I have had AF for something like 8 years now, and I am taking Disopyramide as an anti-arrythmic which usually controls my AF. However, just had a couple of days of longish walks 14 Miles and 10 Miles carrying a heavy backpack, and in the late afternoon of each day, had an extended AF episode until that evenings meds kicked in.
So a couple of questions...
I have seen comments around exercise being a possible trigger for AF, but I can't just sit around the house, so how do you find out how much exercise is too much? Apart from the AF itself being an indicator are there any other indicators such as period of time with an elevated heart rate?
With anti-arrythmic drugs, does increased exercise exhaust the controlling drug faster than when sedentary?
I would have hoped that exercise was a good thing, but if it triggers AF, then I am really concerned that I am heading into a minimal exercise lifestyle. I have already cut out caffeine and alcohol, cutting out exercise would not be a good thing for me........
Any advice much appreciated.
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It's more likely that the increased exercise caused the AF than anything else.Exercise is good for your heart and AF prevention, but there is a big difference between sitting around the house and doing two long walks carrying a heavy backpack.
That level of activity is strenuous and will have triggered the AF because it was probably just a bit too much physical stress.
Luckily, the AF was brought under control by your medication, especially on the second day when you would have been more tired and more sensitive to stress since having AF the day before.
You certainly don't need to stop exercising , or feel that you must do minimal exercise, but you may need to accept that you will need to have the activities differently, check your heart rate as you go and take more rests, or not add extra stress by carrying a backpack.
There are other possibilities to use as well as Pacing.
You could speak to your GP and see if you can have a pill in the pocket to use during or before a more strenuous or long activity.
You could discuss if you need a larger dose when doing certain things or if you should take the evening dose earlier in the day if you are exercising for a long time.
Other things you might need to consider is the environment you were exercising in.
Although it is Winter we do actually lose as much water and salt in Exertion and perspiration doing cold weather exercise as we do in very warm weather.
We just don't notice it because we are wrapped up.
Extra exertion is required by the heart to regulate the temperature and cope with physical activity and heavy lifting.
We also lose more water and salts because of this , and wind chill.
If you were not drinking regularly and having small nutritional snacks regularly on your walks this could have caused AF to occur.
Another cause for afternoon AF alongside the above cause could be autonomic exertion , especially if this happened within an hour of having a big lunch.
Eating a heavy meal and then setting off to exercise again before digestion has finished puts more stress on the autonomic nervous system , as the body tries to struggle to provide enough energy for activity when the nervous system is trying to cope in " rest and digest" mode.
The need to do two things at once causes an increase in the release of adrenaline / cortisol and this natural chemical reaction to over exertion and these can trigger AF to occur.
A solution for this is to walk a little less during the day and extend your trip to allow you to have enough time to rest and digest during lunch , to eat lighter meals and healthy snacks or to choose to do more strenuous paths in the morning but take a slower walking pace on a more level route in the afternoons.
Pacing yourself and taking a slower exercise rate may seem like weakness to some , especially if they've been really active before a heart condition, but actually it allows you to have much more consistency in activity without the chance of symptoms or injuries , which allows your comfort zone increase gradually , which is actually healthier for your muscle mass , joints , heart and general health in the long run.
Even those without diagnosed AF can get AF or heart related symptoms if the hike with a bag , on a steep path after a nice lunch no matter how fit they are.
Thank you so much for taking the time to dig into this. I guess I am going to have to be more aware of my heart rate during my walking days and build in more breaks and hydration. Usually the walks are not so intensive, its just that I had been congratulating myself on getting through the miles, and then to kick into AF after relaxing at the end of the walk was something of a blow. I don't smoke, don't take caffeine, I have cut out alcohol, I am not overweight, so the walks are one of the few things left that I enjoy. Thanks again for your understanding and taking the time to reply, onwards and upwards.
Whenever I exercise my heart rate goes up and I stop to allow my heart calm down. I do my exercise in breaks. Not strenuous exercises like lifting or pulling because it strains the heart. Just slow paced walking and resting. Give the heart some time to rest and pick up again.
