I’m a 76 y.o. man who was diagnosed with paroxysmal AFib late last year. I experienced about four terrifying episodes over a period of a couple of months that lasted from 2 to 6 hours each from October to January. Last sustained AFib occurred in January. Now taking 50 mg Flecainide twice per day and 25 mg metoprolol once per day. No blood thinner.
Until diagnosed, I was enjoying being physically active, but the AFib episodes scared me and slowed me way down. My cardiologist advised that I could “do any kind of activity or exercise I want” and he answered “yes” to my question if I could hike uphill in the mountains at 8000 feet carrying a backpack. Still, it has taken me some time and courage to slowly return to moderately-vigorous bicycle riding and moderately-vigorous lap swimming at near sea level here in Sacramento, California. I do that sort of exercise daily in addition to a couple miles of walking now with no problems so far.
I have been invited to do a 25-mile bicycle ride in the Squaw Valley/Lake Tahoe area next month at an elevation of about 6300 feet. I have not exercised in the mountains since my AFib diagnosis, and I wonder if anybody has had or heard of any experience with problems or with everything okay while exercising at altitude with PAF? Thanks!
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Thank you, Espeegee, for the excellent website. I just read it and recommend it to everybody. I still wonder, though, whether or not exercising at high altitude might add a danger to the positive effects of exercising…?
I used to ski regularly but found I couldn’t do anything above 3000m and even at 1500m I had to rest more and go slower. I ended up in AF every evening, that didn’t worry me but I knew the exercise + altitude would take it’s toll. Nothing terrible happened but it did wipe me out for the apres ski! But then I’ve lived at sea level all my life and always had to allow several days to adjust to any altitude.
General rule of thumb for exercising with AF or in AF was to be able to talk whilst exercising. If you can’t and become breathless, slow down or pause until you can.
Hello again, the ‘walkin’ talkin’ ‘ test reminds me of my marathon running days when we were told that we were not fit enough to do them if we couldn’t run and talk at the 17 mile point!
I don't know anything about exercising at higher altitude than you're used to but I found this article that may be of interest:pubmed.ncbi.nlm.nih.gov/204...
I completely understand your loss of confidence after experiencing AFib. I experienced my first episode Afib last year after exercising. I'd been feeling unwell for a few weeks and had been quite sedentary, then as soon as I was feeling better I did a trampoline session three days in a row, which I should have built up to - even before my temporary break I wasn't doing a session every day in a row, I felt quite peculiar after my third session, felt off colour for the next few hours and then had a very dramatic and unpleasant 12 hours episode of AFib, and have had 4 more since then.
From my experience I would say feel free to continue exercising - I'm now back to my previous levels of exercise - but build up to the level you want to be at, don't just suddenly push yourself much harder. If you want to do a 25 mile bike ride make sure that you're alrady at that level fairly comfortably. The extra element of higher altitude looks like it will require your heart to work harder and raise your heart rate so you might want to check out with your doctor?
Thank you for your thoughtful reply, Helen1956! Yes, I am nearly back to my previous level of exercise at lower elevations, and so I started wondering whether exercising at elevation would be something different for me than in the past because of my recent AFib diagnosis. My cardiologist had no qualms about my hiking with a load at 8000 feet, so I’ll figure it’s okay unless and until I experience a problem. However, the publication you so kindly shared gives me a bit of a pause with its last line, “Altitude exposure carries no identified risk of myocardial ischemia in healthy subjects but has to be considered as a potential stress in patients with previous cardiovascular conditions.” Looks as if I’ll have to determine whether or not AFib falls in the category of Previous Cardiovascular Conditions they mention…
That all sounds good then. Jim's suggestion of having a plan in place in case you want to press the eject button half way through is also really good. Have you had an episode since starting the meds?
AFib wont' kill you but there's an increased risk of stroke so there's that. I note that you're not taking an anticoagulant though your CHADS score is (presumably) +2 because of your age? Mine is +2 also (age + gender) and I'm choosing to not take an antigoagulant despite being under a lot of pressure to do so from doctors (and quite a bit of encouragement to do so on here). I'm certainly hyper aware of the stroke risk when I have an episode but just have to sit it out. In May I had an episode for most of a trans-Atlantic flight which was not a pleasant experience - I did find myself wondering what happens if you have a stroke mid Atlantic! My previous episode had been January so I'd hoped I would be fine, but happily I'm still here to tell the tale.
