When I walk up an incline, my heart rate does not keep up with my level of exertion. So when my heart rate would ordinarily be 130, its stuck around 80-90 and I get breathless and need to stop.
So lets say I do a hike that's 8 km and 300m climb (see link below). On the steep parts i will need to stop about every 40m to catch my breath - for about a minute.
I feel ok for the first 20m and then for the next 20my heart rate is 80 when i feel it needs it to be 130(ish).
[Its a little more varied than this, but lets just say its that way for the purposes of this discussion].
But on an ordinary day, when i do a route like that I will probably walk about 1km in total in that zone where I need my heart rate to be at 130 when its stuck around 80-90bpm.
Is this bad for the heart and/or your health?
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Jonathan_C
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It will depend - many factors but one may be your ‘normal’ resting rate in NSR and what meds you are on to control your HR. My norm resting HR was 65-70 - I was advised to keep my exercise rate then to 120-125. When I was in Af my HR was more like 160-180 so no way was I able to walk very far at all, never mind go hike!
I was also told - rule of thumb for any exercise - you should be able to talk in sentences - if you can’t you need to slow down or rest for a while. Forget the numbers - your body is a much better monitor of what you personally can do - or not. Any exercise that doesn’t stress the heart is good - stress = inflammation not good. If you are breathless, you are stressing your heart.
I was also told - rule of thumb for any exercise - you should be able to talk in sentences...Any exercise that doesn’t stress the heart is good - stress = inflammation not good. If you are breathless, you are stressing your heart.
I can't talk to what is best for you, or even for someone with a pacemaker and in persistent atrial fibrillation. However, as a general principle, while excessive or prolonged stress can lead to inflammation, moderate exercise that increases your heart rate and causes some breathlessness is actually beneficial, improving cardiovascular health over time.
Therefore it is the well calculated exercise stress (often measured by some breathlessness ) that leads to cardiovascular improvement.
So the general advice often given on this forum that you should be able to walk and talk without being out of breath may work for some, but may not be optimal for many of us.
That was the medical advice given at Patient's Day last year Jim.
And it indeed may be applicable for many. But some of us can benefit from higher intensity levels that produce some breathlessness. This might be from brisk walking, cycling or even running or jogging for those that can.
One exercise regimen that has shown great promise for many, is called interval training, where periods of light exercise are mixed with periods of more intense exercise.
And again, some of us may do better exercising at lower intensity levels where you can walk and talk easily, but we have a diverse group here, and that principle may not be universally applicable.
Very good advice it is too. A good baseline for all to take note. I am of the opinion that everything relating to the heart should be in moderation. It's a fine line, and whilst it's important to keep healthy, over exertion can do more harm than good. Personally, rest is just as important to me as excercise. Over exercising can flip me into AF. Just adding my pennyworth.
My cardiologist recommends 30 minutes a day of breathlessness for the heart. About walking and talking, he says the other person can do the talking, but you should be breathless.
That's in general and, on the other hand, I am not supposed to exercise at all when in afib because my heart rate is going too high for this old heart.
About walking and talking, he says the other person can do the talking, but you should be breathless
Lol. Yes, there is no standard or "right" exercise prescription for everyone. And depending on your current condition and comorbidities, your individual exercise prescription can also change.
And I think THAT is the point - the OP was asking how much should I exercise in AF to which the answer is - to the extent that you can walk and talk in sentences.
Not everyone has or wants to have gadgets or has the time to spend working out numbers to do exercise to - that’s why it’s a rule of thumb.
I appreciate all the responses and they are helpful. But let me put what i was trying to ask differently. First - I am not on any meds that control my heart rate, my pacemaker was put in to prevent pauses, i am in persistent a-fib ... also i am 50 so still a spring chicken
When I walk up steep (or even steepish) hills my heart rate does not keep up with the level of exertion.
My question is - is it bad for your health to be in that zone?
The answer is important to me because I like (for my mental health) to get to nice view points when i hike and that involves walking up steep hills ... so while I know its not the most "effective" way of exercising (because I need to stop so often) ...i am trying to establish whether is bad for me.
