Help needed from AF ers who are into fitness!

Having been inspired by posts from followers who mention casually that they work out for an hour a day, walk five miles, cycle, swim, etc I decided that my light housework and gardening was not nearly good enough 🤔 As walking and swimming aren't suitable for me I consulted our GP practice's physiotherapist about my problems with my right leg and decided an exercise cycle was just the thing to complement the exercises she gave me. So a shiny yellow exercise cycle is dominating my dining room but I have a problem. I started off very gently, as advised, but I can't get my HR up to the suggested 105 BPM before my legs hurt and I have to stop 😫 I guess this is doing wonders for my weak leg but nothing for my fitness. Any suggestions? Do I just carry on as I am until my legs get stronger or is there anything I should do different?

30 Replies

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  • You don't mention how long the training sessions you are attempting are, but generally speaking, I think that if you can't manage initially, it's better to cut the duration of the sessions, than to cut the intensity.

    It's usual to prescribe exercise intensity in terms of a percentage of maximum HR. For a beginner starting from scratch, schedules typically prescribe a training zone of somewhere around 60%-75% MHR which raises the question of what your MHR actually is. It's not a good idea for a novice to try and measure it, so the rule of thumb that everyone uses is MHR = 220 - Age.

    All that of course is for someone who is healthy, and therein lies the rub, I've not been able to find out how you judge training zones if you're on meds. I'm 58, so my MHR should be 162, but with being on meds it's actually more like 125-130. Personally, it certainly feels to me as if 75% of 130 is now as hard as 75% of 220 - age used to be, but that doesn't seem enough to produce any fitness benefits. I struggle to reach even the minimum intensity recommended for the rehabilitation of heart attack patients.

    I asked cardiology how to determine training zones, but I didn't get any answer.

  • My bike comes with training instructions and a handy table to work out HR targets, which is how I know 105 should be my initial aim. I have found my HR speeds up for a while then slows to lower than my normal resting HR for a minute, I checked with my oximeter as I didn't trust the bike reading but it was correct. I guess I'll have to start on strength and work up. Our local sports centre has machines suitable for training people with limitations but I'd need the husband taxi for that......

  • I like to get my heart ticking over nicely and just short of being puffed. My treadmill does have a heart rate thingy but I have never used it. I just go by how I feel and about 25 minutes of uninterrupted, steady uphill walking every day makes me feel I've got rid of all the cobwebs. I play a word game (Worcle) on my ipad at the same time.

  • After my spectacular fall I wouldn't risk that though it does seem a brilliant solution to the boredom of walking 😀

  • My chiropodist told me she reads while cycling slowly on max effort. I hold on tight to the treadmill with one hand! Over the years I have managed to pick up a few fractures walking or running along a road. Ice brought me down last time, hence the purchase of the treadmill five years ago. My other half has a gadget for his bicycle that enables him to use it indoors.

  • I thought you meant a real hill 😄 didn't read carefully enough!

  • Be aware of course if you are taking anti arhythmics of any sort then you wont achieve the expected heart rates. Also if you are in AF at the time of exercising then the monitor may under read your rate.

    It may be best to just go on perceived exertion, bearing in mind that interval training gives the best results in the shortest time.

  • I looked up interval training as I had no idea what it is, will have to work up to that l think......

  • It's really very easy. try starting with 1 minute effort alternating 1 minute gentle pedalling. Just 10-20 minutes would be worthwhile

  • Thank you, fortunately I have had a successful ablation and not on any meds either, but I gave in too much to the meds I was taking previously and am aware I am very unfit. I think the effort suggestion is good.

  • It is so great to hear of someone who has had a successful ablation and is off meds. I had an ablation 3 mos. ago, and after the furst week have been in normal rhythm since. I go the surgeon today for folllow up and GREATLY want to get off both the anti arithmetic and anticoagulant. I am very tempted to stop no matter what he advises. I was only on aspirin before surgery.

  • I still take an anticoagulant (Rivaroxaban) but my other meds were stopped immediately after the ablation as I had been having long pauses in HB. I hope your results will be good!

  • I am fascinated to see the responses here. I have only spent one extended period in A-fib, which was for about 6 weeks earlier this year. It was soon after my ablation. I am reasonably fit (the day before the ablation I went for a 6km jog) - but when I am in a-fib I have absolutely no clue what my actual heart rate is. If I jog my hr will go from anywhere between 45 and 195 beats within the same minute without a change in pace. The same applies to cycling.

    In terms of trying to reach the 60% range - I really don't think an afibber should get stressed about that (personal view). Get on the bike and just try work up a sweat, however long that takes. Do some research on the term "going slow to go faster" - you should learn that duration at low intensity is very good for you.

  • I think there's something of a difference between not being unfit and being fit and I can see I've rather been aiming for the former.

