Detraining working well

Hi All,
I am marking my 2.5 year anniversary with AFIB. I would like to share my, so far, success with detraining. As I pointed out in my previous post [Link], my path to AFIB was chronic exercise, which I now realize was my addiction. As I posted before, I tried a myriad of supplements looking for the magic bullet. What I now found out is that for me, detraining and time have greatly lowered my afib burden. As a reference, I had 49 AFIBs the first year (started out with almost nightly episodes), seven the second, and ONE four-minute episode in the first six months of the third year. I am still taking 500 mg magnesium and making sure I get enough potassium by bolstering my diet with coconut water. But I am 100% convinced that detraining was what brought my afib burden down. I walk at least an hour every day and lift weights but make sure my heart rate does not go above 70% of max. My only episode in the last six months was when I went on a strenuous hike with my older son; my heart rate went way above 70% for at least 20 minutes maybe more. I still struggle with not overdoing it.

It seems there is some evidence that detraining can 'clear up' afib.
[Cardiology]

“If they (athletic patients) have clinically important symptoms, many times we’ll decondition them. Often their symptoms will improve, and, in some instances, the A-fib will actually clear up and we don’t even need to go to any medical therapy,” Dr. Estes said. His exercise prescription for deconditioning such patients is “basically nothing more than a moderate jog, a 10-minute mile. They should be able to carry on a conversation, with a peak heart rate no more than 60% of their maximum.”

Thanks to all for keeping this a great afib resource.

Great news, Mike! Thanks for posting the update!!

Always good to hear a success in AF. Congrats.

This is an aspect of the athletic heart syndrome that has gone understudied and underappreciated, according to Dr. Estes, who asserted, “The best available evidence suggests that exercise, if excessive, is probably harmful. I know that’s heresy.”

There is a lot of stuff under that term.athletic heart syndrome. Search around with it, and see what else we can come up with.
[www.google.com]
[www.youtube.com]

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Todd
“The best available evidence suggests that exercise, if excessive, is probably harmful. I know that’s heresy.”

Excessive training has been talked about here for a long time. The question I've asked myself has been, "how much is too much?" In my case, the exercise trigger is the product of duration times intensity. Hence I can do short duration high intensity (like Tabatas) periodically without issue. I can also do long duration, but lower intensity. Long duration, high intensity is a trigger for me. I've had a subjective sense of how much is too much since I started detraining about 14 years ago. When I started coaching my afibber son-in-law, I tried to quantify what was appropriate, from my experience, so he would have a guide. I posted about this here. For longer duration exercise, what I came up with was Zone 2, MAF heart rate (180-age) and always nasal breathing (all have links in my linked post). These are qualitatively about the same - which is basically pure aerobic from a metabolic perspective. Dr. Phil Maffetone came to the "if excessive, is probably harmful" conclusion in the early 70's and then developed his MAF approach. I'm not saying this will work for all, but it has worked well for me and is now working very well for my son-in-law. Certainly, in my & my son-in-law's cases, detraining is only part of an approach, though a material one.

I'd like it to be that simple, but for me, it's not.

Am I an outlier, or are people who reduce their afib burden to ~0 from detraining not on this forum? Of course my afib could start up again, but compared to where I was 2.5 years ago, I really don't think so.

I've also seen articles saying things like afib went away completely after addressing, e.g., sleep apnea, obesity, binge drinking, thyroid issues, etc. But I haven't seen any such posts here, although I have not done a thorough search.

Just curious...

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MikeN
Am I an outlier, or are people who reduce their afib burden to ~0 from detraining not on this forum? Of course my afib could start up again, but compared to where I was 2.5 years ago, I really don't think so.

I think you may be an outlier where detraining is the sole strategy used with the results you've had. The board's founder, Hans Larsen, published this on endurance exercise in 2008. This report was also posted in the Conference Room, which also has posts from members following the report. In this report Hans writes, "Does Detraining Help Prevent AF?
Does refraining from heavy exercise actually work for lone afibbers? Says the late Professor Philippe Coumel, “It is known that in well-trained people suffering from vagal AF, the first step of therapy should be deconditioning by discontinuing high-level training. It may be sufficient to bring about an improvement in the patient and it is often a necessary adjuvant to facilitate pharmacological therapy. [21]. Coumel, P. Atrial fibrillation: one more sporting inconvenience? European Heart Journal, Vol. 23, No. 6, March 2002, pp. 431-33 {worth reading IMO} " also "British researchers support Dr. Coumel’s observation about the beneficial effects of detraining. They report the case of a 53-year-old athlete whose symptoms of palpitations, ectopics, and atrial tachycardia completely resolved after detraining.[22] Spanish researchers report that detraining for 2-4 weeks results in an increase in heart rate and adrenergic tone – both changes beneficial in regards to vagally-induced afib.[23] "

I've encouraged afibbers who show up here who are heavy exercisers to detrain. Generally, many have a difficult time following through with this. In my case, the product of duration times intensity is an acute trigger.