I had one 8-hour episode while taking just metoprolol and weeks later one 50-minute episode two days after beginning Flecainide in late January, but none since. That’s not to say that I haven’t lived in fear of them since, though the worry is subsiding bit by bit as time goes on. Yes, according to my cardiologist, the only strike against me with my CHADS score is my age, so he vigorously recommended I do not take an anticoagulant. I definitely agree with your insistence NOT to take one. I would also decline even against Dr recommendations. Your trans-Atlantic flight sounds like a nightmare; my heart goes out to you, and I’m glad you made it through in good shape…
Your cardiologist vigorously recommended that you not take an anticoagulant with a CHADS score of +2?? That's a new one! To be honest, I'm still thinking about it, the AFib in flight was a bit of a game changer. I'd almost talked myself into taking it this morning, just for the time being while I try to get more of a handle on the whole AFib situation, but then I made the mistake of reading the leaflet that came with the Eliquis I was given. Ugh. I just. don't. want. it.
You (or more accurately, your cardio) has really surprised me now. It just goes to show, at the end of the day it depends who you talk to.
Best wishes with your bike ride! Let us know how it went
I’m not sure what my CHADS score was, somewhere between 1 and 2, I seem to remember, with my age the only cause of an elevated number. I was 75 last year when it was figured it out. So after an echocardiogram and then a treadmill stress test, both of which revealed no organic flaws in my heart, and considering my then state of pretty good health, my cardiologist said that the risk of taking an anticoagulant would exceed the risk of not taking one. My primary care physician agreed. I don’t know if that advice from both docs is contrary to normal practice or not, but I’m definitely happy with it…
Yes, I’ll let you know about the bike ride. Thanks!
That sounds very enlightened - I wish I could see your cardiologist! And it's the first mention of I've seen anywhere of a doctor volunteering that there are risks associated with taking anticoagulants.
Re the CHADS score, 75 and over is +2 (85 & over is +3). I was 65 when diagnosed so that's +1 but I also get a +1 for being female. No other risk factors in my case either.
Every doctor should use both CHADS score and balance that against the HASBLED algorithim to calculate the Risk:Benefit. Every then it’s only a number so cannot be individual, but can at least rule out advising anticoagulants to those with higher bleed risks.
I suspect there's a lot of things that doctors should do. For example, several GP's and my cardio have tried to put me on beta blockers despite my low HR. They've never asked.
What really frustrates me is that not only do they not enquire about me and my health markers, they are dismissive and patronising when I try to tell them.
Example: last year I was having a discussion with the senior GP at my Health Centre and mentioned my low resting heartrate (which is usually mid to low 50's going down to low 40's at night). I'd had an ECG the previous week and the average HR from that was 68. He said that my HR wasn't low, citing the ECG. I reiterated that I was talking about my resting HR and and that the 68 was relative to having walked briskly across town to get to my ECG appointment (running late as usual!) and that I'm always nervous when dealing with medical staff which would also raise it. "Oh, that's ridiculous!", said the GP. "Anyone could say that!". I was speechless. Especially as I wasn't asking for him to do anything about my low HR, it was just as aside in the conversation. I can't see any justification at all for him being so apparently affronted by my actually knowing something about my own body and telling him that.
Edit: on hindsight, I can actually. He was very upset with me because what we were actually discussing was my thyroid meds. I'd told him that I was going to adjust my dose, based on my most recent blood results and the subsequent letter from the Endo specialist (NHS) that I'm under. I told him I'd been feeling tired and sluggish so was going to raise my dose slightly. The GP nearly had apoplexy and said "you can't change medication does based on how you feel". I quoted back to him what the endo specialist had said in her letter, "Your T4 is a bit low so I'm happy for you to raise your dose to ____, depending on how you're feeling". He didn't like that.
