Excessive exercise and AF.

[RaySyl]

Can anybody out there provide a link to any papers linking excessive exercise with the onset of AF? Anecdotal comments would also be of interest.

[Buffafly]

Did you mean excessive exercise long term (over training) or episodic?

[RaySyl in reply to Buffafly]

Yes, I guess I should have been more specific.

[BobD Volunteer]

I am not aware of any papers written on the subject but it is well know amongst medics that there are three groups of people with increased risk of AF.

Teanage binge drinkers. (usually grow out of the problem)

Endurance athletes ( primarily amateurs)

Iron man type competition and cycling seem common. It is also apparent that professional world class athletes who retire and de train in middle age tend to avoid the problem. Draw from that what you will.

Fast jet pilots . (fighter pilots fighting G force. )

Most of the problem seems to be that the excessive work loads on the heart causes the left atrium to expand and this can disrupt the natural pathways which can break down and create chaos.

[john-boy-92]

If you look back about two decades, an elite team of cross country skiers were tested and I think 10% were found to have AF. I use to run around 50 miles a week at 6 to 7 minute pace, Orienteer, cycle, Spin class junkie. Yep! I've got AF that alternates with flutter during exercise. I'm asymptomatic so it took the Bruce Protocol test with a big ECG screen, a treadmill with incremental speed and elevation increase and, two nurses to find that out. When time allows, I use a Concept2 rowing machine outdoors, and I've clocked around 2.3 million metres.

[Omniscient1 in reply to john-boy-92]

Snap. Sadly.

[Speed in reply to Omniscient1]

Similar with me. AF in family but my A Flutter started earlier in life (54) and a few years after training for 2 Ironman. EP thinks not unrelated. After 2 ablations for A AFlutter, now have Pax AF. Usually triggered when HR goes over 140. Now exercise less and aim to keep HR below 140. Still get some spontaneous episodes outside of training. An AF ablation an option but currently monitoring situation and likely if become more symptomatic.

[Decaf_Andy in reply to Speed]

Hi Speed,

Very similar to me - I’m a cyclist (done lots of 100+ mile days), was also finding higher heart rate can trigger AF. I also aim to stay below that.

I’m not sure about taking risks of an ablation, but am giving the drugs a go (flecanide + precautionary bisoprolol- coincidentally the latter, beta blocker ensures I cannot get above 140bpm).

[Speed in reply to Decaf_Andy]

I was on Flecainide and Bisoprolol but in consultation with my EP, came off the BB as it destroyed my ability to get my HR going (from memory it topped out at 110!) and therefore any enjoyment. It was a QOL (quality of life) issue and EP happy to go that route. I believe the Flecainide is also having an effect, though less so, having no impact at resting HR but limiting my max HR to about 150. Would have been closer to 170 without.

It took a 2nd ablation 2 yrs later to fully resolve the A Flutter.

Often though an ablation can be a matter of buying time and having shown to have a pre-disposition, likely to return some time down the road, especially if returning to full on training. It’s all risk / reward and we each have a different compromise point. If you do decide on the Ablation, try to avoid doing too much too soon or you may undo all the good work. This may be true in my case, though you never know. Good luck in whatever route you choose and happy cycling.

[mjames1]

Go to Amazon and get "The Haywire Heart" but Dr. John Mandrola. He's an ep, avid cyclist and afib patient. He not only believes too much exercise can trigger afib, but also that it can ruin an otherwise successful ablation. Lately, I've been toying with "The Maffetone Method", also found on Amazon. Dr. Phil Maffetone's theory is that by working out below the usual exercise heart rate zone, you can get fit without injuries. After injuring my achilles heel, doing interval work, he speaks to me well

Jim

[Ern007]

Hi Exercise helps AF in moderation. AF has lots of triggers, Alcohol often causes AF the day after. I think it's lots of things in moderation..

Here is a link.

nature.com/articles/s41598-....

[CDreamer]

drjohnm.org/2011/04/cw-trea...

TreatingAF in athletes

[DevonHubby1]

In my wife's case she developed paroxymal AF without any extreme exercise. Having been diagnosed and being told her BMI was a contributing factor she resumed dieting and signed up to a gym. She exercised hard every other day, and after 3 months and loosing a lot of weight she had a prolonged and uncomfortable AF episode where eventually ended up in hospital for a week and on discharge was told she was in permanent AF.

I am convinced the high cardio exercise she did was the cause of her long AF bout.

[Ossie7 in reply to DevonHubby1]

I empathise with your wife Devon . My AF has always been blamed on my higher than average BMI. I did manage to lose 3 stone in weight gradually , and then had a horrendous bout of persistent AF . Unfortunately due to stress of my Dad’s dementia , Mum being palliative , Dad dying , etc etc I gained 2/3 Ed’s of it back on . I’m always trying to lose weight and exercise daily but in moderation . No excuse but the beta blocker really seems to limit me losing a pound !

[DevonHubby1 in reply to Ossie7]

Similarly my wife's experience since being on Bisoprolol as a beta blocker is that loosing weight is a real struggle. Diets that used to shift the weight no longer work.

