Sweating it off – Why and how to exercise with atrial fibrillation?

Text: Anni Karjala, MD / Illustration: Erik Lanza

After being diagnosed with atrial fibrillation, many feel concerned about whether and how to exercise. How to avoid the most common pitfalls and safely enjoy an active life? We listed four common questions that arise about atrial fibrillation and exercise.

1) How does physical activity affect atrial fibrillation?

Physical activity has a key role in maintaining good heart health. In individuals with atrial fibrillation, physical activity is considered to reduce the symptoms and improve quality of life (1-3).

Physical activity is also known to impact the risk of atrial fibrillation, but the effect is somewhat two-fold. First, moderate exercise reduces the risk of atrial fibrillation episodes (4,5). In addition to direct heart-health promoting mechanisms, regular physical activity aids in reducing risk factors predisposing to atrial fibrillation, such as obesity, high blood pressure and sleep apnea (3).

While physical activity is no doubt beneficial, regular very strenuous endurance exercise (like running a marathon or other extreme endurance activities) is known to increase the risk of atrial fibrillation. For reasons still under research, this seems to be especially true for men (6).

After being diagnosed with atrial fibrillation, it is better to start slow, listening carefully to how you are feeling.

2) Can I exercise with atrial fibrillation?

Before engaging in physical activity. It is important to get a go-ahead from your physician as every situation is unique.

On a general level, the type of atrial fibrillation has some impact on exercising.

If your atrial fibrillation is chronic (meaning you have it all the time): With properly managed atrial fibrillation, your pulse should not get too high during the exercise, and engaging in physical activity is usually recommended. Discuss with your physician about staying safe while exercising in your specific condition.

If you have paroxysmal atrial fibrillation (meaning episodic atrial fibrillation, where the arrhythmia comes and goes), you can exercise normally unless you are having an atrial fibrillation episode. In paroxysmal atrial fibrillation, exercising during an atrial fibrillation episode may worsen the symptoms and put your heart on too much strain, so during that time, it is better to rest. Sometimes an atrial fibrillation episode may also start during physical activity, and this is a sign you should stop.  

3) Does my medication for atrial fibrillation affect exercising? 

Medication used for atrial fibrillation does not stop you from enjoying the many benefits of regular exercise. On the contrary, properly managed atrial fibrillation will enable you to exercise safely and with less symptoms. However, there are few things worth noting. 

• Some medications will slow down your heart rate and may sometimes cause fatigue. Despite the downside, if medication has been prescribed to you, the net benefit is considered good. As long as your doctor has given you the permission to exercise, you can do so.

• If you are on anticoagulant treatment, the medication increases the risk of bleeding. This is good to keep in mind when exercising.

4) How to exercise with atrial fibrillation?

Start slowly and listen carefully to how you are feeling.

The current recommendations for atrial fibrillation encourage exercising regularly, 3-5 times and for a total of 150 min (recommendations varying from 120-200min) per week with moderate intensity (5,6).

It’s good to remember that if you’re suffering from chronic atrial fibrillation, your heartbeat is irregular and might cause error if you’re used to tracking your heart rate during exercise. In this case, it is even more important to focus on listening to your body.

Source: 
Elliott AD, Mahajan R, Pathak RK, Lau DH, Sanders P. Exercise Training and Atrial Fibrillation: Further Evidence for the Importance of Lifestyle Change. Circulation. 2016;133(5):457-459. doi:10.1161/CIRCULATIONAHA.115.020800

References

1. Shi S, Shi J, Jia Q, Shi S, Yuan G, Hu Y. Efficacy of Physical Exercise on the Quality of Life, Exercise Ability, and Cardiopulmonary Fitness of Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis. Front Physiol. 2020;11:740. Published 2020 Jul 24. doi:10.3389/fphys.2020.00740

2. Elliott AD, Mahajan R, Pathak RK, Lau DH, Sanders P. Exercise Training and Atrial Fibrillation: Further Evidence for the Importance of Lifestyle Change. Circulation. 2016;133(5):457-459. doi:10.1161/CIRCULATIONAHA.115.020800

3. Chung MK, Eckhardt LL, Chen LY, et al. Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association. Circulation. 2020;141(16):e750-e772. doi:10.1161/CIR.0000000000000748

4. Adrian D Elliott, Dominik Linz, Ricardo Mishima, Kadhim Kadhim, Celine Gallagher, Melissa E Middeldorp, Christian V Verdicchio, Jeroen M L Hendriks, Dennis H Lau, Andre La Gerche, Prashanthan Sanders, Association between physical activity and risk of incident arrhythmias in 402 406 individuals: evidence from the UK Biobank cohort, European Heart Journal, Volume 41, Issue 15, 14 April 2020, Pages 1479–1486, https://doi.org/10.1093/eurheartj/ehz897

5. Mozaffarian D, Furberg CD, Psaty BM, Siscovick D. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation. 2008;118(8):800-807. doi:10.1161/CIRCULATIONAHA.108.785626

6. Stanley Nattel, Physical activity and atrial fibrillation risk: it’s complicated; and sex is critical, European Heart Journal, Volume 41, Issue 15, 14 April 2020, Pages 1487–1489, https://doi.org/10.1093/eurheartj/ehz906