To some extent, you can improve the strength and capacity of your ventricles by exercise, such as by walking on a treadmill or at the shopping mall.
You can also improve the oxygen saturation of your blood by using an Oxygen Concentrator ($500-$1,000). While on a treadmill, for example, you can breath in concentrated oxygen through a cannula, a flexible tube you insert into your nostrils. You can measure how much oxygen is in your blood by using an pulse oximeter ($50). The desired range is 95-100% oxygen saturation. (Some athletes with good circulation use this technique to improve their athletic performance.)
Don’t dismiss the treatment options of catheter ablation or mini-maze surgery. Both have high success rates with low rates of complication. With Chronic A-Fib, the longer you wait to cure your A-Fib, the harder it gets.
The Bottom Line: the real question is whether these techniques will improve your A-Fib symptoms of feeling tired and light-headed. I’m unaware of any studies demonstrating the effectiveness of the above techniques for the symptoms of Chronic A-Fib.
¤ The Link Between Infections and Inflammation in Heart Disease. Life Extension Vitamins. Last accessed November 5, 2012 http://www.lifeextensionvitamins.com/cadico6otco.html
¤ Atrial Flutter. Heart Rhythm Society website. Last accessed March 30, 2014. URL: http://www.hrsonline.org/Patient-Resources/Heart-Diseases-Disorders/Atrial-Flutter
¤ “Atrial Fibrillation Educational Material” University of Pennsylvania. 2002, p. 3.[/su_pullquote]
3.“When I have A-Fib symptoms, should I go ahead and exercise or skip it and rest? Can I damage my heart if I exercise in A-Fib?”
This is a hard question to answer, because it depends so much on the type of A-Fib you have and how A-Fib affects you individually. It’s really a judgment call for you and your doctor.
Light exercise: In some people light exercise helps get them out of an A-Fib attack (Vagal A-Fib). In others, exercise makes it worse. When you first start exercising, your heart rate tends to be very rapid and disturbing. If you have A-Fib symptoms, try light exercise for a short time to see if it will get you out of an A-Fib attack. If not, you should probably skip it and rest. Try to exercise when you’re in Normal Sinus Rhythm.
Possible dangers of exercising in A-Fib: When exercising in A-Fib, you may be pushing your heart into higher pulse levels, putting added strain on your atria, getting your heart used to beating in A-Fib and staying in A-Fib longer, etc. But unfortunately we don’t know this for sure.
Some regularly exercise in A-Fib: I have a friend who is in persistent no-symptom A-Fib. He is an active swimmer. His swimming probably improves his A-Fib compromised circulation. He feels better when he can exercise. If you don’t feel bad when exercising in A-Fib, the exercise probably does improve your circulation, in addition to the regular benefits of exercise.
Exercise if you can: In general, with A-Fib, do whatever you can to still exercise. If you can exercise without your heart rate becoming too rapid and you feel like exercising, you probably should. But check with your doctor. If exercising feels bad or brings on an A-Fib attack, skip the exercise. No one’s going to hold it against you if you miss a day of exercise.
by Steve S. Ryan
A 2009 study stated, “Vigorous exercise increases the risk of atrial fibrillation.” But a close examination of the observational study used to support this statement showed that A-Fib is associated only with men under 50 years of age who jogged/ran over four miles a day 5-7 times a week. This is a level of running usually associated with elite athletes.
Other types of vigorous exercise such as cycling, swimming or racquet sports were not associated with an increased risk of A-Fib.
Why elite runners develop A-Fib
The authors of this study hypothesized that several factors might explain the increased risk of A-Fib in elite male runners under 50 years old.
▪ left atrial enlargement
▪ left ventricular hypertrophy
▪ left ventricular dilation
▪ inflammatory changes in the atrium
▪ an increase in parasympathetic tone (the most commonly cited factor)
“Jogging in particular results in greater enhancement of the parasympathetic nervous system compared to other exercise types.” “Heightened parasympathetic tone has been associated with A-Fib onset in patients with structurally normal hearts; and in animal and human studies, parasympathetic stimulation frequently induces and maintains A-Fib.”
Vigorous Exercise good for most people
The authors of this study recognized the benefits of vigorous exercise for most people. “Exercise has multiple beneficial effects on cardiovascular health that may lower A-Fib risk.” In particular, exercise lowers blood pressure, improves lipid profile and glucose control, decreases risk of cardiovascular disease, has positive effects on traditional risk factors such as hypertension, diabetes, cholesterol and obesity, improves arterial elasticity which tends to deteriorate with age, and extends life expectancy.
(Physical inactivity and a sedentary life style is a far bigger health problem for most people than excessive physical activity.)
New Swedish study—intense exercise linked to A-Fib
A new study from Sweden is more critical of vigorous exercise and the risk of developing A-Fib. Men who exercised more than 5 hours/week when they were in their 30s had a 19% higher risk of developing A-Fib later in life than those who exercised less than one hour/week. “Vigorous long-time physical activity seems to increase the risk for atrial fibrillation…Leisure-time exercise at younger age is associated with an increased risk of A-Fib.” But this study was primarily concerned with older men aged 45-79 years (mean age=60).