In Hans' book Lone Atrial Fibrillation Towards a Cure he states on p 154 of my original edition,

"Medical researchers at the University of Barcelona have found that men who engage in vigorous physical exercise for many years have an increased risk of developing lone (vagal) atrial fibrillation. A review of the records of 1160 patients seen at an outpatient arrhythmia clinic revealed that the incidence of lone AF among long-term exercisers was 60% as compared to only 15% in the general population of Catalonia[163].

Most vagal type afibbers are heavy exercisers. This raises the tantalizing possibility that they might actually be able to reduce their number of episodes by cutting back on the exercise. A recent study carried out in Spain found that “detraining”, i.e. cessation or reduction in exercise resulted in profound changes. Blood volume decreased, heart rate increased, and adrenergic tone increased after 2 to 4 weeks without training[164].

One of the members of our group has actually observed that giving up on exercise one week out of every four significantly reduced his frequency of episodes. Of course, abruptly stopping all exercise carries with it a whole new set of problems so a gradual approach is definitely in order. Might be worth experimenting with if you are a vagal afibber."

My burden has been very low for 15.5 years, though not zero. Detraining, though not no training, is a significant part of my strategy (partially thanks to Hans writing about The Exercise Connection in his book, one of the first resources I purchased), though not the sole element. Electrolytes are also very material for me. This has also been true for my son-in-law, as I noted and linked in my post above. I've actually been fortunate I can maintain significant fitness if I follow the limits I suggested for my son-in-law in my linked post.



Edited 2 time(s). Last edit at 05/29/2020 02:46PM by GeorgeN.

It's always the tide.

I'm a cyclist and, 5 years ago, I was riding 6000 to 7000 km/year. Not that much, but maybe too much for me.
I've begin detraining because of my afib. From 2016 to 2019, I only rode 800 to 1000 km/year, barely averaging 20 km/h (25 before, still a quiet rhythm nevertheless).
No effect on my afib.
I take lots of notes, and the only thing I see is I have "quiet" months (2-3 afib episodes, never exceeding 2 hours, few ectopics), and "chaotic" months (6-10 episodes, same length, more ectopics than average).
I don't know why, but I'm sure it's not exercise related.

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In my case, the product of duration times intensity is an acute trigger.

George, how much time after this excess would you likely see afib coming back? Soon after or later, while resting or sleeping?

Pompon & GeorgeN,

I am curious, how high does your heart rate get during exercise?

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Pompon
In my case, the product of duration times intensity is an acute trigger.

George, how much time after this excess would you likely see afib coming back? Soon after or later, while resting or sleeping?

Depends on the "excess effort." My first afib episode was in 2004. I was training for a 13.3 mile run that gained 7800' elevation and topped out at 14,100'. The training run was on another 14'er and it was maybe a two day delay. I woke up in afib in the morning two days after the run. When I would do that run (took me a while to come to the conclusion it was not appropriate for me do participate in these runs), my resting heart rate would stay elevated above my normal resting rate for several days (stress??). Then it would dip below my normal resting rate. This was a risk period for me.

With more "normal excess effort," the delay could be much shorter. About six months after I converted my 2.5 month episode in 2004, I led a snow caving outing for Scouts. I broke trail in 3' snow with a heavy pack, then constructed a 3 person snow cave. Afib came at about 11pm in my sleeping bag in the cave. In 2014, I was skiing on a powder day. I typically ski the steeps off piste. This day, I decided to add hiking for more elevation to each lap. I skied for 6 or 7 hours. After I got home, ate and sat down after cleaning up the kitchen, afib came on.

Any more, I'm pretty good about not exceeding my subjective limits I've linked here.

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MikeN
Pompon & GeorgeN,

I am curious, how high does your heart rate get during exercise?

I can do short HIIT (say 4 minute Tabata) without issue. I'm 65 in a couple weeks and can run it up to 160 or more. For exercise of longer duration, I follow the Zone 2, MAF, nasal breathing I've linked here. For MAF, it is 180 - age or 115. I pretty much know what this is without wearing a monitor. Nasal breathing gets me to about the same place a monitor would. I subjectively figured this out at the beginning of my afib remission journey years ago and then looked around to quantify it when I started coaching my afibber son-in-law. The link is what I've suggested for him and I follow for myself.

More recently, I've been using KAATSU blood flow moderation bands. These will allow you to get a strong metabolic response with light weights. Also will give even moderate MAF/nasal breathing cardio a strong metabolic response without negative afib repercussions (at least for me).



Edited 1 time(s). Last edit at 05/30/2020 10:02PM by GeorgeN.

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MikeN
Pompon & GeorgeN,

I am curious, how high does your heart rate get during exercise?

I've stopped monitoring my HR while exercising a long time ago. I clearly feel where I am and, as I'm not chasing performance, I don't mind reaching limits.
As George said, when I'm not able to carry on with nasal breathing, It's a warning.
I'm 62 and last time I went high (160 BPM) was at the peak of my stress test, in march. I clearly said to my cardiologist "I don't go that high any more while riding my bicycle".
I can go around 110-120 with nasal breathing. It's enough for me. I suspect that the longer I stay above 100, the more likely I'll get afib in the night.
It's not a rule. It's a guess.
Riding my bicycle during two hours without a break, alone, even carefully, is likely worse than riding it one hour with my wife, my sister and my stepbrother, having a stop to chat while drinking a monk beer, then riding another hour back home.
And I agree with George about the fact that going high for a short time has no effect.
BTW, I never had afib after any of my stress tests (and I've had a few)...

