Can strenuous exercise trigger AF & accelerate deterioration of the condition?

[Garywf]

In the twelve months since the last visit to my consulting cardiologist the number of AF episodes as recorded by my pacemaker have increased markedly. The only part of my lifestyle that changed in 2013 was a significant increase in exercise & the fact that I have aged another year.

I will be 68 in a few months & workout at the local gym three days per week (1hour per session), cycle each weekend (~40kms each day) and like to bushwalk or walk long distances whenever I can.

Recent research from reputable sources seems to suggest that too much vigorous exercise may actually be harming rather than helping the condition, particularly in the over 65 age group.

I have become attached to my daily routine & experience withdrawals if for some reason I can't participate.

I would be very interested in your personal experience & any comments you might offer after having researched the relationship between strenuous exercise & AF.

[BobD Volunteer]

There is a definite link between endurance training and AF. . The left atria tends to become enlarged by this sort of training and this can lead to the electrical pathways becoming stretched and losing integrity.. Fighter pilots also suffer in this way due no doubt to the effects of fighting g forces.

That said AF begets AF so the longer you have it the worse it becomes so it will get worse with time . You seem to be going for a double whammy! Remember the pacemaker only paces the ventricle so can't stop the AF.

No doubt you can gradually come of your endorphins if you slow down.

Bob

[Garywf in reply to BobD]

Thanks Bob, sound advice. I plan to manage my future exercise better than I have done in the past. Thanks for the wake up call.

[jbrucej]

Yes, I find that strenuous exercise will definitely trigger AF. Unfortunately, what is "strenuous" in one exercise session that triggers AF may not trigger it the next time. I recently purchased a new chest Heart Rate Monitor that I use with my smartphone that is very accurate. I set alerts for pulse rate and when I go over a certain level, the device will warn me and I know to slow down the exercise rate and I convert back. This way, I can push the heart for good exercise but not push it into AF and do damage and I can customize each workout. Note, I'm on very large doses of beta blockers (metoprolol) and find I need to warm up very slowly so my heart rate can catch up to my oxygen demand; and to cool down slowly so I don't get chest pain when I'm done.

[Garywf in reply to jbrucej]

Thanks for your response to my question. My thinking is that if I modify my exercise, like you, then I can optimize the benefit whilst minimizing harm due to the onset of AF caused by over exertion.

My cardiologist has prescribed stronger medication (including metoprolol) in an effort to reduce the number of episodes I am having however I am reluctant to change due to my concern about side effects. I would prefer to try modifying my exercise regime first.

I also use a smartphone with an app (Strava) to track workouts so the purchase of a heart rate monitor seems like the next logical step. Would you mind providing me with details of your HRM?

[jbrucej in reply to Garywf]

I would not hesitate to try metoprolol. It is a rate control med but for those of us with heart issues, it can help the heart heal (I've had three heart attacks and have quite a bit of muscle damage in addition to the AFib). However, it does take a bit to get used to it and at first, you feel tired all the time so you have to "push through" until your body adjusts.

AFA the HRM, I started with the ANT type receiver that could be paired with Treadmill and other gym type of equipment. I found that it would really exaggerate the AFIB. When I would "flutter" or go out of rhythm, the monitor would show a 220 pulse - not very helpful.

I now use Android (Galaxy S4) that supports the Bluetooth Low Energy ("BLE") and so I purchased a Jarv strap. Not only is it reasonably priced on Amazon (amazon.com/Jarv-Premium-Blu... but I'm very happy with the way it shows the heart rate since it tends to flatten out the peaks and valleys. Since Android just started supporting BLE (Apple has for quite awhile - but I'm not a fan of Apple), there are currently only three apps that you can use. However, that will change rapidly I'm sure since Android supports the 'heart rate profile' as part of their BLE platform now.

One final warning: be careful where you work out. I had a couple of times where the AFib was really bad and I became dizzy and lost feeling in my feet. I have heart failure too and so that was likely due to reduced heart output. But, you wouldn't want to be on a long hike and lose feeling in your feet and have trouble walking out.

In any event, I salute you for not letting your disease disable you and enjoying life as much as you are able.

[Garywf in reply to jbrucej]

Thanks Bruce, I also have an S4 so I will try the Jarv strap. Unfortunately I understand my cycling app (Strava) won't support this HRM so they won't pair over Bluetooth. Not to worry though it will be a good start as I really should know what my heart rate is during exercise.

Thanks again for the good advice!

[Garywf in reply to jbrucej]

Bruce, I spoke to Medtronics today about possible interference with the pacemaker by the HRM. They told me that the safe distance between the two should be 15cms (6ins), have you had any problems due to the proximity of the HRM to the pacemaker? I am thinking maybe to be cautious I should get a wrist watch type but they seem to be considerably more expensive.

[jbrucej]

Hi Gary,

I've managed to avoid a pacer so it's not an issue yet for me. Keep in mind that if you go with the new Bluetooth Low Energy, it is an extremely low transmitter power. In fact, a small coin cell battery will power the device for about two years. You may ask Medtronics about using one of those since it's a different beast from regular bluetooth device; say, the hearing aid bluetooth device worn around the neck that I also have.

I'm not sure that the wrist watch monitors would pick up the crazy afib stuff. Perhaps a medical person could weigh in. My experience wearing a strap while exercising on a Treadmill shows that as long as I'm not in AFib, the heart rate monitors on the TMill match the strap exactly since I think the heart signals are strong enough to reach the hands. But with my old ANT type strap, the rate would go to the max of 220 on the strap monitor (around the chest) and the Tmill hand monitor would show 130 or so. With my new strap, I think the sensor flattens out the peaks some and so it doesn't show the 220; but it does show a higher rate than the hands when I start to flutter. So the hands might show 110 and the strap now might show 130 or 140. I find that when I slow down and the strap rate slows and I return to NSR, the strap and hand monitors again show the same rate. This all pretty crude but for me, it allows me to see that I'm hitting AF early and I can slow down before I get dizzy and lose feeling in my feet and this allows me to push to the edge and get the most out of my workouts.

Hang in there and keep working at it. I was told by my cardiologist that I would not be here if I had not been exercising regularly since my STEMI had the "widow maker" artery 100% blocked for over an hour and the heart managed to stay beating till they got the stent in since it was accustomed to running in low oxygen mode from the exercise. Unfortunately, it left quite a bit of scar tissue and the electrical system all amuk. But I can still hold my grandchildren and get some cardio workouts so I'm not complaining and I enjoy life now as much as ever.

-bruce

[Garywf in reply to jbrucej]

Thanks again Bruce, I will follow your advice. Got it sorted now. By the way could the loss of feeling in your feet be a side effect of Metropolol?

[jbrucej]

I don't think Metoprolol is the cause of the numbness in my feet. I've taken it for years for high blood pressure and periodic ectopic heart beats prior to experiencing regular AFib and didn't have the feet problems.

I have peripheral artery disease (clogged arteries in my legs) and congestive heart failure (weak heart). I think when I'm working out on the TMill or even taking long walks, when I go into AF and the beats get weaker, the blood circulation to my feet decreases to the point where they get numb. So I try to keep the AF down so I can keep walking or using the Tmill.