Work out impact

First, I greatly appreciate all the information I find on this site. I have not taken the time to do all the research and information gathering that many of you have - so, apprecaite your willingness to share. I am 53 / athletic / former collegiate basketball player with long standing persistent AFib. I have an ablation scheduled at Mayo on 5/1 and I have a couple questions regarding exercise.
1) I tend to workout quite vigorously. It's something I've always enjoyed. Montitoring my heart rate during exercise is obviously, with the AFib, a bit inconsistent. However, I do get to some quite high exercise induced / AFib impacted rates. I've always felt that the more I strenthen my body through hard work the better...but, seem to get soem conflicting direction on intense exercise. Thoughts?
2) When I originally had intermittent AFib, I could actually convert myself through intense exercise. However, I am unclear as to whether intense exercise post ablation will be positive or negative? If I am able to achieve post ablation NSR can intense exercise trigger another AFib onset? Thoughts?
Thanks again.

Keith,

When I read your post, I thought "Wow".

You and I are very similar. I'm 52. I've played organized basketball all my life. Didn't play at the college level, unless you give me credit for intramurals---lol. However, I continued to play in leagues and multiple nights per week for years. I've also enjoyed working out intensely, including with strength training, and tried to always maintain a fair level of fitness---as my job required it (police officer).

When I was diagnosed with afib 1/14/14, it came as a complete shock to me. I had not felt poorly nor had any racing heart or heart palpatations. After diagnosis, I thought I could exercise my way out of it too. My cardiologist blessed my 75 minutes of daily cardio at the gym. According to my chest strap monitor, my HR would always spike to 200-220 after a few minutes of strenuous elliptical. I just continued to exercise through it and then did 30 min on the treadmill with afib induced high HR......but at that time.....early on......I didn't realize what was happening as this was all new to me. I don't think the cardiologist initially believed my reports to him of the 220 HR during exercise. I finally put it in writing to him in an email and he quickly scheduled me for a treadmill test-----which confirmed my exercise induced afib, even on the Tikosyn----and he quickly referred me to an E/P. You are already beyond this point.

I've said here several times that if I had it to do over again, I would have done it much differently. Instead of trying to exercise my way out of it, I would have done the opposite and given my heart a break---a chance to rest.

I eventually went through Tikosyn, Flecainide and Metoprolol----none of which worked well for me---at varying doses.

I went through a few chest strap heart monitors until I found the Polar H7, which I believe is extremely accurate. I used it before my ablation and it would clearly show me when my heart spiked on the gym equipment and my Iphone. The advantage of recording it on the Iphone is that it can be saved---if you want to show it to your doc. It works with all of the equipment at my gym. I also use it with my Iphone during outdoor activities like tennis or walking.

In any event, my recommendation to your first question, based on my experience, is to give your heart a break. If exercise initiates afib----I would suggest stopping your exercise until post ablation, since you already have your ablation scheduled. There are many others here who I'm sure will contribute and tell you the opposite of what I've said---others, like you, will sometimes convert back to NSR with intense exercise. Truly, it is an individualized thing---what works for one person may not work for another. Exercise NEVER quelled my afib---it only caused it.

As far as post-ablation intense exercise goes, I can't tell you about that. I had my Natale ablation eleven weeks ago today on 1/27/15-----and I have not exercised with any heavy intensity at all----as most of the knowledgeable, education people on this forum recommend against it during the blanking period. Many recommended giving the heart a full six months break before working your way back into your exercise program. I'm still debating with myself about whether or not I can stay away that long. Honestly, I have cheated a little and done some light exercising of all types----and my heart always responded appropriately. I'm still going to give it a little bit more time before pressing back into strenuous activities. I think Dr. Natale recommends against lifting heavy weights.....

At this point, I'm thoroughly satisfied with my ablation. My afib had progressed over the year I knew about it to being almost constant, even on the meds. I had a few blips right after the ablation, but my heart rhythm and rate have been good since the early blips.

Please return and keep us updated on your status after you have your ablation. We are interested in hearing from you.

Best wishes.

Sincerely,
Ken

Keith7931 Wrote:
-------------------------------------------------------
> I am 53 / athletic / former collegiate
> basketball player with long standing persistent
> AFib.

This is what brought you to the afib party.

> 1) I tend to workout quite vigorously. It's
> something I've always enjoyed. Montitoring my
> heart rate during exercise is obviously, with the
> AFib, a bit inconsistent. However, I do get to
> some quite high exercise induced / AFib impacted
> rates. I've always felt that the more I strenthen
> my body through hard work the better...but, seem
> to get soem conflicting direction on intense
> exercise. Thoughts?

Exercising while in afib is, IMO, not helpful to your heart. You are "piling on" to an already stressed heart. While exercise may be good for the keeping your blood sugar under control & therefore reducing plaque deposition (and this may be debatable when exercise is taken to the extreme as it can be very inflammatory), it is not helpful to the heart's electrical system.