I had an AF episode in July last year after a training cycle session for a sprint distance triathlon. The episode was triggered after eating dark chocolate following a large lunch. I took an extra tablet and it eventually cleared. Since then I have restricted the exercise I do, keep a close eye on the heart rate, and purchased a Polar heart strap, which gives more precise heart rate figure.Like you I like walking, but exercise has to be planned strategicalky to aviod injury.
Interesting, with Christmas moving into the rear view mirror, the episodes I have had over the Christmas have also been around an excess of seasonal sugar. I keep an AF diary to track any possible triggers, and chocolate has been in the mix.
I think of it from a cholesterol point of view. If any food can increase the cholesterol then aviod it or reduce the intake.At Christmas I avoid alcohol in foods, and just stick to non-alcoholic drinks.
Sugar is the hardest food to avoid, but can be reduced substantially.
Preservative in foods is hard to avoid, but once again can be reduced to manageable levels.
Caffeine is a big one to reduce. I always drink decaffeinated drinks, and have a variety of caffeine free teas available to consume.
It really is quite hard to maintain the diet. The easiest way is not to buy it.
Common sense with hindsight, but at the time, no issues, heart rate not excessive or arrhythmic, not out of breath, so at the time it looked like all was good. It was after the walk that arrhythmia issues kicked in, so I guess it's a slow process of discovering limits and building that common sense understanding.
Hi very good conversation about rowing as a trigger a couple of days ago - see if you can search for it.
As a general rule, intense exercise can be a trigger for AF and whilst you were certainly capable of walking those distances, let’s not kid ourselves those are challenging distances especially with a heavy backpack.
If you are also on beta blockers then your max HR will be 110-120 and so when exercising try and keep HR at 95ish. That will allow you to exercise the heart (which is good) without stressing it (which is bad).
I’ve now sold my Concept 2 rower and had to accept that I am now in a different stage of my life for fitness. I do power walks of 9km 3 times a week with a pace of circa 8:30 per km. I’m investing in a decent treadmill for the days when it is really cold and raining.
You aren’t heading into a minimal exercise lifestyle, but a different exercise lifestyle. Incorporate rest days, do some weights in addition to cardio and keep cardio at steady state (no more HIIT) and maybe no more route marches 😉
Thanks for this, I think 'different exercise lifestyle' is a useful way of looking at this, I am on Disopyramide which is an anti-arrythmic rather than a beta blocker, so my heart rate shouldn't be artificially/chemically suppressed. Looking back at the Apple Watch stats, my HR was 80-90bpm, so it may be more about the duration rather than the intensity, so more deliberate breaks and hydration may be the way to tackle this. Thanks for taking the time to reply.
I’m really interested to hear that you are on Disopyramide for your AF and not beta blockers. I also have AF and am on Bisoprolol (a beta blocker). The side effects are awful and I am trying to wean myself off gradually and stop taking them completely. It is a little daunting as they artificially lower the heart rate and not sure what to expect from the withdrawal.
Can you tell me a little more about the Disopyramide please, and how long have you been on them, as it seems like a better alternative to beta blockers.
I have been on Disopyramide since I got diagnosed with AF, a little over 8yrs now. There have been times when it was really hard to get hold of, but (fingers crossed) it now seems to be back in stock. During one of the spells when it was out of stock everywhere I was put on Bisoprolol beta blockers, no side effects, but I was struggling with the blanket damping effect, and still getting continuous AF so a bit of a non-starter for me. So then it was suggested I go to Flecanide an alternative anti-Arrythmic, but luckily, Disopyramide came back in stock so I didn't get to try that. Disopyramide works for me, with no obvious side effects, so I am sticking with that, up until I get the chance of an ablation. If you are struggling with beta blockers, then try and get a consultation to discuss anti-arrythmics, failing that I understand there are other beta blocker options.
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