  • What set me off was going on a (slightly) uphill walk with a friend and being barely able to speak while she kept up a nonstop stream of conversation, she loved it 😛

  • I agree with you, but not sure why you are saying that in response to my comment. The going slower approach is used to get very fit. (this is in reply to Rellim)

  • I've aimed to be healthy rather than fit and haven't ever tried to work up the sweat you mentioned! When I turned 40 (just over 30 years ago) I had a two year old and a baby and my sister had just died and I had her children (14, 13 and 10) to consider as well. I felt it wasn't fair to them (or my husband) to neglect my health and I started jogging a mile an a half every day and I watched what I ate. I am just a little miffed at the way my heart has repaid me for this minor bit of effort and talk of lifestyle changes working wonders for one's AF fall on quite stony ground too. I am not really into fitness - but I walk up stairs instead of taking the lift.

  • It is great that you are introducing another form of exercise. You dont mention how long you have had the bike and how many times you use it per week. It will take time to build up both aerobic endurance and muscle endurance and fitness, starting to notice improvement over months rather than days.

    Also decide what you are aiming to do from maintain healthy fitness to win a race.

    As for intensity, initially this is a matter of listening to your body. the numbers we are given in guides are normalised across so many peole that it doesnt take into acount any differences in ability and health as @Jonathan_C mentioned.

    Without HR numbers guiding you can use 3 levels of intensity, easy conversation and normal sentences, conversation with short sentences and breathing heavily, cant speak. Initially working between the first 2 should see improvements over a couple of months.

    If the bike has gears make sure you are in a gear that you can turn the pedals reasonably quickly rather than having to push down on the pedal very hard each time.

    This will allow you to use the bike regulalrly, with good recovery between sessions, and start to build the mucle endurance at the same time.

    Enjoy.

  • Thank you, the exercise bike is new which is why I thought advice would be a good idea, absolutely no intention of getting on a real one let alone racing, I leave that to my sporty granddaughter!

  • We all have different capacities for exercise. The 220 minus your age is repeated by a lot of people - even my GP - but it''s an indicative formula thought up by two cardiologists on a flight. My previous GP like me was a runner and like me would switch off her heart rate monitor alarm. In the gym I would have to set the aerobic machines to a false age of 33 - I was 69 - to get the right workout. I have exercise induced AF and my heart rate easily reaches 200 bpm and, in hospital during cardiac stress testing it''s been measured on an ECG peaking at 235 bpm whilst exercising. I hope that''s convinced you that the 220 formula is not holy-writ.

    When exercising - and I need to take my own advice here - you need to warm up, not only to gradually increase your heart rate, but also to lubricate your joints and gradually take them through the range of movement. At the start, spend five minutes easy pedalling with no resistance and then introduce a little bit of resistance. Unless you are using a Spin bike, there won't be momentum to carry your legs through the rotation when the pedals are at the top and bottom. That leads to a somewhat of an unnatural pedalling motion that will contribute to the tiredness in your legs.

    Despite being a "cardio bunny" over many years I had a stroke, but in accordance with NICE advice and that of my Neurologist I walk and I'm getting back to the gym and the rowing machines.

  • There are numerous formulae for estimating MHR which are the product of a lot of research, they weren't just dreamt up by a couple of cardiologists. The problem with them is that they are a population average, so they can't tell you anything about where you personally lie within the distribution.

    en.wikipedia.org/wiki/Heart...

    As a beginner, the important thing is to build up gradually and not be impatient. When I started exercising in my early twenties I had no idea about warming up, training zones, recovery, or anything else, and I ended up making myself ill through ignorance (and bad advice from the doctor).

    When I had my first Bruce test at the hospital they took me up to 220-age, and at the time I was tempted to ask if we could keep going and see what my maximum actually was. I'm glad I didn't now, as it was a few weeks after that test when I developed AF.

  • I use the Metzl variant of the Karvonen formula that includes heart rate reserve but it is not suitable for people new to cardio exercise. The 220 minus your age is a misnomer and is widely quoted, but I think that we will have to agree to differ. My Bruce protocol test was lengthened because of my cardio fitness and peaked at 154% of the age related predicted MHR at 13.5 METs (8 mph equivent on the flat). My resting heart rate was around 45 bpm at the time - hence a significant heart rate reserve - and, my sub-maximal VO2 was 52 none of which were taken into account. I can still achieve over 200 bpm in AF during exercise - about 8% down on power according to my turbo trainer - so according to a GP I have arteries of a 21 year old and clean as a whistle: I doubt it. I'm lucky that AF doesn't affect my ability to exercise but was probably a strong contender in my stroke last year.

  • I'm interested by your Bruce test. I managed to get up to 15.6 METS, and yet I was unable to exercise with even averagely fit people, I couldn't even keep up with children in the canoe club. The NHS insist that I don't have overtraining syndrome, and my Bruce test performance does nothing to convince them otherwise, but I don't think the ability to take my output up to 15 METS for such a brief period says anything about whether I'm overtrained. I had no tolerance to high intensity exercise, except in non-repetitive, short, one-off bursts.