Recently due to her AF becoming persistent and significantly impacting her QoL the consultant switched her to Nebivolol. The diet she's on appears to be loosing the weight this time.

[Ossie7 in reply to DevonHubby1]

and how is she getting on with the nebivolol ? I tried diltaziem in the early days but didn’t get on with it . Maybe I could request a BB change ?

[DevonHubby1 in reply to Ossie7]

So far, so good. Been on it a month now. ECG and 24 hour monitor tomorrow at hospital and then if cardiologist happy a possible cardioversion.

[Ossie7 in reply to DevonHubby1]

oooh , hope she gets one , so nice to be back in lovely sinus rhythm , even for a short time as gives the heart a good rest

[KiwiBlake]

I developed AF approx 3 years ago, at the age of 49. In my mid 40's I brought a mountain bike, thinking that I needed to get into better shape (I was 75 kg, at 5'8" tall). My kids said I was developing a "Dad bod". I used to go absolutely hard out on my bike, used to really get the heart pumping, to the point it was almost jumping out of my chest. I lost about 5kg, but now really regret it.Coincidence that I got AF, I really don't know, no AF that I know of in my family, so I'm ruling out genetics.

Like they say "every thing in moderation ".

[Foxey2]

I have always run and cycled but upped my effort and distances in my late 40’s, bam 3 years later my first AFib episode. I have always had what I thought where palpitations but maybe it was the start of afib, the fact it got worse when I upped my exercise who knows but the evidence would seem to support it 🙁

[Speed]

Search on here for previous threads on this subject. Some useful information and anecdotes.

[LMCPL]

I don’t know about excessive workouts contributing to AF. I worked for 50 years, long hours & busy days running 3 small companies. Then wham out of the blue AF…! Since diagnosis in 2019, I’m probably the fittest I’ve been my whole life. Walked over 1,100 miles, cycled 3,200 & just taken up swimming again & done over 100 miles this year. I find this keeps me on an even keel.

[Jajarunner]

My 'speciality'. I keep a blog about this very subject. It also lists all the studies I consulted. It's interesting because there is a lot of misinformation about this subject and what even constitutes high exercise. One study, often quoted, is comprised of fifteen participants, all men!!!Here's the link

hhtafibathlete.blogspot.com...

Have fun 🙄

[OzJames in reply to Jajarunner]

thanks for sharing your blog. It sure is a learning curve… I have now switched from my ocean ski and running habits to a Nordic Track bike 4 times a week . I also walk briskly every day and do reformer Pilates twice a week. I’m on a small dose of Metoprolol day and night about 1/6 th of a tablet I reduced from the 1/4 tablet the Cardio suggested.

I start pulling back my exercise effort when I notice HR getting close to 130 as it invariably goes over that when one slows up anyway. I feel better for it. I’ve stopped the beers and wine and occasionally have a sip of my wife’s. Only decaf coffee and have followed the breathing ideas from James Nestor’s Breath book. Also taking Mag taurate and glycinate, D3 and coq10. It’s trial and error I guess. Last CV was in Dec 22. My history was PAF once every 5 years since 1993. Always induced by alcohol, caffeine or stress then followed by vigorous exercise within 12 hours of drinking etc... I wonder why it’s taking me so long to change my habits!

[CyclingRunner]

Yes, got it. I’ve posted a long thread on it before. Turns out I have family history in AF, and very tall and exercise a lot. Luckily I’ve been able to manage it quite successfully. Take 1/4 50mg metopronel before exercise and knocks about 15-20 bpm off HR. Also reduced the intensity so now try to keep max HR sub 150, which is easy with the BB. Trained quite successfully for a 230k ride which ultimately got cancelled so did the 170k option instead - BB tapers off after 3 hours so took another 1/4 to keep steady. Have started running a bit more and cranked out a half marathon a month ago as well as cycling 5+ days per week.

I’m also more acutely aware of the lead up to AF during harder efforts, so back off when I start skipping too many beats. My cardio reckons eventually I will need an ablation, but I’m only 48 and so far so good.

I did reduce alcohol consumption a little bit - too much has always given me heart palpitations, but still drink more than I should. Also take magnesium as well. So for me it’s been disappointing not to be able to go flat out - prob 2k’s per hour down on avg speed, but happy to still be out there.

[Sixtyslidogirl]

Sorry to hear you are in this position, and massive sympathy. It’s particularly annoying to realise that you might have caused your own problem while doing what you thought was a good thing.

The Haywire Heart is a good, if depressing read on this topic, plus papers etc. There are quite a few elite athletes with Afib is my understanding. One person’s excessive is a runner’s normal week. I am 62 and started running competitively in my 50s. I started to get ‘palpitations’ during menopause and had what was probably an episode in Feb 2020, saw a sports cardiologist who gave me a treadmill test when started to see skipped beats over 170pbm, so his advice was keep it under 160. I did that for a long time then drifted up and had another episode in Sept 2022, April & May 2023. Hoping to get through June without one..

