Hello - I think there are two bits of background that are important to the discussion I would like to have:
1) I live in persistent atrial fibrillation. I see this term used differently by different people, but I used to describe my condition of ALWAYS being in arrythmia. My heart does not go into normal sinus rhythm and then go into a-fib in response to triggers - it is always arrhythmic - always in atrial fibrillation (it is permanently like that).
2) I am 51, I have a normal BMI and am in atrial fibrillation because of a congenital heart disease (aortic stenosis) - i.e. my a-fib is not the result of an unhealthy lifestyle and I think it is reasonable to say it is not due to age.
The main form of cardio I get is walking/hiking. When I walk on a flat (or very gentle sloped) area I can walk for 3-4km (or even further) without needing to stop to catch my breath. But the steeper the hill the more regularly I need to stop to catch my breath. If I hike in a mountain and walk up a steep hill - which in some places is like walking up a long flight of steep stairs with large steps - I need to stop to catch my breath after 30 seconds or so of walking (those hikes take a long time).
I am trying to summarize this for discussion with my EP to get his advice.
The way I feel it works is that when i walk on the flat my heart rate can keep up with the level of exertion. So on a flat walk I need my heart rate to be 90- 100bpm and it (my heart) gets to that range as quickly as i need it to - which means I can walk without needing to stop to catch my breath. But when I walk up steeper hills my heart rate does not keep up with the rate i need it to be given the level of exertion. For example it stays at 90-100bpm, when I feel it needs to get to 130bpm. Lets call it a 30% difference - or 30% over exertion. The steeper the hill the larger this difference gets and the sooner I become breathless and need to stop.
I can maintain a 5% difference (or over exertion of 5%) for a few minutes (probably less than 5), which helps when I am walking on an undulating path as I will typically get to a downhill during which i can recover without needing to stop. But I cannot maintain a level of 40% over exertion for more than about 20-30 seconds (don't get too simplistic about the values, they are ball parks used to illustrate an idea).
If I walk for an hour and stay below the 5% limit - i can probably walk about 6km in that hour without needing to stop. Its a reasonable workout and I can recover from this quickly enough to be able to this every day. If I did that sort of exercise 4 or more times a week i am sure that alone (along with a healthy diet) would be sufficient to maintain good cardio vascular health.
BUT If I go for a proper strenuous hike - with a 300m+ vertical ascent over 4 or more km - I will repeatedly go into the 30% or 40% zone of over exertion and regularly need to stop to catch my breath on the uphill's. I will feel very tired after this and I know I need 2 days break before I can attempt it again i.e. if I do one of these on a Sunday, i would not attempt another equally strenuous workout until Wednesday (BTW I seldom do that sort of hike more than once in a month).
The question I am exploring is: is it bad for my heart and/or health to go into that zone of over exertion? Or what zones are ok to go into and for how long?
Thanks for listening 😘
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Jonathan_C
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Good question and excellent, concise summary of your conundrum. I have no answers other than when I saw cardiac rehab at roughly your age now, (female), they gave me numbers based on a formulae to keep my HR below 120 when exercising and it seemed to work. 20 years later I find I get breathless more easily so keep it down to about 105-110 and stop if it goes higher as I know from experimenting, that like you, the consequences will mean extreme fatigue for the next 24 hours.
About 10 years ago I remember a question being asked at Patient Day to several eminent EPs and their replies was when exercising in AF you should be able to walk and talk sentences, if not enough breath then slow down.
Personally, based on your experiences, in your place I would keep to the flat and undulating walks and it’s not going to get easier as you age. As to whether or not it will damage the heart, question for your EP. As ever I believe there are two opposing views 1) that occasionally pushing cardiac output to maximum is helpful and 2) we should listen to our body and when breathless believe it’s telling us to slow down.
Twenty years later and only with occasional bouts of AF I find that I am breathless sometimes walking up the stairs, whether or not in AF so another part of me is jealous you are still able to walk more than 5km - enjoy.
Now I'm not medically trained but what I would say to you is that by doing too much strenuous exercise when in constant AF it could cause your heart to become enlarged.
Now onto the the words persistent, constant (which I use) and always (like that too). I don't feel that the word persistent is a strong enough description. To me persistent means to keep on trying to attain something spasmodically. It may be described in a dictionary otherwise but to me it means to keep on and on about something. Like someone going to their boss for a wage raise just about every day, before he starts work, to me that would be called being persistent. It doesn't mean that he's sat asking for one every minute of his life.
It's probably just me thinks this way. I'd like to hear what others think about the word persistent and how they see what it depicts.
My cardiologist described my "persistent" afib as a 100% burden, he said I was never out of afib, so as far as I'm concerned, that means I have permanent afib, but for some reason many on here seem to disagree & say that permanent afib means that we've come to an agreement with our cardiologist that no further treatment will help.
