Exercise and training with AF

[WaveDaring]

Hi, I'm 59. My AF came on just over 6 weeks ago and has been persistent since then. Resting heart rate was around 50 and is now low 90s; max HR was 180 but without beta blockers will now rocket to over 200 with very little effort. I'm on 1.25mg of Bisoprolol and 20mg of rivaroxaban and am waiting for a cardioversion, hopefully in the next 4 weeks or so. I did an iron distance triathlon 2 weeks before the AF started and it came on at the end of a hot, hilly 100km bike ride in Mallorca. Possibly a perfect storm - not being fully recovered from ironman, dehydrated, fatigued and carrying a virus (I also developed cold sysmptoms the next day). Anyway, I've read lots and have found this forum useful but am struggling to get a clear view on training with AF. I hear the full spectrum from "don't do any exercise at all" to "do whatever you want/can". I can't hit the numbers I was doing before AF due to reduced cardiac output and the beta blockers limiting my heart rate but training still makes me feel good and I'd like to continue to try and maintain fitness. Are there any other endurance athletes out there with AF? I'd love to hear other people's advice and experience.

[BobD Volunteer]

As I am sure you must know now, athletes such as yourself (along with fast jet pilots) are prime candidates for AF because the heart really was not designed to do what you want it to.

The options are obvious but I know how difficult it is for people to accept that their competition days are over. All I can say is listen to your body but of course if you have spent years ignoring it that may be hard. Exercise is good. Over exercise is bad. Find some middle ground.

Cardioversion will not cure AF as I hope you know so if it works for now please don't be tempted to go balls out again. Try to stay well hydrated (pee clear) at all times and you may survive a bit longer but AF is usually a progressive condition so be careful. Nearly every marathon fatality has been due to athletes going too hard when they have a pre existing condition.

[WaveDaring in reply to BobD]

Thanks, Bob. I have actually been listening to my body, normally hearing creaking joints and sore muscles, but not much from the ticker. I have had ectopics in the past, had them checked out, and was told they were quite normal and nothing to worry about. It seems to me that this is an area where many GPs and A&E departments may need some education. Nobody ever asked me about my training load/regime and I never really thought to mention it as I assumed it was doing me good. I now know better.

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I’m sure that BobD will not mind me adding that even if the Cardioversion only works for a short while, it does indicate that you might respond well to further treatment such as an ablation. The unfortunate truth is however, extreme sports can often cause AF and that is likely to continue whatever treatment you have, especially as you get older, but of course, the choice is yours!

I quite fancy a Bultaco Brinco R (worth a google) myself, but then you also have to take account of the significant increased risk of internal bleeding should you fall off.

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Yes, I’m also an endorphin addict with persistent AF/AFL. I do regular cardio at the gym. Anything more than low to moderate intensity usually means a couple of days of regular ectopics which are worse than the AF.

Only your EP can give you tailored advice, after looking at the inside of your left atrium. I remember a thread about combined ablation and cox maze procedure, I believe it was started by johnMiosh an endurance cyclist.

[johnMiosh]

Hi WD.

I have seen many questions on the forum from endurance athletes over the last few years about how to maintain their level of fitness, how AF affects HR zones for training or how to get back to competition. You appear to have adopted a more cautious approach, which is probably wise. The Beta-blockers will make you feel like you are running through treacle, so maintaining a high level of fitness is impossible. I put on three kilos while on beta blockers, despite eating better and giving up alcohol.

I have been a club cyclist since 1975 (I am now 55). In the 1980s I also used to run, mainly 10Ks and half marathons. Endurance exercise is in my blood; both my parents were competitive cyclists and my mother was also a formidable 100 m runner.

My mother was diagnosed with a "benign" arrhythmia in 1970, but it wasn't until I developed AF three years ago that I realised she had the same. I am convinced that exercise was the main cause of my AF; but a stressful job, a love of alcohol and meat based diet probably had a significant contribution.

Up until a few years ago, my resting HR was 57 and my tested Max was 185. When my AF became persistent, I was given beta-blockers and Rivaroxaban this recduced my resting HR to 47 and I was advised to keep my exercise HR below 130. Eventually, I had a hybrid ablation; a mini-maze in April 2017 and a catheter ablation in October 2017.

Since then I have had minimal heart issues, but I am still wary of overdoing it. During my period of treatment I swapped the local hills for gentle trundles along rivers and canals at minimum HR. These were generally 20 - 30 miles at 13 mph; most people would consider this excessive, but for me they were relatively effortless.

Last November I came off all medication and gently returned to road cycling. I am now riding through the Peak District averaging 15 mph but I am feeling far below my level of fitness of years ago. However, it feels good just to be on a bike and I don't want to jeopardise the level I have reached by pushing for something a little too far.

Last weekend, I returned to the velodrome for a training session and experienced a momentary spike of 200 HR during a modest sprint. I have decided that I am not quite ready for this yet and will continue to monitor my peak rides. I am intending to join my club ride at the weekend; this will be my first group ride for two and a half years. It will be with the slowest group, but I am looking forward to it.

I see my competitive days are over, but what I have now is far in excess of what I expected a couple of years ago, so I am happy to adapt to my current circumstances.

[GordonS in reply to johnMiosh]

John, I am 67 waiting for my second ablation (first one in 2010) I have only been a club cyclist for 5 years or so and used the cycling to get back to a reasonable level of fitness. I ride with the social group most of the time at the moment and try not to push myself too hard, although I have won the occasional sprint home! I think you have it right that we need to listen to our bodies and adapt our expectations accordingly. I am taking part in the Manchester 100 mile this weekend, hoping to average 15mph but that will depend on HR. Good luck with the club ride on Sunday.

[WaveDaring in reply to johnMiosh]

Thanks, John. Good to know there is life after AF, even if it's a long road to get there. Looks like I'll be working on my golf handicap for a while; at least the beta blockers might help with that Hope you recovery continues to progress.

[Geza10]

Hi I have lone af fitness is the culprit I am 60 male and always done sport army pti semi pro football still play now my hr is not the same as most 4years ago af came into my life and was not expecting it my hr resting was 35-45 and sleeping it went to 23

My rate now is 50-60 and it does not rise above 150 when playing two players in the game both have af 42years old and 48 they have the fast heart rate and feel wiped out during the game they are both having ablationns now so some of us can get away with training (just not as good as before af) and others find it hard to train at all like the other members say listen to your body

One more thing I have done is clean up my diet and drop a stone was not really overweight but as you get older it's harder to keep the weight in check

I beleve it has helped me out and if you have done fitness all your life don't stop

Keep the body moving and heart strong as you know it's a muscle and needs to be stimulated

Keep motivated wave daring