It also found that high levels of leisure-time exercise at an older age did not increase the risk of developing A-Fib. The authors hypothesized that leisure-time exercise may be of lower intensity at an older age.
They also found that more leisurely activities such as brisk walking or cycling at age 60, even if over 60 minutes a day, were associated with a 13% decrease in A-Fib over those who got no exercise at all. An accompanying editorial suggested when it comes to exercising “maximum cardiovascular benefits are obtained if performed at moderate doses, while these positive aspects are lost with (very high) intensity and prolonged efforts.”
(This study didn’t address the interval exercise technique often used in sports training and in gym workouts of varying intensity exercising—pushing oneself to the max, resting, then alternating with less vigorous workouts.)
What about those of who love to compete at a very high fitness level?
Dr. T. Jared Bunch of the Intermountain Heart Institute in Utah sees a number of very highly skilled endurance athletes. They go from marathons to triathlons to 100-mike bike races. Even though they are amazingly fit, they tend to develop A-Fib. The A-Fib develops despite these athletes having normal blood pressure levels and heart function.
There are many potential reasons why. These extreme athletes often develop what is called an ‘athletic heart’. The heart chambers are slightly enlarged. These adaptive changes allow for a higher cardiac output during exercise. However, some of these changes may also promote abnormal heart rhythms by changing the underlying architecture of the atrial chambers.
It is possible that repetitive wear and tear from the intense daily workouts is a factor and results in small areas of fibrosis in the upper and lower heart chambers which promote A-Fib and other arrhythmias. With improved MRI cardiac imaging, these small areas of fibrosis can now be visualized. Also, changes in the autonomic nervous system may irritate tissues responsible for generating A-Fib.
Finally, the personalities that often allow excellence in endurance athletes may also promote heart disease by the way the body and mind responds to stress. In total, endurance athletes put significant stress on their heart.
Should Intense athletes stop running and training?
Should intense athletes stop running and training? No. The intense athlete lifestyle reduces other heart risk factors and improves quality of life, not to mention the personal satisfaction and sense of fulfillment that comes from competing at a high level or winning a race. In the above Swedish study, low activity level people (couch potatoes) had more disease-related deaths.
Dr. T. Jared Bunch gives the following recommendations, which intense athletes can use to help their heart health:
▪ In periods in which they are not training, interval training that allows the heart to recover during exercise, can be used to maintain aerobic function and muscle strength.
▪ Intense athletes who train early in the morning should make a conscious effort to get restorative sleep. For most of us this means about 8 hours of sleep.
▪ Intense athletes who have prolonged training schedules need to pay close attention to maintaining their electrolytes. Loss of sodium, potassium, magnesium, and calcium are sources of heart electrical irritability.
▪ All athletes need to get routine screening of their blood pressure, cholesterol, and fasting sugar. Most of the time these are normal. But in those with genetic risks, they can be abnormal. If treatment is started early, lower doses of therapy can be used that do not impact athletic performance as much as treating the disease later in life.
Intense athletes have to face the fact that they’re more at risk of developing A-Fib and conditions like small heart injuries and fibrosis and need to monitor their heart health more carefully.
‘Knowing your heart’ is the best tool in prevention. Understand your heart rate: your normal rate at rest, early in exercise, during peak exercise, and in recovery.
If you develop changes in this normal heart rate spectrum or start to feel palpitations, you may need to see an Electrophysiologist (EP) before A-Fib develops. Testing may include an MRI to look for heart function and fibrosis as well as an ultrasound of the heart (echocardiogram) and a heart monitor. Your EP should measure the diameter of your left atrium and monitor for enlargement over time.
That doesn’t mean you have to stop running, but you have to be smart about it. Did you give yourself enough time to recover after the last race? What did the EP tell you about your overall heart health? Are you taking time to rest, sleep, and decrease other stressors in life? Is your diet a healthy one, centered on whole foods?
The intense athlete might think: “But if I develop A-Fib, I can just have a catheter ablation (PVI), can’t I? I’ll be A-Fib free and can resume my training and racing.” Not necessarily. Even though your pulmonary veins have been isolated, it’s possible to develop A-Fib in other parts of your heart. The conditions (intense running and training) that pushed you into A-Fib are still there. We can’t say for sure that you will develop A-Fib again, but we also can’t say that you won’t.
As an intense athlete you may not want to hear this. But if you develop A-Fib, you may have to think seriously about changing your life style or training schedule. You will find that alternative exercises and programs yield positive benefits. Of these, Yoga and walking seem to have the strongest beneficial effect on A-Fib. For intense athletes, walking is part of life, but Yoga may not be. Yoga is a great way to shape up both mind and body and help with the body’s stress response.
After a successful ablation, the intense athlete, may decide to just live with the risk of developing A-Fib again. (There’s always a possible second ablation.)
If you reach a time in your life when you transition to lower daily intensity programs, your risk of developing A-Fib may start to come down.
Last updated: Thursday, December 8, 2016