Being someone who has only discovered that I had Afib & HF 5 .5 months ago, & have not had so much as a cardioversion yet, it worries me that both could be correct, ie, if I'm in what is called persistent, constant or permanent afib, does it mean that my chances of ever going back into NSR are non-existent?
Not until or unless your cardiologist says there is nothing he can do to return you to NSR. Just because you are in constant AF now doesn’t mean you always will be unless a cardioversion attempt doesn’t work for even a few minutes. However there are conditions such as morbid obesity or valve disease where ablation wouldn’t be possible. You need more information from your cardiologist ❤️🩹
I was in Persistent Afib for over 2 years.I was constantly in Afib but some days symptoms worse that others.It probably took so long to get it sorted because of COVID and the effect it had on the NHS system.It was persistent as there were solutions that had not been tried.Also my persistence in trying to get it treated.Now 2 years in NSR after ablation.
Although I am getting occasional Arrythmia readings creeping back.
I’m exactly like you. My persistent AF is there 24/7 and never goes and that is what I understood persistent AF to be. Likewise, mine is due to congenital heart disease and aortic valve replacement and is not triggered by anything.
Mine has been constant 24/7 every day and night since November 2024. My AF burden is 96 - 100% every week. If not persistent then what would it be called?
Many years ago manual workers tended to die at about 65, hence the setting of the pension age. I’d concentrate on living longer, not trying to get fitter 😀
That may be true for some but not sure I want to live longer if I can’t maintain some level of fitness so sometimes we have to compromise, which I suspect is what you were implying?
Couldent agree more as I see no point in spending the rest of my life watching TV or reading to the point where I can not do simple tasks at the least. Still a 6klm walk is a fairly good daily regime and I probably would avoid doing what is going to knock me for a few days!!. That has to logically be a bad thing for you.
It's a good question.In your case the aortic stenosis is the issue that is more concern if you are causing over exertion whilst you exercise.
Aortic Stenosis is a progressive narrowing of the aortic valve, eventually it can require a transplant.
One thing you do need to do alongside maintaining a healthy diet, lifestyle and BMI is to keep the symptoms of other heart conditions and Arrhythmias as stable as possible to delay it's progress.
Exercising beyond the cardiac output you can maintain causes breathlessness, pain in the chest or shoulders, palpitations, and as you have described so well the feeling that your heart is working too hard but can't kick up a gear.
With AS , even if you have a mild condition , this is partly because of the narrowed valve reducing blood flow and oxygen volume.
If you continue to exercise beyond the abilities of your valve to compensate for exertive change you increase oxidative stress on the valve and damage occurs more quickly.
Over time over exercising the heart can cause other problems like triggering AFib initially or making Permanent AFib worse, it can also cause other issues of thickening or shape changes in the heart itself as it struggles to maintain a function level it's not capable of maintaining.
People with Permanent AFib may have slightly different rules in terms of exercise because they don't trigger new episodes, but they are still told to listen to their body and it's symptoms and maintain a stable normal blood pressure during activity.
People with AS are generally told to exercise regularly but keep to low Intensity exercise activities for longer periods if they can. They are encouraged to walk but things like hiking on steep inclines , or hill and mountain walking aren't suitable because of the extra strain the overexertion to climb up puts on the aortic valve.
You are doing the right thing in terms of stopping on steeper walks to catch your breath, but this may not be enough if your hike is long and you must overexert yourself to often to achieve it.
You also have to consider the altitude you are exercising at as higher altitude also reduces oxygen quality making breathing harder and further reducing oxygen flow to the heart per breath.
Drinking water as you exercise can help , particularly during strenuous sections but it can only mildly reduce the exercise intolerance not prevent the potential of over exertion if you are doing something that usually requires high cardio output for an extended time.
Basically, every one can have a different exercise intensity requirement depending on which type of AFib they experience, but most importantly which other heart or other health conditions they may also have even if they are generally strong or healthy in other ways, this can be the same whichever age , gender or BMI you have.
If it takes anyone , even a generally healthy person, more than a few hours to recover from exercise and it causes symptoms like recurrent breathlessness , palpitations during activity and fatigue or DOMS ( delayed onset muscle soreness) after exercise, they are doing too much for their health level and that causes oxidative stress , inflammation and rather than making your healthier it causes damage over time. Eventually it can cause more serious health issues , heart problems or in cases of stenosis increase the chance that you will require a valve replacement earlier than you could have done.
I live in Wales. I miss galloping up the mountains and coast steering but I know I can't manage that anymore , it's not sensible for me to do no matter how much I'd love to and my muscles and bones could take it.
I choose smaller , flat or less steep routes , take more rests , I'm careful about routes I take, you are also trying that by increasing distance by adding more flats or drops on a walk but it would appear from your description that it may not be enough and you would be better choosing different types of hike , longer easier hill walks rather than shorter, steeper routes.
That will help protect your heart and give you better consistency overall which is healthier for you in the long run.
No pain , no gain is an outdated and dangerous myth.