Triggers for me so far are extreme exertion, cold.

I now monitor my heartrate and rhythm with a frontier x device which you can wear while running. From this I can see that even though I am not in AF, I am having more ectopics. I am doing the Zoe nutrition stuff (more veg, less to no animal fat, less sugar), given up alcohol and caffeinated coffee). Giving up cake is more of a struggle. I am also doing the Maffetone running plan, so keeping my HR under 120. I am about a month into that.

My left atrium is moderately dilated @ 34 ml/m2. I don’t think you can get it down again from what I have read.

I am not on any medication but have apixaban, bisprolol, flecanide pill in pocket.

My treatment so far has been from private sport’s cardiologist but have an NHS appointment in August which I got after my penultimate episode was captured by NHS hospital. So it will be interesting to see what they say, whether better to get an ablation in before the AF progresses too far or wait till it’s all much worse.

[JOY2THEWORLD49]

Hi

Researching AF excessive. exercise is one pointer.

Research Radcliffe Research UK or AF pointers.

cheri JOY. 74. (NZ)

[intheweeds]

I am 62 Female and have been PAF since Sept last year. I get palpitations and have had 3 scary AF and palpitations all night episodes which scared the bejeezus out of me.

I had spent the last 40 years in highly stressful very physical jobs AND I trained like mad, because I believed that being as fit as possible would keep me healthy!

Now I believe I caused my dilated atria and leaky heart valves by this extreme lifestyle and it has given me anxiety. I cannot stop worrying about how I did this unknowingly to myself and there is no cure. And it will get worse I guess.

Oh, and I know that stress can bring it on!

[MaxfieldP in reply to intheweeds]

Dear intheweeds, don’t panic! The human body is amazing. Please, do not think about be responsible for overexercising your body. We act with the reference we had at the time we made decisions. And please, do not think it will get worse. In my case the PAF subsided. My case is like yours. Overexercise. I suffered with paroxysmal AF for 9 years and today I am almost without symptoms. Today I am 76 years old, and I have only occasional ectopic beats (extrasystoles) and occasional tiny AF episodes (less than 30 seconds. Sometimes during the night. Sometimes (rare) I have tachycardia (without rhythm variation) and I my heart beats awake me. But it is essential do not panic. Be calm. Sometimes I seat, read four or five pages of a book, calm myself and sleep again. Sometimes I take half a pill of Zolpiden (before 3 am) because it is a hypnotic with rapid effect and short duration. But, please, do not panic. Keep calm, relax, and enjoy your life. Take care.

[intheweeds in reply to MaxfieldP]

thanks so much for taking the time to reply to me. Your words mean a lot and have actually given me some hope. I really appreciate what you say and that the human body is amazing. Thank you and best wishes to you.

[MaxfieldP]

Dear RaySyl

About medical information on the theme, here are some links:

Overexercising and the Risk for Atrial Fibrillation:

verywellhealth.com/exercise...

Excess of exercise increases the risk of atrial fibrillation:

pubmed.ncbi.nlm.nih.gov/280...

State of the Art Review: Atrial Fibrillation in Athletes

pubmed.ncbi.nlm.nih.gov/286...

The post "Scottish Triathlete with new afib diagnosis", initiated by "tridye" contains some valuable comments on the matter.

healthunlocked.com/afassoci...

About my experience and anecdotal comments, I transcribe here part of my answer to that post 3 years ago:

“… I am 73. I had my first AFIB episode during a mountain running competition, when I was 66. I ran 8 km uphill and had to walk slowly the downhill part. I was triathlete between 50 to 57, age group. I've been jogging and running since I was 30. Biking, mountain bike, all my adult life. During the last 4 years of my active outdoor life I did mountain running. And so, I had Paroxysmal AFIB. And, at the same time, my knees were worn out.

Thinking about AFIB, I am almost sure I really pushed my body and, specially, my heart, a little far from the safe limits. Curiously, as far as I can remember, the occasions that I was worried about pushing my heart to the limit was during some strenuous mountain bike weekend training with younger (better shape) friends.”

I hope the above is useful to you. Best wishes.

[CyclingRunner]

The excessive exercise concept is interesting. In my case I would suggest I had a whole load of generic factors, and the reason I developed AF was that I was pushing it so hit the wall earlier. If instead of trying to win the sprint, chase people up hills or finish in the top 10% for my age group I had a more moderate approach (like exercise 2-3 times per week rather than 7) then I would have still got it but maybe at 65-70 (like my dad).

I freaked out a bit when diagnosed, but found that knowledge is power and in my case it’s controllable if you can resist the urge to try to push yourself over the top.

The Haywire heart book is good - but you’ve also got to remember that the mindset and body of a super elite althlete is a bit different to the most of us, so the option of going a bit slower is really hard to do. Also everyone’s AF is a bit different - one of the guys who used to cycle in our club got AF, but his hit the night after a ride and went on for hours and hours, so he stopped.

I found more loved experience on the forums so keep asking questions!

Cheers Tom