Haha....sorry to bang on, CDreamer, this topic really gets me going! It appears from what I've read from you that you've had your own issues with doctors so hopefully you understand my frustration
I had but was lucky enough to find excellent GP care, thankfully. Interestingly the GP who fought my corner with cardiology retired early & is now an assessor for QCC.
Now we have moved - not so sure. I’m going for a blood test this afternoon so will find out more.
I have been asked on several occasions to be a trial patient for GP training & I always push - Listen carefully to what your patient is saying - they are the experts on their body - you just have expert medical training.
Thankfully my neurologist allows me to adjust my dosage according to how I feel - not many do though and my GP reported back to him that I was excellent at managing my condition so they were both happy to not be prescriptive as they are with some people - who suffer accordingly because they are told to take 3 pills a day & don’t know what they are taking or for what. There seems to be many people who are like that and still believe that doctors know best.
It’s a partnership & requires a working relationship between doctor and patient. When you don’t have that the stress it incurs basically cancels any remedial affect a doctor could offer.
So sorry your GP practice doesn’t seem to get that.
You said: "It’s a partnership & requires a working relationship between doctor and patient. When you don’t have that the stress it incurs basically cancels any remedial affect a doctor could offer."
Oh my, this is SO true. Thank you for saying that; it's entirely my situation. I have said multiple times to medical staff pressuring me in some direction or other, I am completely open to whatever treatment is necessary, but until I can discuss it with a doctor who has made some effort to understand me as a whole person, not a 'walking condition', who is prepared to listen and not talk 'at' me, and who I have some level of trust in as a result then I will continue to make my own decisions as best I can. And take full responsiblity for that.
I'm not at all surprised that you've been asked to take part in GP training; you're very wise
In general, most do well with "moderate" exercise and afib. And like the article says, it's often beneficial. Once we get beyond moderate, people tend to react differently. With some, no problem. With other it triggers afib.
As you know, altitude makes the same exercise more difficult than at sea level. One big question is how did you react to riding at altitude before you had afib? I never did well at altitude without acclimatization even in my 20's, when afib was non-existent. but that's just me.
In any event, you should have a back up plan what to do mid ride if you start feeling you're over your head, as well as a back if you go into afib mid ride.
If you end up going, please let us know how the ride went.
Never had any particular trouble with altitude, even without taking any time for becoming acclimated to it. We’ll see what happens now. I appreciate your suggestions for plans for dealing with any worrisome symptoms while riding. Will let you know how it goes. John
Thanks, great article, Espeegee! I was already convinced that exercise is good for me but I didn't know that it reduces frequency and duration of AFib episodes
I have had P aFib for 9 years with no episodes for at least 7.I take low dose Bisoprlol with 75mg Flecainide 2x. I'm 67.
I haven't had any AFib problems day tripping up to Tahoe to ski moguls. I do walk every day for an hour+ with 300-500 ft of elv. gain so I don't get winded skiing.
If you have to do any climbing on a bike at altitude, that could be challenging. I'd say first time out explain your situation and take it easy.
It took me a couple of years to get comfortable living with AFib.
A newer Apple watch will tell you what your heart is doing and give you piece of mind. My heart rate won't go above 145 with the drugs.
I also carry a Flecainide and Bisoprolol pill in the pocket (PIP) with me in case I do get an episode. If you haven't already, ask your doctor about carrying some medication with you (PIP) and how much to take.
If you are really worried about a break through AFib event you could also ask your Doc if you could take 75 mg the morning of your trip vs 50 just as a preventative.
I did drive out to Colardo this winter. I spent my 3rd week at Breckenridge. The hotel was at 9k ft elv. and the top of one of lifts was at 12,700. No problems. Well except I'm not 20 anymore.
Thanks, jesonoma, for the good advice. I have been briefed on using Flecainide as pip but hadn’t thought of taking a little extra dose before exercising at higher altitude. Will definitely email cardiologist to see what he thinks…
Like CDreamer I reluctantly had to give up skiing - downhill & nordic. AFers on this Forum seem to struggle to get back to 'their old life' as the Holy Grail. I have moderated my exercise/life considerably and very happy with the consequences, which include being AF free!
