Detraining

I received the following e-mail and am wondering if anyone else has benefitted from detraining, and also if anyone has experience with resuming endurance exercise after successful detraining.

I just wanted to express my great appreciation for your article entitled "Endurance Exercise -- Is It Worth It?". As a relatively young a-fib sufferer who was previously an endurance athlete, your article did a better job of summarizing the current research on this niche than any other I have seen. I was aware of several of the academic works you cited, but not all. Thank you.

I suspect you are busy and have since moved on to other a-fib topics, but I have a follow-up question in the off chance that you have seen subsequent research or written another piece on the subject. I have been able to virtually eliminate my own a-fib by cutting back on endurance exercise. I used to exercise 7 times a week, now I do just one bout. I suppose this demonstrates the "detraining" theory.

I have seen research on rats that suggests that after detraining they are sometimes able to "retrain" and do not suffer a recurrence of the same a-fib effects. The idea is that the prior damaging electrical pathways were disconnected by the detraining, and the heart happened to rebuild itself in a different fashion the next time. Have you ever heard of this tested on people? More generally, is there any scope for the heart to heal itself over the years, in terms of a thinner left ventricular wall and recovering from prior stressors? Your report makes this sound unlikely if researchers find that cyclists 30 years removed from their competitive days still experience elevated bouts of a-fib, but I thought I'd ask anyway.

Thank you,
EL

Hans,

I can tell you what I've done.

1) I eliminated endurance training and competition
2) am still very active, but don't emphasize endurance activity.
3) training is generally strength "super slow to failure" with some high intensity intervals (i.e. Tabata) every so often.

The super slow to failure is designed to activate and fail the whole range of muscle fiber types, from slow twitch to super fast twitch. A reference is [www.bodybyscience.net] The intervals mainly fail the super fast twitch. Neither takes a lot of time. McGuff, one of the authors contends that cardio is not necessary. Anybody interested can read the book, but it has been my experience.

If I do activities of long duration, I try to not make it "hard." That is I go for a 5 hour hike, rather than a 5 hour competition to see who can do it the fastest. This tends to make it much less stressful on the heart/system.

Amazingly, the super slow to failure routine once or maybe twice a week, combined with my keto-adaptation is sufficient to allow me to keep up with my friends who train like rats when we do activities like alpine skiing, back packing, hiking 14'ers and rock climbing.

I did not detrain until several years into my afib journey. I do it to keep the damaged minimized. If I overdo activity (all day at max HR, for example snow shoeing with a 60 pound pack for 8 hours through deep snow), it is a trigger in the vagal sense (i.e. after the activity, when relaxing) and can be delayed even for a day or two.

George

This article was on Marketwatch yesterday.

[blogs.marketwatch.com]

I have detrained also, I do very limited "cardio" (barely qualifies) keeping my rate in the 130s for 20 minutes. Contrast that with 4 years ago when I exercised for extended periods in the 180s.

I have to say that I miss running, the endorphins during and after a run are addictive.

Good for EL, to be able to abate it by only detraining, he is very fortunate-

EB

Gentlemen,

what you guys are doing as detraining still sounds like heavy training to me.

My normal resting pulse is under 60. Low 50s in the morning a bit higher later in the day though under 60. BP 105/75

Since I detrained I have not had afib for six years though there are many factors involved and I can't attribute the change in some sort of proportion.

I spend half an hour four five days a week with heavyweights eg shrugs with 110 lb dumbbells, dead lifts depending how high off the floor up to 450 lb. My pulse probably goes up to about 80. I work on the treadmill for minutes until my pulse goes to 110 then stop. That's it.

My doctor says my heart is fine especially at my age which is now 78.

Fortunately my detraining has not proved a psychological problem as it apparently does for some

Thanks

Alex

I read in Dr. John Mandrola's blog yesterday (don't have the exact blog entry link) about a study that showed that detraining does NOT reduce the incidence or severity of AFib in ex-endurance athletes. I saw that study in his reflections on 2012 post that he recently posted (not sure if it was in that exact post or if I clicked through a link in his post and read that in another blog entry of his). His blog website is [www.drjohnm.org] (it is excellent reading for anyone with AFib and I've found it to be an addictive blog).

About Diane's post,

you have to be very careful about studies whichever way they go. People respect them too much without knowing the details and specifics.

There are questions of size ,how they were conducted etc et cetera. I once pointed out at a meeting I could do a study proving organic fruit had less nutrients by selection of where to get my fruit. In Melbourne all we need to do is to pick a shop I know that has super fresh non-organic and a shop I also know that has low quality ancient or tired organic.

I did the detraining based on being advised I had a very healthy but large heart and Afib. Keeping it large or making it larger didn't seem a likely benefit. And I would have more time to read, fly an aeroplane and be social

Strenuous training was most unlikely to make the AFIB better and detraining was unlikely to make it worse.

As Jackie has said we are all individual experiments in such matters.

Alex

Alex

Actually my post yesterday was incorrect (sorry, but I was reading and posting at work, and didn't have time to track down the website and verify). Apparently studies show that detraining does reduce PVCs and PACs (and presumably AFib) but other studies show that detraining doesn't eliminate slow heartbeat brought on by intense exercise, which also significantly increases the need for pacemakers in old age.