> 2) When I originally had intermittent AFib, I
> could actually convert myself through intense
> exercise. However, I am unclear as to whether
> intense exercise post ablation will be positive or
> negative? If I am able to achieve post ablation
> NSR can intense exercise trigger another AFib
> onset? Thoughts?

It is a good question. I would certainly allow your heart plenty of time to heal before putting the "pedal to the metal."

I've not had an ablation, but have been fortunate to control my afib with magnesium, potassium and taurine plus the very occasional dose of on-demand flecainide to convert an episode (one dose in 23 months). I too came to afib through chronic fitness. I played college football and later competed in high altitude races (like 13 1/3 miles starting at 6,300' and ending at 14,100'. I've had afib for nearly 11 years. It took me a while to understand a) not to exercise while in afib and b) that endurance exercise brought me to the party, so I should moderate.

As I like to be active, my question to myself is "how much is too much." My own answer is to not do any endurance training. This does not mean I never do endurance activity, but minimize my time in it. For training, I do infrequent HIIT (like 8x 20:10 tabatas) and super slow strength training to failure (once or 2x/week). This combined with a keto-adapted diet allows me to keep up with all my cardio fiend friends for my fun activities. These include alpine skiing, rock climbing, hiking, backpacking & etc. I do push myself but still moderate. For example, I will ski the steeps and off piste from 8:30-4, without stopping. I commonly ski 30,000-50,000' vertical/day. However I won't join my friends in skinning up and skiing down because the skinning up is a fairly intense endurance exercise. I know that all day, max heart rate exercise will bring a delayed vagal trigger for me.

You might be interested in this thread on this topic: <[www.afibbers.org]

George

Keith,

I've got to thoroughly agree with George-----exercising in afib is likely exacerbating the problem. I wish I had known---instead I tried to exercise out of it----and watched my ejection fraction get reduced to 51%, then 46%, then 45%. I had the ablation within weeks of the last reading. Time between 51% and 46% was about 5 months. Give your heart a break----especially if you are planning to have an ablation next month. Take time off afterwards to let your heart recuperate. It's been tough for me to stop....and honestly, I've cheated and exercised during this blanking period, but I haven't pushed myself to max......just enough to watch my heart and know that it is responding appropriately with added resistance and lessening resistance. The smart part of my brain tells me to continue to rest longer, but emotionally, I feel the strong yearn to do something. I'm sure you will go through the same process. Rest as long as you can.

George's advice about "how much is too much" is excellent. I'm going to be toying with it still over the next couple of months before going back into it "full speed". Listen to what your body is telling you. I didn't understand what mine was saying and my doctors continued to go along with my exercise program. In hindsight, I think it was a mistake. Fortunately, everything is going well today.

Best wishes.

Ken

Thanks George for posting that link that included my post which contains these (following) reminders. It should also be remembered that magnesium acts as an antioxidant which helps lower the resulting inflammation that results from heavy exercise and the ROS damage that occurs with prolonged aerobic exercise. So always optimizing intracellular magnesium is most important for afibbers as well as heavy exercisers.

Shannon has posted previously that heavy weight lifting is found to cause damage to heart valves.

On the topic of Exercise as it relates to arrhythmia either before or after ablation, there are highly significant key points to keep in mind about Fibrosis, Afib and magnesium deficiency. While fibrosis occurs in other organs, this is about fibrotic heart tissue that can cause arrhythmia. All afibbers, former and present, must always be aware of the importance of optimizing intracellular magnesium (and of course potassium)...... forever.

Cumulative damage over time leads to areas of ischemic heart tissue.

It’s known that aerobic exercise produces oxidative stress which triggers inflammation which produces fibrosis or an attempt as a repairative mechanism in cardiac and lung tissue damage which can result in various locations for fibrosis. Oxidative stress and tissue remodeling are involved in the development of fibrosis of the lung and heart.

Oxidative stress is also involved in the skeletal muscle dysfunction, which may be associated with exercise intolerance and insulin resistance in HF. Therefore, oxidative stress is involved in the pathophysiology of HF in the heart as well as in the skeletal muscle.

Also, note this report:

[www.medhelp.org]

Can Excessive Endurance Exercise Damage Your Heart?

Pro-arrhythmic Effects of Excessive Endurance Exercise
Although it has been recognized that elite-level athletes commonly develop abnormal electrocardiograms and benign atrial and ventricular ectopy52-54 the “athlete’s heart” adaptations to long-term, high-level exercise training traditionally have not been thought to predispose to serious arrhythmias, HF, myocardial infarction, or suddent cardiac death. However, recent data indicate that adverse cardiac remodeling induced by EEE can, among other issues, create an arrhythmogenic substrate17, 26, 45, 54 Indeed, chronic sustained vigorous aerobic ET such as marathon or ultra-marathon running or professional cycling has been associated with increased risk of atrial fibrillation,17, 36, 45, 48-50, 55-60, 67 and complex ventricular ectopy including ventricular tachycardia and SCD30 even in very fit individuals.52