And I think the answer is "it depends". i will discuss this with my EP.
Don’t know if this is relevant to your situation, but let me tell you of my recent experience. I have had a pacemaker (twin lead) for 10 years+ and up to recently been in permanent af, (normally low rate, pulse ~ 60). Have been breathless on any exercise for a couple of years now, but after my last annual check, the clinicians added in “rate-response” to the pacemaker functions. The effect has been amazing. I am more energetic and a lot less out of breath, and can even manage a flight of stairs! It certainly worth the discussion with the EP. 🤞🤞🤞
When you speak to your ep, maybe bring up the topic of an exercise stress test and/or cardiac rehab program. Here your heart and bp will be monitored during exercise. So you will have more data to make decisions on, other than perceived exertion. Exercise/hiking seems to be an important part of your life and finding your "safe zone" might be worth the extra effort.
It sounds like your pacemaker and/or any rate drugs you're taking are not allowing your heart enough oxygen to jeep up with the physical demands. And then there's you a fib assuming you're still in persistent afib.
Given all this, best to address your symptons and exercise program with whoever put in the pacemaker.
Thanks , i forgot to add - the only meds I am on are anti-coagulants and I am in persistent a-fib. My pacemaker has no effect on my heart rate when exercising - it prevents it from dropping below 45bpm.
Mine limited my HR to 80 for 6 months which was infuriating as I couldn’t even walk up the gentlest incline. Once the limiter was removed it was a different story.
This is one of those " how long is a piece of string" questions.Everyone is individual when it comes to their exercise tolerance.
It is usually better to workout within your Comfort Zone , that is the exercise level you can do without causing stress exertion and symptoms.
The reason for this is to reduce your risks of making your aFib worse , triggering an event or symptoms, and to prevent the risks of developing other health problems , including cardiac events or stroke.
Everybody's comfort zones are different and your comfort zone decreases or increases with your current health level.
Your " new normal " will be different to your " old normal " after you develop a health condition , even if you are medicated and your muscle mass and strength are still good.
Your comfort zone increases by adding in extra repetitions , more time exercising or slightly harder routes, little by little, when the workout you are doing begins to feel very easy and you feel you still have more energy .
Your comfort zone decreases if you have had to do less physical activity for some time because of illness or injury.
You can't push yourself to do exactly the same level of exercise as you did before immediately after you have been inactive or begun to get symptoms from a new health condition.
No Pain , No Gain is a dangerous myth, especially for people whom have cardiac issues.
Your body will not react well to this exertion even if it coped with it before.
Your body will tell you it is doing more than it can handle by causing a spike in blood pressure and heart rate changes and symptoms like breathless, cramps, dizziness, chest pain, excessive sweating or overheating.
If you keep pushing and not listening to the advice your body gives you , you can trigger worse symptoms or cause yourself an injury which is counterproductive to your fitness regime because you can't exercise consistently.
It sounds like you are trying to do far more in terms of distance and intensity than your body and heart can cope with at the moment, even if your muscles and mind may want to do that activity.
You will need to accept that you need to make some activity changes in your life and exercise at a less intense pace to be able to get the most out of your workouts and reduce your risks.
You will need to scale back your route and the terrain to the simplest level and work your way up slowly from there.
In the end , you could find out that you can do the hikes on hills that you are talking about , at a slower pace and with more breaks , but you will need to be patient to get there, or might need to accept that you may not be able to do such intense workouts. Times are not important like they may have been before.
If you aren't medicated as yet and have Permanent aFib and a Pacemaker you could also talk to your doctor or specialist at this point.
It may be time for you to begin medication to help you to control and improve your symptoms during activity, alongside sensible activity pacing techniques and self care.
You might require other checks on your heart and circulation or some adjustment to your pacemaker.
If you received a Pacemaker recently ( in the last three to six months) you might still need to give things time to improve whilst doing less intensive exercise that does not require a heart rate in the high cardio output range.