  • I depends whether your exercise is limited by the AF. Provided that I'm not running, AF has little effect on my exercise. Yesterday in the gym I did a 5km row, followed by 20 minutes on a Spin bike that included 65 rpm standing "climbs" and high cadence work with a peak of 140rpm, plus around 15 minutes of yoga and Pilates stretches. All of that was between 160 and 180 bpm. I haven't downloaded the HRM trace yet but that is likely to have a high AF component that can be identified by "spikyness". My image on this forum is taken from a video shot last December by the Nice Biscuits production company. That shot is me on a bike + turbo trainer and, there is quite a bit in the video of me cutting down scrub with a bow saw and billhook. I think the video is still under embargo as it's being used to promote anticoagulation to clinicians in the UK and USA. I will post a link after the promotion if the forum administrator is OK with that.

  • My issues with exercise pre-date the AF by at least two decades. The AF started shortly after my first Bruce test in 2009, but they sent me for that test to humour me because I'd already been complaining about difficulty exercising for most of my adult life.

    I did 15 METS in my second Bruce test in 2012, after I'd developed AF, and I felt absolutely lousy, but there was no sign of any AF on the ECG during the test.

  • Overtraining can show up in the r-r interval as it has less variability. The ithlete app can identify it after a few readings to establish your norm. However, it needs a stable heart pulse for 55 to 60 seconds otherwise it shows error. Interestingly ithlete showed an error several days in a row before my stroke, but none of my other devices did. Fifteen METs is very close to running at 10 mph (6 minute miling) so you had / have the potential to be a good club runner. On the standard Bruce Protocol 15 METs is at least 15 minutes at 18% elevation and 5 mph, which is a great result. Why did they stop the Bruce Protocol at stage 5 if there wasn't any sign of AF?

    My heart wave form was monitored in real time on a presentation sized display during the Bruce Protocol test. It was when I went into AF that I thought I'm feeling good and ready to really go for it. The subsequent print out showed that I was alternating between atrial fibrillation and atrial flutter. That ended the test and I returned to NSR in less than 10 minutes.

  • The test was terminated at 173bpm,(because 220 - my age was 167) after 13m 03s, 5mph, 18%, 15.3 mets.

    I've never been able to run more than a few yards, as I mentioned, I left the canoe club because I couldn't even keep up with children. At that time I was swimming a mile against the clock 3-4 times a week, but my time for that was about 32 mins, nearly twice that of a competitive swimmer. Cycle touring, I've never overtaken another touring cyclist, and could never keep up with the ones who caught up with me. Hills always had to be climbed at the slowest speed I could balance the bike (about 2.3mph), and even then I had to ration myself and avoid more than one or two big climbs in a day otherwise I would be going home prematurely. My average speed was about 8mph.

    Bruce tests say nothing about whether someone has OTS, because people with OTS can often perform well on isolated occasions (even putting in personal bests at times). The problem is that they can't sustain intense exercise. I performed well on the treadmill, but as I said, as a result of that test I went rapidly downhill immediately afterwards. The same happened with the second test in 2012, again they saw nothing wrong, but I deteriorated rapidly afterwards, and ended up on an ambulance a few weeks later.

    I've been resting now for six years, and show no signs of recovery whatsoever, any attempt to retrain again fails as soon as I try to increase the intensity of my exercise.

  • Wow you have inspired me to start a good excerise programme soon 💪🏻

    If you are on beta blockers your heart will not go as high so maybe discuss with doc about that

    Well done for trying i must do more 🌺

  • You have to keep working to develop both stamina and strength. Keep working and sooner or later it will develop. Stay within your burning aerobic and anaerobic heartbeats per min. 220 minus your age x 80 % is what you are shooting for for 30 - 45 minutes. Pain Free. DO something every day. Hard, medium and easy days..

    I complain that my resting HB is still too high from ablation so that I am always in 2 or 3 gear already that my threshold is shortened. DO something. You body will tell you "When".. I was competitive for 30 years.

  • I joined a gym to increase my top body mass and strength and make me look better after my aortic valve replacement and bypass operation. I have continuous regular irregular AF. I also go to Ienga yoga once a week and dance tango when my balance allows it. All this is non aerobic but I have added an electric motor to my Brompton folder. To be honest now being able to get to those places which are now out of reach with my ordinary cycle has lifted my morale enormously and does get my heart rate up if I don't use the motor too much. I am now 78 but have noticed a negative change in the last three years. You can also take the folder on buses and cruise ships by the way!

    I eliminated most sugar, caffeine, alcohol, most fats and have never smoked. I have taken enzyme Q10 for about six years after a bad experience with statins. I have kept my BMI at 25. I make my own muesli and am a great believer in wheat germ and nuts with lots of fruit daily

    I have also found it helps enormously to have an event horizon pencilled in your diary which means you always have something to look forward to . You can ink it in in when you have firmed it up perhaps by paying the deposit for example.

    Whilst many of us suffer from serious medical problems attenuated by drugs attention to our mental well being is probably just as important in the long run.

    Hope this helps a little. Good luck!

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