Fitness training and AF

I had an episode of 2 days ago AF and ended up in A&E with a very fast irregular heart rate. I have had some minor symptoms before but this was the first time I have been diagnosed with AF. After several hours on medication I reverted to regular beats and was allowed home in the evening with prescription for 5mg beta blockers, but no anticoagulants deemed necessary at present.

At the moment I feel exhausted and get easily breathless. When I feel up to going back to the gym, how hard should I push myself? I have been in training to do ski touring and although I mentioned skiing to the doctor I don't think she had any idea of how strenuous an activity it is. I have been training quite hard up till now. Will I be able to go skiing now? I feel shattered.

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14 Replies

  • Hi, physical exertion can be a trigger of AF for some people. Take it easy, get use to your meds and then slowly restart training and slowly build it up. I found an exercise bike a good way to get back into exercise as I felt better been sat down. Good luck I hope you get out skiing.

  • Get a heart rate monitor and set limits so you will be aware of your heart going too fast and can train in control.

    Work out your heart rate zones and avoid going anaerobic. So for most training at zone 2 (just able to talk comfortably) or 3 (too hard to talk, but manageable for fairly long periods)

  • Beta blockers are notorious for reducing your ability to exercise, next time you see your doctor ask him about Diltiazem. My cardiologist has put me on Diltiazem (Adizem) expressly because it doesn't undermine your ability to exercise to the same degree as beta blockers do, see here:


  • HI ectopic, thanks a lot, please can you send the reference for the article as I can't get the link to work

  • That's interesting, the link was the one I downloaded a copy from last April, but it's now behind a paywall. The paper is:

    Atwood, Myers, Sullivan, Forbes, Pewen, & Froelicher:

    Diltiazem and Exercise Performance in Patients with Chronic Atrial Fibrillation

    Chest/92/1/ January 1988

    If you search for it on Google Scholar, then click "all 8 versions" one of the other links reveals all without a paywall.

  • Check out this link which I found quite useful.

  • Thank you everyone this is really helpful!

  • It depends on how much aerobic training you've done over the years, whether it's normal for you to have a high heart rate during training, your blood oxygen level particularly if you ski at high altitude. The 220 minus your age formula was just a arbitrary set of numbers. If you have a long history of aerobic exercise, the Metzl or Karvonen formulas may be a better fit. Text books say a 30% reduction in output power during AF but from my experience, aerobic fitness is likely to reduce this to 20% or lower. Weight bearing exercise may not be tolerated during AF, I found that a Spin bike or Concept 2 rowing machine was much easier when my heat rate was around 200. It might be worth using the ithlete ap that measures the r-r interval to determine when you should train, have an easier day, or complete rest.

  • I forgot to add that a Bruce Protocol test conducted by clinicians may be useful to check your heart during aerobic exercise. You will exercise on a treadmill that gets progressively faster and steeper. Your ECG will be shown on a large monitor and your blood pressure will be taken periodically. You will need to tell the clinicians of your aerobic fitness as I my case, AF only appeared after they had run the test for longer than they would normally do.

  • There are a lot of sporty types on this forum that have AF. I use a heart rate monitor when I go out cycling to try and avoid overdoing things. I was cycling at altitude in Colorado last September. See earlier posts. However the difficult question is whether a long history of endurance exercise has caused changes to the heart that bring on AF. And whether continuing with strenuous exercise is making things worse. A number of us have opted to take things a bit easier but not give up totally as we like to have "the wind in our hair". Good luck.

  • Hi thanks. Did you have to adjust any of your medication when going to a high altitude? I have a skiing holiday booked for 7 January but now am thinking of cancelling. As I am not on anticoagulants I am worried that blood gets thicker at altitude so increasing stroke risk. And if I get put on them then I don't think skiing is advise in case I crash.

  • I did not change any of my medication. I am on warfarin and the advice from my electrophysiologist was to stay hydrated. This increases blood volume and is probably more relevant. Professional cyclists who took EPO had to keep well hydrated. Regarding crash risk whilst cycling, I wear a warfarin wrist band, always wear a helmet, take care on descents, and avoid icey roads. The main risk is internal bleeding eg to the head, that is not obvious.

    I will not let AF control my life. I make sensible modifications to lifestye but try as best I can to carry on.

  • I have a suspicion that the body learns after a while to go into AF during vigorous exercise. During running I'd regularly push past 80% MHR on runs (not HIIT) and, I'd "red line" most Spin classes during a sprint. However I had to take a break of 18 months when my lungs took a severe dislike to dronedarone and amiodarone prescribed for AF. When I restarted the gym I didn't go into AF for at least a couple of months even though I wasn't taking any medication.

    Don't give up exercise, but take medical advice. I had a stroke in July and my consultant neurologist has said that it's OK to use my bike on a turbo trainer (post-stroke I'm blind on one side), to do Pilates with modifications and, do scrub clearance with a voluntary group.

  • The following papers cover the eligibility criteria for participating in sport with arrhythmia, they're for competitive athletes, but give an idea of the considerations:

    Heidbuchel et al:

    Recommendations for participation in leisure-time physical

    activity and competitive sports in patients with arrhythmias

    and potentially arrhythmogenic conditions

    Part I: Supraventricular arrhythmias and pacemakers

    Zipes et al:


    Eligibility Recommendations for Competitive Athletes With Cardiovascular Abnormalities

    Task Force 7: Arrhythmias

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