Despite the fact that these studies excluded athletes with findings to suggest arrhythmogenic RV dysplasia, the VA typically originate from a mildly dysfunctional RV,23,24,54,61 that may be the result of prior myocardial injury from excessive and sustained aerobic exercise training. Myocardial fibrosis (fibrillary collagen deposition) develops as a reparative process in response to damaged myocardium. This patchy myocardial scarring can favor reentry and is well established as a substrate for arrhythmia susceptibility.62, 63

Chronic excessive endurance exercise training and competition also stimulates multiple other disruptions within the system including episodic release of excessive catecholamine and resultant coronary vasoconstriction, chronic elevations of heart rate during sessions of protracted aerobic ET leading to decreased diastolic filling time of the coronary arteries, increased demand for oxygen, changes in free fatty acid metabolism, lactic acidosis, and metabolic derangements.43 During an extreme endurance event, in susceptible individuals the heart may not be able to cope with the prolonged and sustained excessive physiological demands, thus increasing right heart preload and afterload, which initiates stretch and subsequent chamber dilatation in response to these hemodynamic changes.58 Right heart dilation and hypokinesis following protracted exhaustive exercise training has been documented using both CMR and echocardiography.23,45 Diastolic dysfunction of both the RV and LV has also been observed in individuals doing chronic EEE and racing.64

During the post-endurance exercise period, the cardiac geometric dimensions are restored and many athletes continue this cycle with long distance exercise training, marathon running, transient chamber enlargement, and subsequent myocardial recovery. With this recurrent stretch of the chambers and re-establishment of the chamber geometry, some individuals may be prone to the development of chronic structural changes including dilation of the heart chambers and patchy myocardial scarring in response to the recurrent volume overload and excessive cardiac strain.59

Approximately one in three finishers of a marathon, irrespective of baseline fitness level or the time it took to complete the race, will have a post-race spike and fall in cardiac troponin and BNP.60 It is logical to hypothesize that a subset of these individuals eventually go on to develop patchy cardiac fibrosis. These abnormalities are often asymptomatic and probably accrue over many years; and may predispose to serious arrhythmias and/or sudden cardiac death.

Risk Stratification of Endurance Athletes
Currently, we have no proven screening methods for detecting the CV pathology associated with EEE. A logical strategy for now would deploy post-competition cardiac biomarkers, echocardiography and/or advanced imaging such as CMR to identify individuals at risk for and with subclinical adverse structural remodeling and the substrate for arrhythmias.61 For any individual who is considering EEE efforts such as marathons or day long aerobic races for any other activity that elevates cardiac output for a sustained period of time (continuously over several hours), it may be reasonable to obtain a maximal treadmill exercise test to screen for ischemia and/or exercise induced arrhythmias24 and Heart CT for CAC scoring, particularly for those who are over age 50 and who have been chronically training for and competing in EEE events. Aortic pulse wave velocity could give an inference into the development of vascular stiffness that may not be readily appreciated by cuff blood pressure measurement.

Avoiding Exercise-Induced CV Damage
Suggestions for an exercise routine that will optimize heath, fitness and longevity without causing adverse cardiovascular structural and electrical remodeling:

Avoid a daily routine of exhaustive strenuous exercise training for periods greater than one hour continuously. An ideal target might be not more than seven hours weekly of cumulative strenuous endurance ET.1,2,9,51

When doing exhaustive aerobic ET, take intermittent rest periods (even for a few minutes at an easier pace, such slowing down to walk in the middle of a run). This allows the cardiac output normalize temporarily, providing a ‘cardiac rest period’ when the chamber dimensions, blood pressure and pulse come down closer to baseline resting parameters before resuming strenuous exercise again.2

Accumulate a large amount of daily light-to-moderate physical activity, such as walking, gardening, housekeeping, etc. Avoid prolonged sitting. Walk intermittently throughout the day. Look for opportunities to take the stairs. 1, 2 Buy a pedometer and gradually try to build up to 10,000 steps per day.

Once or twice weekly, perform high-intensity interval exercise training to improve or maintain peak aerobic fitness. This is more effective in improving overall fitness and peak aerobic capacity than is continuous aerobic exercise training, despite a much shorter total accumulated exercise time spent doing the interval workout.65, 66

Incorporate cross training using stretching, for example, yoga, and strength training into the weekly exercise routine. This confers multi-faceted fitness and reduces the burden of cardiac work compared to a routine of daily long-distance endurance exercise training. 1, 2

Avoid chronically competing in very long distance races, such as marathons, ultra-marathons, Iron-man distance triathlons, 100-mile bicycle races, etc., especially after age 45 or 50.

Individuals over 45 or 50 years of age should reduce the intensity and durations of endurance exercise training sessions, and allow more recovery time.


Jackie

Great contribution, Jackie. I especially appreciate the specific tips at the end of the article. The article supports what you and many others have already been saying.

Hope you are feeling well today!

Ken