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Pompon
I can go around 110-120 with nasal breathing. It's enough for me. I suspect that the longer I stay above 100, the more likely I'll get afib in the night.
It's not a rule. It's a guess.
Riding my bicycle during two hours without a break, alone, even carefully, is likely worse than riding it one hour with my wife, my sister and my stepbrother, having a stop to chat while drinking a monk beer, then riding another hour back home.

Much of my activity for the last many years has had an intermittent component. Alpine skiing and rock climbing, for example. Long duration, sustained activity, for example, a hike, has been done at relatively low heart rates, lower than the MAF rate. I don't join my friends who will do century bike rides, or my friend who will skin up and ski down at the beginning of a ski day. More recently, based on the Zone 2 work of Iñigo San Millán, I've been doing 20-40 minutes of cardio, but at the MAF heart rate. When I do this, I do not feel tired at all after the session. My friend, Dr. Mark Cucuzzella, was the one that originally told me about training at a MAF heart rate. Mark has been training this way for 20 years. He says he always wants to come back from a run feeling better than when he started - not wiped out. Mark has run 30 marathons under 3 hours. But his inflammation and stress from exercise remain very low. When I suggested this approach for my son-in-law, my daughter started using it, too. She told me she was amazed at how good she felt. She'd go out for a long run and not come back wiped out. I know every afibber is different, but I think this is at least a place to start for an afibber whose path to afib was excessive exercise.

GeorgeN and PomPon,

Thanks for the info, your inputs are very helpful. The MAF rate for me is 75% of max which is close to my current threshold of 70% of max. So far this rate is working for me.

Thanks, George. I'll try to stick to the MAF method (and to use my HR monitor too).

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MikeN
GeorgeN and PomPon,

Thanks for the info, your inputs are very helpful. The MAF rate for me is 75% of max which is close to my current threshold of 70% of max. So far this rate is working for me.

For my 34 year old son in law, the rate would be 146. That seems to be working for him, too.

I read one of Maffetone's (MAF) books (his website). He makes a big point about training the body to use fat for fuel. This is because his HR zone is pure aerobic. In 2017, Mark Cucuzzella wrote a blog post that included results from a lab VO2 max test that year at age 50. If you scroll down a little more than half way, you'll see the results of the second (2017) test. In it, Mark's max HR was 178. His AT or anaerobic threshold was 170 and AeT (Aerobic threshold or crossover from fat to glucose) was 160 BPM. What is remarkable is how close these rates are together. They also calculated Mark was metabolising 1.9 g/minute of fat If you don't have a point of reference, this is extremely high. It would be very unusual for a typical carb burner to metabolize more than 1.0 g fat/min. Fat metabolism is actually much "cleaner" than glucose, so not as hard on your system (in terms of reactive oxygen species generation). Mark says he feels like he is "loafing" when he trains. While not an afibber, I think his message of not injuring yourself is spot on for those of us who are.

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Dr. Mark Cucuzzella
If you finish a training run and you don’t feel you can do it again, you are probably running too fast

Here is a podcast where Mark describes his approach.

My daughter & son-in-law are both military officers. Not in combat arms, but they still are required to maintain fitness. My daughter is slightly "Type A" and always wants to max her fitness test and usually for the male standard. My (21 BMI) daughter said some of her times were improving, even though she'd only been doing this (MAF/nose breathing) for a few months. With the lockdown she and her husband organized a "virtual" half marathon for their units. After a 12 mile training run, she commented on how good she felt compared to how she would typically feel. Also the difference in how she fuels now for a long run, with modest carbs, but not as restrictive as keto. However, she now tests positive for material serum ketones on a fasting test. My (20.7 BMI) son-in-law is doing these runs, too without negative afib consequences. I probably would not be doing this much volume in his circumstance.

Personally, I do a lot of body weight, suspension (TRX), balance and light weight training with the KAATSU bands on. I rarely break a sweat. A few times a month, I'll throw in a Tabata session on the Schwinn Airdyne fan bike. During the lockdown, the KAATSU people started offering a Zoom class every weekday. It lasts about an hour & is all bodyweight. Periodically (maybe 6x per class), the instructor has a "heart rate boost" exercise for 90 seconds with 3 different 30 second exercises. I do them, but don't push them. I add in a few MAF cardio sessions a week for 20-40 minutes on the Schwinn, a fan rower or a Nordic Track skier. I'm in good enough shape that I can hike up the steep approaches to the climbing crag with a heavy pack on, always nasal breathing. My climbing partners who do tons of long duration cardio (mostly biking) are typically having to breathe with their mouths open after a bit. For me, this approach allows me to maintain reasonable fitness to do all the activities I like to do, however I don't trigger my afib. I'm now in the camp that thinks something like this may be an approach to optimize for health span.