Exercise advice

[Jst455]

I'm hoping someone here might be able advise on exercise for people with AF.

My background is: I am 55 years-old, had a heart attack 4-years ago (stent inserted); AF a year later; another fast AF a couple of months ago.

I was admitted to A&E, and after 12-hours was restored to sinus rythmn after lots of Bisoprolol. The A&E dept. referred me to Cardiology for follow-up and ECG, but sadly, Watford General Hospital Cardiology says that AF does not reach their 'threshold' for a follow-up consultation, and when my GP tried again, they 'declined' his referral. He is honest enough to admit that he is not a cardiology specialist. So, it's up to me, Dr Google, and my friends in this forum.

All I was told by the hospital was that it's important to resume exercise, but to not 'overdo it', and if I feel unwell I should stop. That latter point doesn't really help because with heart disease I feel unwell most of the time!

My exercise regime is a 30-minute session on an exercise bike, 5-times a week. I divide the session into 3 periods of 10-minutes: a slow warm-up, intensive middle period, then 10-minutes slowing down to end. I increase the resistance setting on the bike as I approach the middle 10-minutes, then decrease back down to easy towards the end. I try to then do 5-minutes of breathing exercises, and drink some water.

My resting pulse is usually below 50bpm (due to taking 1.25mg daily of Bisoprolol, I suppose), so I am scared to push myself above 100bpm during exercise. I probably average 90bpm during most of the session. My PI can reach 30%, and my O2 sats sometimes 100%. My blood pressure at rest is usually 120/80, slightly higher after exercise.

Am I doing too much, or too little? Is the exercise bike considered useful exercise, or am I a lightweight? Any advice welcome.

[Hidden]

You sound very fit physically. Your exercise regime does not sound excessive, though there is little evidence that anything other than regular modest exercise is of any physical benefit. No type of cardio equipment is unsatisfactory, though a rower gives a better all body workout than bike or treadmill.

Endurance training over many years can be very damaging to the left atrium in a small minority, particularly when associated with hypertension and a genetic predisposition to AFib. That was my experience.

Having said all that, I found huge satisfaction in outdoor exercise. The psychological benefit of outdoor exercise can be immense. The endorphin highs of hill running with my dogs is a fond memory.

Your medical care is not up to you, though keeping yourself fully informed will keep your medics on their toes. NICE guidelines are there to help your GP manage your AFib, with the option for referral for an Electrophysiologist (EP) opinion.

[Jst455 in reply to Hidden]

Thank you Badger, that's very kind and helpful of you.J

[beardy_chris]

One of the difficult things about AF is that your tolerance of exercise can vary day-to-day. One day you might be able to exercise to a high level but during an AF attack, even walking might be difficult. I'm not a medic but I think the important thing is not to 'push through the pain'. I went to a presentation a couple of years ago where a cardiac exercise specialist introduced the concept of the Borg scale (Google it). This seems a sensible way to manage your exercise rather than exercising to particular settings on your bike.

I hope this might help a little. In general, exercise is good!

Best Wishes.

[Jst455 in reply to beardy_chris]

Thank you Chris. Yes, I looked at the Borg thingy.

[jwsonoma]

Hi,My younger brother was diagnosed with 45% blockage in the arteries to his heart at 55. He went on the Dr. Dean Ornish low fat vegan diet to reverse cardiac blockage. 5 years later he was well enough to complete an IronMan at age 60. He doesn't do full marathons any more but he is committed to the diet. When he started jogging just after the diagnosis I beleive his doc told him to keep his HR below 130 but you should check with a specialist. His wife was diagnosed with breast cancer at the same time and she is on the diet as well. My wife has been vegan for decades and I finally gave up cheese 5 years ago to also be plant based.

This is a life time goal so don't rush into it. My brother's goal was full recovery in 5 years. He measured improvement in months.

There has to be resources to guide you in diet and exercise for heart attack recovery. Check out Dr Ornish. Good luck.

[Jst455 in reply to jwsonoma]

Many thanks!

[CDreamer]

For information go to the AFA Patient Resources heartrhythmalliance.org/afa...

It sounds as though you have what is termed ‘low AF burden’ meaning infrequent AF episodes but I have to say I haven’t ever heard of anyone being refused a GP referral for AF.

The trouble with general cardiology is that they tend to be specialists of the heart structure and plumbing whereas Electrophysiologists the specialists of the electrics. It maybe that because of your MI and stent that is considered the primary concern and that’s the problem with specialities!

Badger has given you good advice re exercise - one of the EP’s that I see says that as a general rule of thumb you should be able to exercise whilst holding a conversation and that if you get breathless you should either slow down or pause until you can breath easily.

I used to do intense interval training but because I have a neuromuscular condition meaning my muscles just stop working after a short period, my regime on bike was 90 seconds 2 mins rest - repeat x 3. Nowadays I find even that difficult but age also has consequences so moderate walking for 20 mins/day is considered adequate.