Feeling the strain doesn't make it good for you , that's your body telling you it's under unnecessary stress and advising you to stop.
A hike or exercise activity does not have to feel strenuous to make it a proper work out, the opposite is true, a proper work out should exercise the body but within the region of physical comfort.
Basically when you describe exercise out put you shouldn't be describing it as or trying for overexertion, exertion is your aim.
If you don't overexert your body your comfort zone and exercise tolerance increases at a healthy pace without causing damage .
Thanks - lots to chew on here. Interestingly a few weeks ago I was in Windhoek for a work trip, which is higher altitude than where I live, and i found that i was a lot less breathless than expected when walking around - and there are some steep hills in that city!
I am going to my EP at the end of February and will give you feedback - the last time I spoke to him about exercise he encouraged me to jog!
Umm, well you know how Jim Fixx , the guy whom was credited with " inventing " jogging died...... A heart attack at 52 , while jogging. I do sometimes wonder whether EPs and Cardios actually link together the different needs of our different cardiovascular issues before making suggestions about exercise, or if they know anything about exercise at all!
After seeing the micro fractures in a person's ankles on x-rays from jogging in comparison to walkers and proper runners I wouldn't jog , unless it was to save my life from a mob of wildebeests 😆😆😆
hi I have controlled permanat AF i have no other heart issues I keep myself fit exercise everyday using dumbells plus pilates and some walking however I am very mindfully and I make sure my heart rate dosent go above 130 seems to work for me
My husband has exactly the same as you. There is no guidance apart from 'carry on as normal ', whatever that is. Blearyeyed's reply is the best advice and explanation we have ever had, so thank you for that. However, changing one's expectations of what one can do or should/shouldn't do is really hard, especially if one is active, 'healthy' and really, really enjoys hill hiking. But I guess going for less strenuous walking seems to be the best thing, to slow other problems developing. Very frustrating! I look forward to hearing what your EP says in Feb.
Assuming you have not got cardic or other medical conditions that contraindicate that percentage and his heart will not reach those higher numbers anyway so it is not a realistic option for him.
The thing is, I don't think my heart rate (at least not what my HRM is showing) is a reliable indicator of what I am doing or my cardiac load (or whatever the right term is).
On any given day I can walk up a very steep hill for 2 minutes and my heart rate will stay at 90 bpm that entire time - i would get breathless and would need to stop a few times on my way up.
3 minutes later I could be walking on a flat road and my heart rate will be at 130bpm and i will feel totally fine. ...
and then ... 5 minutes after that I could walk up the first steep hill again and my heart rate might go to 140 and I will be able to walk to the top of the steep hill without needing to stop... and it will feel good ... and on any other day, all of the above numbers could be completely different.
This is how my heart works, its constantly irregular
thank you for this post Johnathan, it’s something I often wonder about too as I get a bit puffed up hills, it’s not so much out of breath more my legs just lose their energy.
I’ll be interested to hear what your consultant says.
But I also have Rapid AF and finally in 2021 I was transferred to a Private Cardiologist who gave me Diltiazem 180mg CD which took my uncontrolled 156 bpm to 51 in 2 hours. I was taking only Bisoprolol from Metoprolol 186 bpm.
Beta Blockers, those two via 24-hr Heart Monitor proved their inability to control.
Metroprolol - breathless on any exertion, and pauses at night!
Bisoprolol - None of above but continuation of fatigue.
In both having to stop walking flat or worse in elated terrain.
I was told it's because the beta blocker is fighting to level out my heart rate so not enough even supply of oxygen.
I show a severely dilated left atrium. A low grade Systollic Heart Murmur. Systollic function working well.
So later last year BP low. I had trouble after picking up my ping pong ball getting back normal vision etc.
Also after walk closing my eyes I had 1/2 vertigo I would call it.
I reduced the Bisoprolol 2.5 to 1.25 amd then none.
So only on Diltiazem now but remain on the reduced 120mg CD not 180mg CD that was too much.
Settling my BP controlled 120 but rises over the day.
H/Rate controlled 100 or under but can start 75 - 90 now.
But my normal H/Rate at night is 47avg over 3 x Heart Monitors doesn't change.
Since dropping Bisoprolol my stamina walking has increased. But I could never walk more than 200metres I reckon. Stopping still. Not breathless. Rest for 5 minutes is sufficient unless elevation is the problem.
My Hospital H/Specialist wishes me to push myself some. But never to overdo it. Pace myself.
But the sleeping is less without Beta Blocker.
I haven't had and cannot have a cardioversion, ablation or on anti-arrhymic med eg Flec... but Diltiazem has an additive of being a SAFE anti-rhymic med by reducing the heart rate.
Did you doctor discuss the need for statins ? And ever important as you likely know is maintaining excellent blood pressure. High blood pressure affects the aortic stenosis and afib.
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Root Cause of A-Fib. 
Anxiety and A-Fib
Permanent a fib
None the wiser
