Exercise and AF

[Hindmarsh]

I was diagnosed AF over 10 years ago. Treated with flecainide and apixaban. I also have meds for high blood pressure and statins for high cholesterol. Just diagnosed type 2 diabetes and need to lose weight. Am going to the gym and have access to a personal trainer. My problem is that I am now frightened to push myself exercising in case I trigger an AF episode. I cannot predict when that is going to happen and sometimes it doesn't until a few hours after a gym sessions. I think I need to monitor my heart rate. Would a fitbit be any good? My trainer is working with me but has no experience with this condition. Can anyone help please?

[BobD Volunteer]

Best advice is to make sure that whatever exercise you are doing you can still carry out a normal conversation. Make sure that you stay well hydrated at all times as well. Water not tea or coffee of course.

RE weight loss this is vital with AF anyway as is a diet more biased to plant based food and non processed meals.

[Guitar335 in reply to BobD]

Hi Bob, Im really interested to hear more of the benefit of plant based over meat in relation to AF and what research it is based on.

Thank you

[BobD Volunteer in reply to Guitar335]

Use the search box top right and there will be plenty of signposts.

[Barny12 in reply to Guitar335]

I posted this overview on the benefits of plant based diet on AF on a separate thread:

onlinelibrary.wiley.com/doi...

hope you find it helpful.

[irene75359 in reply to BobD]

BobD , why not tea? I drink squash, yes, and copious amounts of weak tea. But I never drink water. Apparently tea is as good for rehydrating as water. Is there something else about tea that I don't know about?

[BobD Volunteer in reply to irene75359]

No tea has a diuretic effect just as coffee. Plain water best especially in hot wheather.

[Aurealis]

There are age-related target maximum heart rates for exercise. See this

heart.org/en/healthy-living...

I have no experience of Fitbit but some running machines have their own heart rate monitor and I find Apple Watch helpful.

[Barny12]

I have exercise-induced AF and for me anything more strenuous than walking on the flat can trigger a bout. Starting gently at the gym and keeping a diary of which exercises you do and how you feel afterwards/the following day is probably a good idea.

If you're specifically trying to lose weight, though I'd personally go the healthy eating route (mainly plant based/little or no dairy) and keeping your portion sizes small.

Good luck with it all.

[Hindmarsh in reply to Barny12]

Your comments are really helpful! I lost over a stone in about 9 months by diet but have hit a wall now - hence the gym! Your diary suggestion looks good .

[sandoval22]

If you are trying to lose weight then cutting out the carbs will do more than any amount of exercise. I increased the treadmill by 0.1 mph each time until I got back to pre cardioversion speed after my cardioversion. Took about a month.

[Johnboy64]

BobD’s comment re being able to hold a conversation whilst exercising is spot on. A cardiac nurse I spoke to wasn’t too bothered about my heart rate (as measured by a Garmin) but was clear that being able to hold a conversation was key.

[UkeMan]

Everything as above, but first warm up raising your heart rate slowly, then I go for moderately to quick walk (if in a gym use the tread mill). Depends on your your resting pulse rate but you need to raise it to between 100 and 120 beats per minute sinus rhythm (slightly out of breath - i.e. be able to hold a conversation), reduce carbs and sugar to the minimum (replace with protein), no alcohol, if you go out in cold weather for a walk cover your mouth with a scarf. If you feel dizzy, pains in chest, laboured breathing, AF - stop immediately and if necessary seek medical advice etc.

[Hindmarsh in reply to UkeMan]

Thank you

[john-boy-92]

Exercise heart rate monitors tend to be inaccurate with atrial fibrillation and atrial flutter. I've used Polar heart rate monitors for years; a specialist cardiac nurse confirmed that they aren't too inacurate with AF. There are a few that use green LEDs without a chest strap, but even with a Polar Vantage V heart rate monitor I use a chest strap. That said, a heart rate monitor during exercise can be helpful but advice on maximum heart rates during exercise if you have AF is difficult and, we are all different. Machines in a gym can pick up heart rate signals from other people: mine used to be picked up by tradmills on either side. If you get a heart rate monitor, wear it when you are walking and doing everyday things to get an idea of your normal heart rates.

[Hindmarsh in reply to john-boy-92]

Thank you

[Jajarunner]

Also if you are on betablockers all the Heart rate prediction calculators will be wrong. You should be breathless but able to talk and not gasping.

[Hidden]

Make sure to keep hydrated when you exercise. Here is what I found that will trigger your Afib. Try this and you probably will lose weight also:

-------------------------------------

After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 50 grams today, so AFIB episodes are more frequent and last longer (which confirms the fact that Afib gets progressively worse as you age) . If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out, and have done it a hundred times since. In addition, I have noticed that moderate exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??

Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. I suspect the Pancreas is involved, but not sure yet. I also suspect there is a gland(s) that are sending mixed signals to the heart, perhaps one telling the heart to beat fast, another one telling it to beat slow, so the heart doesn't know what to do - and you get skipped heart beats, Afib, etc. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer

PS – there is a study backing up this data you can view at:

Cardiab.biomedcentral.com/articles/10.1186/1475-2840-7-28

[Hindmarsh in reply to Hidden]

Thank you - interesting!

[cpalmermn]

Can you tell when you are in Afib? Currently the newer Apple watches can identify Afib, I personally use a device with smartphone app called Kardia to monitor mine. Best thing is to start easy and see how you feel. Activity usually helps suppress my Afib, but I often then get episodes the night after pushing hard on the bike, etc. I’ve pushed myself endurance-wise for years, also a known cause of Afib for some.

[johnMiosh]

Hi Hindmarsh.