If they recommend medications you would still need to take the advice about slowly building up your exercise routines . You can't just take the medications and think you can instantly return to your " Old Normal" activity levels.
Medications don't work like that , they only help your heart manage the symptoms they don't cure them so they still need you to make sensible exercise and daily activity choices based on how your body feels each day. You would still need to slowly build up your exercise tolerance and hiking routine to prevent the symptoms of breathlessness.
You may also find going to cardiac Physio helpful in training you to improve your breathing and heart rate. Sometimes it's also worth looking at your diet and hydration levels to make sure they are appropriate to help your heart rate and blood pressure. You can also ask a cardiac specialist for help about that in your individual case.
Sometimes , you might find that the cardiologist would recommend changes to how much salt you have in your diet and suggest wearing compression clothing but you need advice on this before you begin.
The method described above is a sensible one, you should be able to hum or talk without getting breathless whilst exercising , this does prove that you are working out at a level your body and heart can cope with. If you begin to find it hard to hum as you go that's the time you need to scale back the climb and/or the pace you are working out at before you get breathless , taking a minute to have a good drink and some deep breathing before you continue also helps both your heart and general health.
This is one of those " how long is a piece of string" questions. Everyone is individual when it comes to their exercise tolerance.
I agree. I suggest moderation is key here. It's also important to get the mismatch between exercise and heart rate checked out - certainly if you feel breathless.
I'm sure you'll be OK but contact your medic to double-check.
I understand how you are feeling. When I first started Bisoprolol it was too much. My heart rate would be 70 when two weeks before it would have been 110. I couldn't walk far without getting breathless. Maybe ask cardiologist to check and make sure the pacemaker isn't acting on your rate. Every AF story is different and maybe you can keep doing your hiking but take the break when needed. At least you are still out there hiking. My cardiologist told me to try to keep my rate at 100. If I take it up to 130 for too long that can trigger AF. Go back to your cardiologist and explain this situation and he/she may have then answer. All the best with it.
I cannot say what is bad for your heart or any heart for that matter but, as a retired leisure centre manager I will say that you should always listen to your body, you should be able to exercise and talk at the same time, and don't push yourself too far. As someone who exercises regularly you must be quite fit, check with your cardiologist on his/her views and remember, everything in moderation........listen to your body....
The heart is just another muscle, so the argument goes, and if you don't use it and exercise it, the worse it will become. Obviously this is all relative and if you are fit enough to go hiking, regardless of HR (assuming it is not into the high levels) then it is not going to be doing any harm by being in AF and making you breathless in circumstances when in the past you were not.
The breathlessness is a function of the malfunctioning of the heart muscle in delivering sufficient oxygen into your blood, though if you are some kind of rate control medication such as beta blockers then this will stop the heart rate increasing as it would normally in vigorous exercise.
I take moderate exercise every day (at 78 and with permanent AF) by walking 20 metres up a 45 degree grass slope. It makes me totally breathless most times and I have to stop every few metres, but I do believe it has done me good over time and sometimes I am able to do the whole thing in one go.
Interesting replies but how do you know what is keeping your HR low and is it doing harm, that seems to me to be the question? Only a medic can answer and I hope you get better answers than my husband. He is on Bisop and Ramipril to control AFib and his HR won't go above 90 on a hill, so he, like you, has to stop. He can walk forever on the flat but has to rest on hills. He has had AF for decades, but only since having meds has he had this problem but the Dr's just say, carry on as normal. But he doesn't know what normal is any more. Good luck in finding the answer!
It sounds as if you have nothing to control your afib. The pacemaker will not help the afib and you are not on any medication for it. It seems to me that you/they should be tackling your afib with medication or ablation. Since my ablation I can do much more.
