I apologise if my tone comes across as obnoxious, but I would to be clarify my line of enquiry (the e is intentional your grammar buffs ;). I am 48, I have been in persistent a-fib since November 2021. I have a congenital heart disease (stenosis of 2 valves) which I think is the cause of my afib. Besides my afib, I am in reasonably good health.
I would like to compartmentalize two issues. First, is regarding exercising in a-fib. I know its good and as long as you are careful its safe and each person has their own experience of a-fib when exercising etc - I do not want to focus on that (although this may be the answer to my actual question).
The question I have is about getting / improving your fitness in persistent a-fib - so that you can do more or just enjoy exercise more or not end up totally f*ed after a hike that you used to be able to do regularly.
What is the most efficient way to do this? I feel like the best approach is to build strength, as strength is a form of fitness.
A sub-question is - does exercise get easier if you get "fitter"? Does a heart in a-fib respond in that way?
I feel like I have not articulated myself well, but I am sure many of you can share opinions and experiences that will help.
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Jonathan_C
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This is what I am trying to do and have been since I switched from paroxysmal to persistent in a day.This journey has lasted for 18 months with various set backs.These were failed CV , physical injuries & COVID.When I first switched no chance of doing any excercise for a few weeks.Tachy,Dizzy totally breathless & total exhaustion.My first attempts were neighborhood walks and only about 1/2 mile.Hr shot up & stayed up. Gradually stretched myself with many rests to maybe a mile.Then couple of miles.Now doing about 3 miles on a walk. Listened to my body.I also used to crown green bowl & excercise classes twice a week.6 months ago I started excercise classes again and bowl a couple of times a week.I used to bowl 5 or 6 times a week + comps.
Still can't do inclines & heat.
To put this in context before I switched to persistent and taking walks in lock down I wasn't fit and had to sit every 3/4 ml & this improved and regularly walked 5 to 7 miles with making 3 or 4 rests .
Its hard to say what is good and not good in your situation Jonathon with regards to my own Afib but for me (I'm 52 with permanent Afib for 25 years+) I have found the fitter I am the better my overall health is. I am less breathless, less fatigued and suffer less brain fog, I feel much better mentally, physically and I look better.
Unfortunately us Afib'ers do need to know we will most probably never be as fit and strong as an average able bodied soul with no heart issues, it just is what it is BUT as long as your Cardiologist as said its fine to exercise then slowly increasing your daily routines will make it easier over time ...in my personal experience.
Like anything though it takes time to get fit, and longer for us, due to our conditions so go easy and be gentle. Also make sure your diet is ok as well as that impairs fitness.
I am currently doing a mixture of walking, run-walking and I go the gym to do strength training. Strength training is probably more important than 'cardio' in my eyes as muscle loss is a major problem as we age. It is really important we keep hold of our muscle mass as we age or we end up feeble and weak, once its gone its very hard to get back!! The medical term is 'sarcopenia'.
Be gentle, be consistent, be self aware and eventually you'll find things easier... but also know your limits.
Thanks - this is reassuring. You make some important points re muscle mass. I prioritise strength training as its more enjoyable because my hearts response is more predictable. I know I can do x reps of something and then know I will need to stop and can plan the workout around that. But with cardio, so far I have found I only get the same sort of control if I am on a rebounder (trampoline).
I need to lots of time to get a decent cardio workout walking, which i just don't have during the week.
I will start being more experimental - will try run walking and spinning.
Like anything though, small steps. Believe it or not walking is a very very good cardio workout and you don't need loads of it. With the run walking I literally just slow jog (not much faster than walking pace) for 1, 2, 3 or 4 minutes then walk for the same time. I mix it up just to keep it fresh. That stimulates the heart without pushing yourself and your heart to exhaustion, it is far more enjoyable than just trying to continuously run and when you do hike you will not feel as exhausted either. If you have a Garmin watch or similar you can set it to prompt you when to walk and when to run.
...Go easy if you start spinning classes as its very easy to over does it, everybody goes mental when I watch them.
Thanks - by spinning I mean putting my bike on a stationary trainer at home and doing some sessions there.
In response to your comments about running - I should have mentioned this as an example earlier - I live in Cape Town and I often hike up to a waterfall - the total distance of the loop is 4km, but its a 300m ascent and descent - so quite steep!
I have to take regular breaks to catch my breath. I don't think my heart rate monitor gives an accurate reading with a-fib - but the times when I feel the biggest struggle is when I would expect my HR to be around 140 - 150, but my monitor says its in the 80s.
My heart is simply not responding to what I am doing as I am doing it. One of my cardiologists said to me that when you are a-fib your heart rate is chaotic. And this fits that description well.
At the moment I am "fit enough" - as in I have the muscles and I am not overweight etc - to be able to run. But if I jog for about 50m I will be at the point where I am completely out of breath because my heart is not responding to what I am doing.
Spelling isn't an aspect of grammar, by the way! I think walking and swimming are the ways to good health, cycling, too, and that there's not a need to be excessive with any of these, just do them regular and often to attain good heart health. My wife does daily Pilates and i can attest to the value of that as exercise, too. Moderate and comfortable exercise needs combining with a decent diet that cuts out excessive calories and reduces refined and heavily processed foods, oils and carbs where comfortable and possible.