I am guessing that the gym is not a lifelong compulsion for you, but is relatively new to help deal with your weight. I am a cyclist and exercise addict whose AF was most likely caused by physical activity. I am currently in NSR after an ablation; two years and counting.

If my assumption is right, I am not sure that a HR meter will be appropriate for you. A fitbit or similar wrist based meter does not work well for someone in AF; it will record pulse (up to a limit) not electrical signals and will significantly underestimate HR. When cycling I use a Garmin with a chest strap, this accurately records HR in AF, I have past readings up to 250 bpm.

Most athletes use HR meters to monitor exercise intensity based on different HR zones based around their resting HR and Maximum HR (Max HR needs to be tested, age based calculations don't work). I still use a HR monitor now, but only to ensure I don't go above the limit agreed with my cardiologist. My instructions are to slow down or stop if it goes above this and go to A&E if it rises further and doesn't quickly return to normal.

For your weight loss goals, you probably need to exercise at a level where you are slightly out of breath, but capable of carrying on a conversation; you can probably achieve this more accurately by how you feel than by keeping to a target HR.

A HR sensor may be useful as reassurance, but try a cheap chest strap based one, such as this from decathlon.

decathlon.co.uk/onrhythm-11...

[Hindmarsh in reply to johnMiosh]

You are right - the gym is out of my safety zone! I lost weight relatively quickly by diet but now need something more as that weight loss has now stopped. Your comments about the fitbit are helpful - I think I will just take your advice to go to a "just out of breath" level - it has to be better than what I was doing before (nothing!). Appreciate your help.

[Janelr]

I love my Apple Watch it shows af monitors heart, steps etc even tells me to stand get moving reminders . I have a Notification if heart goes over 100 whilst I’m inactive.Even my arrhythmia nurse approved of them.

[momist]

A Fitbit can monitor your heart rate, and record the highs and lows and graph them for you. However, be warned: when you are in AF the Fitbit heart rate is totally erroneous. The reason for this is the way that all these wrist worn monitors work. They have little LED lights and a light sensor underneath that detects the very slight change in the redness of your skin when the pulse of blood pressure dilates the capillaries. In order to read this as a pulse rate, it has to look for a REGULAR rhythm in that colour change, and filter our random changes. When if AF, not every heart beat results in a pulse of pressure, as sometimes the heart is empty at the time of the beat.

The Apple watch with an ECG function works differently, as does my Withings Move ECG watch. However, the Withings does not read heart rate except when doing an electrical ECG, for which you have to be sitting very still. I assume the Apple watch is the same. I'm told that some Apple watches use both systems, but the pulse rate during AF would still be totally inaccurate, you would have to sit still and do an ECG to see what's happening.

[Hindmarsh in reply to momist]

Thank you. That is really helpful. Have decided to save my money and monitor how I actually feel and keep a record. Am still determined to go to the gym - otherwise I am in danger of just sitting out the winter in myvarmchair!

[momist in reply to Hindmarsh]

OK, enjoy your gym. I've had paroxysmal AF for three years now, and I still don't know what is 'triggering' it. I do now know that keeping well hydrated is one of the best things to reduce it's incidence, and also in my case I have to eat both regularly and very plainly. Alcohol can be taken, but only with care and hydration. As regards exercise, well in my case I think that it helps me to keep the AF away, but any stress involved with the exercise is likely to set it off. So as long as you enjoy what you are doing and don't find it stressful, you may well get away with stretching yourself at the gym.

I've recently demolished a garage, broken up the concrete base, and shifted all the rubble into three 8 ton skips. I'm now in the process of building a self designed timber shed on the site, not for a garage but more of a cabin/workshop/garden shed. It's hard work but I'm enjoying every minute of it and go to bed tired out every dry day. I look forward to rainy days for a rest, (but yesterday was too much!).

[Hindmarsh]

Thank you all for your helpful comments and advice. I think I now have a workable way forward.

[Joesephhagnau]

I also gave AF triggered by exercise for the last 8 years. My episodes always happen in the evening during or a couple hours after intense work out.

I now monitor and keep my heart rate to under 105 bpm.

We seem to bee in grrr he same boat. Best of luck.

[Hindmarsh]

Stress - - in Whataburger is definitely my main trigger.

[Ianc2]

Hi Hindmarsh.

I think the 80% food/diet, 20% exercise ratio is the way to go. I have a fitbit which I use to record my activity levels and track my friends. It helps to motivate me to get out and about, and I now have a state of the art set of wet weather gear, so my excuses for not going out are limited.

In the area I live in there are quite a few old railway lines that have been made into footpaths, which are great for walking. My plan is usually to walk for 3 miles, stop and have a decaf coffee and then walk back. It is great being away from the traffic and to look at the changing of the seasons. The last of the Autumn leaf show is currently reaching it's final stages and the golds and the reds have been outstanding this year.

For me it is not so much about intense workouts as maintaining stamina levels through regular exercise

[SteveT66]

Hi Hindmarsh,

Lots of great advice above. I've been diagnosed with PAF for about 6-7 years now and I still do a lot of exercise. I can push myself hard and get exercise rates up to 170+, but the key for me is to ensure that it always comes back down when I warm down, as mentioned above.

One thing I do now is more strength exercising with my PT. This will help with weight loss as the larger muscle mass will increase you calorie usage, even at rest, and make cardio exercising easier. It also has the benefit of not raising my heartrate to anywhere near the levels of the cardio exercise I do.

I always exercise with a Polar chest strap. If I know what the numbers say it gives me confidence. I've had a few scary moments with SVT / PAF in the past where I wasn't wearing my chest strap.

Good luck, Steve

[Hindmarsh]

Thank you all!