My wife suffers from PAF and was fine at the bottom of Mount Tieje in tenerife. She took the cable car to the top and was struggling to breathe....as soon as we got down she was fine.
A friend who went on holiday to Peru recently had quite a few problems because of the high altitude there and he doesn't even have a heart condition. This website discusses AF and high altitudes: a-fib.com/faq-how-does-high...
The general advice seems to to procede with caution.
Hi,I can swim quite fast at sea level but I found on a trip to the Sierras at 6,000 ft that it was quite a bit more difficult. I was really surprised and had to change my one breath every 3 strokes to every two. My son who I can normally beat, managed to beat me easily. Having said that, I can hike around up to 8,000 ft without problem. I have cycled around Arches NP OK at about 5,000 ft. I was OK PAF wise, but I would be most concerned if I wasn't on an anticoagulant!
I think the various posts have conflated two facets of the question. 1. Exercise for people with PAF. I think a distinction needs to be made between explosive/high power exercise and endurance (a cardiologist said to me think Ussain Bolt vs Mo Farrah) 8and their relevance for andregenic (sp??) and vagally mediated PAF. When I first got PAF (25 years ago), I mainly suffered the former, so avoided excessive stresses. But, over time, I think mine has morphed into vagally mediated. Now my trigger is most commonly an endurance activity. But, with care over lifestyle, attention to hydration and electrolytes, I more or less do what I like. I rock climb, hill walk, mtn bike and have just finished a 1,000 km road bike ride from Venice to Belgrade, in 30C+ heat most days. I take 100mg Flecainide twice a day. I've had no problem at all. 2. Going to altitude. In my youth, I regularly went climbing at high(ish) altitudes, max of around 6000m. I was always slow to acclimatised and had to take my time. Since I got PAF, I've never been above 3,500m. I was ok but was nervous about pushing myself higher.
Final note - I was prescribed Bisoprolol but found this was performance reducing, so I weaned myself off it. I should add the usual caveat, that we are all different and I'm not medically qualified. But, from my experience, exercise done sensibly and PAF are not mutually exclusive.
Thank you, Kent, for this excellent, most informative response. Though you are about 10 years younger than I, your range of activities, especially as a senior with PAF, is impressive and thoroughly inspiring. I am new at having PAF, but I have already learned, I think, that I can continue with those activities I have always enjoyed as long as I accompany them with, as you say, “care over lifestyle” and plenty of common sense. When I had my first hours-long horrific AFib episode about 8 months ago, I thought that was the finish for me, with just bed rest and sitting in my future, so I have definitely come a long way.
Ha ha, yes, epeegee, I’m 76 with most my life behind me, too. I like your attitude and philosophy about this, and not worrying about stuff unless something untoward happens seems the happiest way to proceed at this age while enjoying whatever activities one can still enjoy. Happy days to you!
Well, I'm certainly not in such excellent shape as you are or able to do such intense physical activities (and have no experience in high altitudes), but I recently hiked on a long journey into a very steep gorge and successfully made it back up the cliff -- in 92f temps (33c). I was never so hot in my entire life. Unfortunately I had to rest halfway up, but at least I didn't go into a-fib which I feel is a personal success. I would agree with your cardiologist to go on and do it, re your 25-mile bike ride, as I feel extra exertion within reason strengthens the heart. Best of luck to you!
Very interesting question! I first discovered that I had afib when hiking at altitude. There is a huge increase in work load when you go from sea level to say 10,000ft, strap on a backpack, and start hiking uphill and doing that all day. Lots of multipliers. A good way to reveal any underlying heart issues that might not show at sea level while doing much less work. A lot of these cases probably get written off as Altitude Sickness, because by the time you go to the doctor some days later you are probably back in sinus rhythm. For the first few years of afib, I had to be very careful about where I would hike (you need to have a downhill route back to your car). Nowadays I can hike just fine if I take flecainide 100mg twice a day. I tried the 3x100mg pill-in-pocket, and while that works very well, I prefer not to have the episode at all. I think the exact altitude is not critical (your 6,000ft destination is not really very high), it's the combination of all the other multipliers.
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