You might like to also look at this blog by an Electrophysiologist who is also a keen cyclist and suffers AF - Dr John Mandrola - he also co-wrote a book called The Haywire Heart all about endurance at athletes and the affect training can have on the heart

drjohnm.org/2014/02/13-thin...

[Jst455 in reply to CDreamer]

Thank you Dreamer good advice.

[Desanthony]

You should ask for a referral either to a different hospital or to an EP. When this C19 pandemic is behind us also consider going to a Phase3 cardiac recovery exercise class - the first few months are dead easy but you progress beyond that. I got the information on classes near me from the British Heart Foundation. The exercises are done with the supervision of a physio and Cardiac nurse - though I believe some areas differ.

[Jst455 in reply to Desanthony]

Thank you for replying. I had cardio rehab after my MI and that was great, but I have not been offered it this time, not even privately. I suppose all the NHS services are breaking down becasue of the pandemic, so if they can keep patients off their lists, they will do.

[Desanthony in reply to Jst455]

I wasn't offered it either I asked for it and got it. At the moment though these classes will not be running and if you have already done one then you know the score. Just take it easy and work up. Whenever you feel out of breath stop, have a drink of water and take a break.

[Jst455 in reply to Desanthony]

Thank you. I just want to do enough and no more; I'm not aiming to become a body-builder, just keep healthy.

[BobD Volunteer]

The most simple guideline for exercise is that should should be able to do it and hold a conversation at the same time. Listen to your body and don't over do it.

[Jst455 in reply to BobD]

Thnaks Bob, I've heard that too. I'll have to get used to my own conversation, but I'm such a bore!

[Desanthony in reply to Jst455]

Yeah me too.

[ranobeer]

Hi JK5AEO, I am 56 and have been running since recovering from Atrial Flutter 4 years ago. I was running 10k 3 times a week and then in November went into permanent Afib. My cardiologist advised me to carry on running and although I couldn't run as fast as I had been doing I gradually built back up to 10k. I was really nervous as my heart rate was 200 but I do think keeping it up helped me physically and mentally. I would definitely seek medical advice though. I've now had another ablation and just waiting to see when I feel up to running again, again my cardiologist told me it was OK to but things have gone a bit haywire so I am just walking at the moment.

[Jst455 in reply to ranobeer]

Thank you Rano. I prefer walking to sitting on the static bike and I used to walk 10-miles a day. But until we have had both jabs we are sheltering; about 1 in 3 people in our village are anti-vaxers, so it's still a bit dangerous out there.

[TracyAdmin Partner]

Gentle regular exercise is an important part of a healthy lifestyle. It is best to exercise at a level that is comfortable to you and not too strenuous. If you about to embark on any new exercise regimes then it is advisable to speak to your healthcare professional. If you would like some information regarding exercise and healthy living, this is all covered in our 'A F Factfile ' heartrhythmalliance.org/afa...

[Jst455 in reply to TracyAdmin]

Thank you Tracey, this is really helpful. I wish I could speak to a doctor, but have simply been refused; I guess it varies between health trusts.

[Spudly22]

I agree that there is great support from this forum but it’s also important to try and get advise from a cardiologist. My choice was to pay for two private appointments with my NHS cardiologist- he could access my records and give me undecided attention to my specific questions for the 30 mins each time to help me move forward. Not sure if this is an option for you.

[Jst455 in reply to Spudly22]

Thank you Spud. I was told by a doctor at Barts that private practice has been restricted during COVID, so perhaps it will be available again soon. I'm not a millionaire though, sadly!

[Tomred]

Your regime sounds good to me but I'm no expert

[Jst455 in reply to Tomred]

Thank you Tom. I'm most grateful for all the replies.

[Offcut]

Talking from a personal prospective it is best to start the exercise slowly and calmly then look at moving the intensity up. I was told don't go past 150 BPM Which now is not that easy ( I have to many comorbidities now) but then a slow warm down after the exercise. Well worth looking at CALLANETICS or Pilates using your own body tension to exercise.

Be Well

[Jst455 in reply to Offcut]

Thank you Offcut, wise words.

[Mjlarson11]

I have AFIB and a so far a successful ablation. I was (and still am) an avid biker. My cardiologist gave me two restrictions 1. Keep HR at any moment under max for my age (155bpm) and keep my one hour average HR under 140 bpm (90% of max) while exercising. I usually ride about (4) hours a week with an average HR between 115 - 135.

I would however continue to search for a cardiologist opinion or perhaps a new GP who is more experienced and confident with heart issues.

[Jst455 in reply to Mjlarson11]

Thank you, this is very helpful.

[Mjlarson11]

Also meant to mention this. I am in the US and most of our healthcare system is a private network and somewhat easy to get into. Two of the leading cardio centers in the US are the Cleveland clinic and Mayo Clinic. Both of them offer one hour virtual consultations after they have read your file. Somewhat expensive but if you have the means it could be worth the piece of mind.

[Jst455 in reply to Mjlarson11]

Many thanks. You get what you pay for, and the NHS is free!