The aim is to keep the left ventricle of the heart as healthy as possible for as long as possible! Drugs seem able to help as being cardioprotective: statins and some antihypertensives, for example.
Not obnoxious at all btw! I read that you're wondering if the heart itself can benefit from judicious exercise - am I right? It's a muscle after all. I did read an article a while back about a study of AFibbers in Finland that looked at the benefits of regular exercise. If I recall, those who exercised regularly in the tripa did better than the control group - (who didn't do regular exercise). I think it was people wuth paroxysmal AF but it looked like a reliable study and maybe worth checking out. Likely to be in Science Direct or Pub Med.
hi not clear about this as you don't mention medication. When I'm in Afib without meds my pulse can be up to 200 so exercise is a no no. But when medicated either with betablockers or ablation/cardioversion I'm more or less 'normal'. Beta blockers make me more tired so can't do too much but can build up slowly to reasonable level, can do say 6 or 7 mile walk with local ramblers, but tired after.
It varies from person to person. Functional strength is useful in day to day. I had a stroke in 2016 and since then I've covered 2,200km on a rowing machine, plus walking, and clearing scrub in a nature reserve with a 5kg battery backpack and 5kg pole cutter. My AF is asymptomatic and last week my Polar HRM recorded a spike of 204 bpm during a rowing machine session: too high at 75 years old. My muscles improve but not my AF. As a stroke survivor, my brain benefits from oxygenated blood during cardio.
Hello John. Good to hear from another home rower, who is also 75 !May I ask how long is each of your rowing session, and the average power (watts / Calories)?
Do you monitor your max HR and try to keep it modest ?
I'm replying whilst in bed, so I don't have access to my Concept2 log! Before COVID vaccinations (I was designated clinically extremely vulnerable) I was doing 8 to 10km sessions at 2:30/500 metres. The COVID vaccinations have caused a lot of mucus so that limited sessions after the first, second, and third vaccinations. I use the rowing machine on the patio year-round, so I'm limited by weather but have a view to Failand Ridge seven miles away. The fourth vaccination has been less troublesome, so it can be 3km at 2:10 to 2:20, but a typical session these days is 5km with an occasional 7km at 2:20 to 2:30. My usual stroke rate is 25 once I've warmed up, but the first km is around 22, and I'll warm down until my heart rate is around 130. I have a Polar Vantage V HRM with H10 chest strap, and they are paired using ANT+ to the Concept2 PM5 monitor on the rowing machine. During cardio exercise I flip flop between fibrillation and flutter, and my heart rate can increase or decrease rapidly in 5 to 7 bpm steps. I try to limit my heart rate to around 160 to 180, but last week I recorded a brief spike of 203. My damaged knees have been a bit troublesome, so I've dropped the foot rests to the lowest peg. Back in the day when I was in the gym, I would set the damper at 10 and aim to do 10km in an hour. Andrew Marr's stroke and Concept2 written advice caused a rethink as I'm a stroke survivor. I now set the damper at 3. I have the Concept2 one million meter (American spelling) club tee shirt and a Cafe Press two million tee. I wear them when I'm a mystery patient for medical students, as that really throws them, and runs contrary to a stereotypical 75 year old.
Hello John. We must have been separated at birth !
I am very sorry to hear of your stroke and I hope that you have recovered fully.
Also sorry to hear that you are in AFib whilst rowing, and the 204 HR is too high.
I would even say that 160-180 is too high.
The Concept 2 formula would have us at 150 or so MHR and the training zones would take us much lower for steady state row.
My AFib started in 2018 and for the past two years (until 3 months ago) I did very little rowing because I was afraid to have episodes.
I started rowing on the water (Canary Wharf in London) in 2004 when someone at work needed an extra oarsman.
We rowed in a traditional Thames Cutter boat, 6 oars plus coxswain, and a guest for the festive events. I did the Great River Race on the Thames in 2004 & 2005 with the Buccaneer and Trinity Tide crews (wooden boats).
Like yourself, I used to put the damper on 10 because I thought that it was what was needed. In 2009 I moved to Greece and in 2010 bought a Concept 2 Model D (PM3) to train for the indoor rowing race in Athens. I had a month to train and got a silver with 3:46.6/1000m distance (only 4 of us in the 60-70 age group).
Before the race, a chap told me to row on setting 6 and it felt easy after our 10.
I am almost at 10,000,000 metres since November 2010 and re-started about three months ago. I now row 45 mins @ 2:35 / 500m average pace (occasionally 2:25 for 15-20 mins) and keep HR at 110 - 115 max.
If I go all out or do HIIT, I will pay for it in the middle of the night.
My Afib actually started when I was training for a race in 2018 and was doing 500m @ 1:50 and 250m at 1:42. Maybe I did too much at 72 years old.
I now row at very low stroke rate (13) and damper setting 1.
This gets me about 7 watts per stroke, which is not a technical yardstick, but helps me to pull long and strong.