In the same way that a stroke is different for everybody, so is atrial fibrillation and atrial flutter. I found the best way to diagnose arrhythmia and associated waveforms is a Bruce Protocol test. You have the usual array of ECG electrodes on your body that are analysed in real time, and shown on a large display that is constantly monitored by a cardiac nurse. You walk on a treadmill with incremental increases in speed and incline. At the moment that arrhythmia is shown, the display is captured. You then sit on a chair and your recovery in both heart rate and sinus rhythm is timed and recorded, again by using the large display.
What I haven't mentioned so far is that I assume you are using an electronic device to measure your heart rate. You need to know how that device handles arrhythmia. Some will treat it as a data error and will either delete it or average it, so the displayed rate is incorrect. I pair my Polar Vantage V heart rate monitor (HRM) with a Polar H10 chest strap and the Performance Monitor (PM) on a Concept2 rowing machine. After discussing this with Concept2's electronics specialist, we came to the conclusion that the PM4 was treating AF as an error and discarding it. I changed the PM4 to a PM5 and used ANT+ to pair to the PM5; that solved it. A few years ago, I discussed HRMs with a cardiac nurse who said that Polar are less susceptible to AF.
To summarise, like data from a computer and AI, evaluate the data as it may not fit with the real world or your perception.
I had paroxysmal AF in my running, cycling, and gym days. An EP told me that I didn't need an anticoagulant, as my high heart rhythm during exercise was due to being a very fit athlete. I knew from the Bruce Protocol test that my heart flip-flops between atrial fibrillation and atrial flutter during exercise. I was prescribed dronedarone for rate control which caused pulmonary toxicity, and in the hospital (without my consent) I was given amiodarone in a saline drip. Eighteen months later, I had a full stroke. Since then, I've featured in an infomercial for Pradaxa anticoagulant and, I participate in several online lived-experience studies for universities, the Stroke Association, and the Atrial Fibrillation Association.
I've found that HRMs using green LEDs to measure heart rate are reasonably accurate up to 130 bpm. Above that, I would only trust a good chest strap and transmitter. If you use a chest strap, be aware that some can pick up erroneous signals from a Tee shirt rubbing on the strap.
I too am in permanent AFib. I’ve got a pacemaker to stop loss of consciousness from pauses in heartbeat. Was only on anticoagulant, Apixaban. No rate control.
Heart rate was usually 60-90 at rest , up when exercising, slow walk! I could walk long distances on flat but was breathless in any incline. Pacemaker downloads 6-12 monthly apparently showed nothing amiss during last 5 years.
Recently I’ve been feeling unwell, lack of energy, no stamina, sometimes lightheaded etc. Most recent pacemaker download shows that my heart rate has been spiking to over 200 at times, not associated with exercise as it happened during night as well as daytime. I was not aware of this, as apart from breathlessness, I don’t have symptoms from AFib now. When feeling lightheaded BP and heart rate (Kardia) seemed normal. Now back on Bisoprolol and heart rate dropping so pacemaker getting activated more than previously .
I quite often get a vertigo like sensation, but could also describe it as lightheaded.
Sometimes it comes from moving from a crouched position to upright too quickly - like when tying laces or doing stretches, but it does also happen out of the blue, and its not nice.
"moving from a crouched position to upright too quickly".
That could cause a drop in blood pressure.
Pre pacemaker I think mine were caused by pauses between heart beats, no idea if also caused by spikes in heart rate.
I never managed to capture a pause or sudden spike in heart rate on Kardia.,but my heart rate varied enormously when I had paroxysmal AFib. Episodes varied, some with near normal rates at other times high heart rates. But that's AFib, keeps changing even when permanent.
No seating much in the train stations. Cheapest bus to TOKYO from Narita Airport is the JR bus 7. @1500 yen. I paid $220NZ for taxi which was not there Booking.com! Bus charged me 3500 yen.
Taxis work out about 2500 for 2km. Or 1/2 hr.
I hope she enjoys her stay. Including breakfast is the best way.
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Persistent/ permanent AF episode and exercise 
Root Cause of A-Fib. 
Is this A Fib
Can we develop a useful formula for calculating what is an acceptable heart rate for an individual in AF? (when to seek medical attention)?
Heartrate when walking