Here's Dr. John's blog page I was referring to: [www.drjohnm.org]

Diane

Diane,

Dr. John says, "Heart rhythms for which the elderly require pacemakers are normal in the trained athlete. "

In the Circulation article referenced by Dr. John, [circ.ahajournals.org]
They say "Athletic patients with these bradyarrhythmias are almost always asymptomatic, and profound bradycardia in the context of rest or sleep does not appear to portend a poor prognosis. Heightened parasympathetic activity, specifically increased efferent vagus nerve activity, is responsible for these bradyarrhythmias. However, some experimental data suggest that repeated exercise training may also lead to intrinsic sinoatrial node slowing.93 In the asymptomatic athletic patient with any of these common bradyarrhythmias, reassurance and documentation of an appropriate chronotropic response to exercise are typically sufficient to exclude a pathological process."

The point of Dr. J's writing is not that most athletes will require pacemakers, but that athletes present with rhythms (mostly bradycardia) that, if in an elderly person, would be prescribed a pacemaker. Dr. J is saying that docs need to take into account a person's history before prescribing, not just looking at the presentation.

I have a 74 year old friend. Recently on a visit to the Mayo clinic for a follow up on non-cardiac treatment, his resting heart rate was determined to be 40. In an unfit person, this might be a sign of cardiac insufficiency, but since he is fit, they saw no problem. He is not an endurance athlete, but has always kept fit.

More of a problem is that in someone susceptible to afib the excessive vagal responses can lead to afib.

George

George

George,

The Body by Science training program sounds interesting. Do you need any special equipment to do it?

Hans

Hans,

In the basic Body by Science routine, they utilize 5 exercises.

leg press
pull up
push up (as the opposite of pull up, hands up, not a common pushup)
press out
row

The idea is to do them super slow (up and down) continuously till failure in a minute or two. They use machines. The metrics are 1) time under load and 2) weight. If done properly and with enough rest, you should be able to increase one of these metrics every time.

As usual, I never do anything by the book. My main piece of exercise equipment in the TRX, a piece of webbing designed for body weight exercise. Calibrating the metrics is much more difficult with this, however I can take it anywhere with me. Also, the basic concept of super slow till failure still works.

The idea being to fatigue the range of muscle fibers from slow to super fast twitch. It is the super fast twitch that take a long time to recover (which is why they suggest only doing this once a week).

One of the authors, Dr. McGuff, contends that aerobic exercise is not needed, that it is all adaptation. My experience has proven this out as my fitness is good enough to keep up with my friends who do endurance activity all the time.

From an afib perspective, the super-slow till failure is very gentle. It is by no means easy!!!! It takes much motivation to push yourself to this level. However the chance of injury is very low, as the weight is not great. Also, I would suspect you would not have the heart enlargement issues of other approaches. High intensity interval training will also fatigue the super fast twitch muscles, but is much harder on the system.

Using this approach, it only takes about 10 minutes a week of exercise. For all who scoff and think this is easy, try it!

George

George,

Found your reference to Body by Science quite interesting. Being in good physical condition has always been important to me but gradually had problems with arrhythmia so I stopped my exercise programs....had bilateral total knee arthroplasties within the past five years and was just getting back into full participation in any physical activity when the arrhythmia problems began to develop. After an ablation in March 2011 was somewhat hesitate to completely immerse back into physcial exercise and have only worked out sporacially. So, was very interested in your comments.

After internet research on the strategy decided to try and am three weeks into the plan. Follow the five basic exercises but also have added a couple of others (also include a short stationary bike ride as a warm-up). At this point I follow the strategy about every 5-6 days. I have been quite surprised t the the level of work that can be obtained in such a short time frame!!!

Steve
Spring, Tx.

Sounds interesting, , George, I have a trx and love it. What exercises do you substitute? I have found I have some problems exercising in the recumbant position. Seems to trigger my afib more.

John



Edited 1 time(s). Last edit at 01/22/2013 05:11PM by John21.

Steve,

I'm glad it is working for you!

George

John,

I do the TRX old Military Fitness Program at the twelve week level (basically upper body one day, lower the next) over two days. It doesn't follow Body by Science exactly and I'm not sure my adaptations are optimal. My takeaways from Body by Science -BBS are (1) superslow till failure and (2) sufficient rest time till you work out again. A disadvantage of using the TRX for this approach is the difficulty in measuring load and time under load, which is part of the BBS protocol. Initially, I tracked time under load, but it was too much hassle with the TRX for me. I just do the routines superslow till failure. It works for me.

If I am very active anyway, I will modify. For example, I'm skiing six days this week so may not work out at all, or only do the upper body/core routines.

Another story is that I eat a ketogenic diet and remain keto-adapted. The combination of BBS and keto diet allows me to do what I like to do and remain fit and lean. I spend little time actually working out.

Hope this helps,

George



Edited 1 time(s). Last edit at 01/24/2013 11:43AM by GeorgeN.