My resting HR is around 53, and if the heat feels dodgy, I will take a 50mg Flecainide and half a 1.25mg Bisoprolol. I believe it helps.
I am paroxysmal and my AFib has gotten better, I feel, since re-starting the rowing.
I also upped my vitamin D3 from 31ng/mL, aiming for 64ng/mL, which I read is optimal for avoiding AFib.
I will re-read your post to see if I missed anything, and will leave a comment.
I am thinking of having a mini-maze thoracoscopic procedure, like MummyLuv on this forum. Please check her posts and her surgeon in Sheffield could say if it could be for you. She had it in London.
You were rowing properly, not the dry land stuff. I avoided the gym for years as I enjoyed running outdoors; the typical male 30 year old 'I'm going to die any minute from a heart attack'. That led me to Orienteering and being south west M35B champion at age 40. AF limited running (uncomfortable) and a poorer time than expected at half marathon and 10K, meant shifting to the gym. Initially it was Pilates, yoga, and Body Balance: old hippy head. Later it was Spin classes, functional strength, rowing machine, and the rope machine. That ended when ladder leg presses maxed the weight and gave me three hernias: bilateral inguinal, and femoral. Then there was the stroke. It made sense to buy a pristine second hand Concept2 to use at home during recovery. The patio is quiet and away from over-loud Spin classes, and people who drop loaded barbells. During the winter, it's heavy gloves, fleece hat and top.
I've always had a high heart rate during exercise, and like a GP who got me back into running, I would switch off the alarm on my HRM. My cardio fitness was the reason why an EP said I didn't need a coagulant: I had a stroke 18 months later. I then featured in an infomercial for Pradaxa that was distributed to clinicians in the UK and the USA. A while back, I spoke to an EP who carries out ablations, and we both agreed that I was too old for it to be successful. He told me that whilst he did that procedure, he wouldn't have it.
I've survived a stroke when the ambulance crew hadn't realised what had happened , peritonitis when a GP thought I had gastric flu and I wasn't operated on until the following day, femoral hernia (should have been emergency surgery) when I drove to Cornwall and back, and pulmonary toxicity when they wanted to sedate me in Intensive Care and put me on a respirator (50% chance of surviving). I think that neither heaven nor hell want me; can't say I blame them!
Sounds like you're too hard on yourself !Now is the time to bring yourself back, in a measured way.
I wasn't thinking of a catheter ablation.
I would not have one because they are 50% or so successful after five years and require repeats.
I was thinking of keyhole surgery that ablates the nerves on the outside of the heart where the nerves originate. That way the heart muscle is not damaged and no hole in the septum that separates the right atrium from the left (CA).
Also they clip the LAA (Left Atrial Appendage) so no more anticoagulants are needed.
I did not know all this until I came across the Wolf Mini Maze. Dr Wolf first developed the procedure without opening the chest in 2004.
It all depends on the condition of your heart.
I suspect that if you can exercise at that level, you ejection fraction is good (no heart failure?)
Do you get very breathless and any chest pain or ache when pushing yourself?
Dr Wolf is a miracle worker.
Be well John and let us know how you are doing. Saul
I can get a bit breathless if I'm walking up hill and talking, but otherwise I'm OK and never pain or aches. Scans of my lungs on the Internet - jrcpe_45_3_medford2.pdf - when I had pulmonary toxicity, look like severe COVID. My lungs will have scar tissue but nothing can be done about that, so I'm grateful that I have the lung use that I have. I remember being tested in a thing like an airtight telephone kiosk, and I blew the pointer off of the scale. I learnt from that experience, when a clinician says a department is interested in you, that it usually doesn't bode well. I was diagnosed correctly on the third admission to hospital (specialist respiratory department), as previous diagnosis by less experienced clinicians thought (because of my age) that I had community aquired pnuemonia or cancer. It took the Professor of the respiratory department to realise that if I remained hypoxic with a powerful antibiotic and 4 litres/minute of oxygen, then it wasn't pnuemonia. I hope that the subsequent paper by the Consultants and published by the Royal College of Physicians, Edinburgh will stop misdiagnosis and, indentify dronedarone and amiodarone as a causitive factor in pulmonary toxicity (cryptogenic organanising pnuemonia). The outcome at the time was not good, and the prognosis was bleak (death or disability). Given all that's happened I'm in pretty good shape, save for fighting the DVLA Medical Group for the return of my driving licence: the stroke cause right side hemianopia with macula sparing (translated: my peripheral vision on the right is reduced).
I do have a tendancy to Ryder's syndrome so it can take time to measure my SpO2, but generally I'm 98 - 100%. Doppler scans of my heart valves show normal turbulance and, a tilt table test was negative with a double shot of nitroglycerine. I reacall that I have a slightly delayed P wave.
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I think walking and swimming are the ways to good health, cycling, too, and that there's not a need to be excessive with any of these, just do them regular and often to attain good heart health. My wife does daily Pilates and i can attest to the value of that as exercise, too. Moderate and comfortable exercise needs combining with a decent diet that cuts out excessive calories and reduces refined and heavily processed foods, oils and carbs where comfortable and possible. 
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