Running with Afib

I am a runner and also love indoor cycling/spin classes. My new EP told me I should not perform exercise that gets my HR over 100bpm for any extended period of time. I'm a vagal paroxysmal afibber. She said I should try and keep my HR at 100bpm or below while exercising (suggests brisk walking) with occasional rounds of 60 seconds pushes to increase the HR.

Exercise has never brought on an AF episode for me, and it's was keeps me sane! In fact it is the opposite. I was meditating the other morning and had an episode.

Anyway, I am not sure the science or logic behind this advise but wanted to see if anyone else out there has any advice or insight on keeping the HR at 100bpm or below during exercise. Or if it is OK to get it above that with AF. I usually don't get my HR up more than 125 when exercising as it is, however, I just don't want to do any further damage to my heart either.

My other EP was fine with me running and said it was good for me and I could even continue to do half marathons! Any insight is much appreciated.

I came to afib via chronic fitness over 16 years ago. I figured out an afib remission plan that includes electrolytes and detraining. This is what I suggested for my 34 year old afibber son-in-law, which comes from my experience:
[www.afibbers.org]

Here is another thread on the topic you might find interesting: [www.afibbers.org]

I don't know about the 100 BPM limit. The MAF limit I reference in my first link is 180-age. The Zone 2 limit referenced basically keeps you below your lactate threshold. The simple answer I use is to always breathe through my nose. I'm now 65. I can still alpine ski hard 7-8 hours without a break on the steeps off piste - breathing through my nose at 13,000' (but joining my friend who likes to skin up and ski down is not on for me). I can rock climb all day at 8,000'. But I don't do chronic endurance activities beyond my subjective limit. My trigger is the product of time and exertion. I can do a long time at relatively low exerciton or high exertion for a short time (i.e. HIIT, Tabatas).

My son-in-law got serious about following my suggestions last Dec (2019). He's only had two episodes since. He was having many before (he's now had afib for about 5 years).

Everybody is different, but I think the stress of doing long duration, high exertion activity is an issue for afibbers who have this chronic fitness history.

Are you asking about exercise while in NSR and you have had AFIB occasionally, or actually running while in AFIB?
Your doctors answer makes more sense in your were actually in AFIB. I wouldn't worry if it was below 120, While someone is in AFIB, a fast HR makes filling the ventricles with blood hard to do. Atrial kick, or Atrial pumping is lost, so it takes longer for the ventricles to fill up. If your Heart is going fast over around 100-120, then when the Heart beats, it pushes out blood from a partially filled ventricle chamber. There is probably variation from person to person, and I have exercised considerably during AFIB, and I notice start to lose cardiovascular output roughly at around 100-110. I try to stay between 80-110 while exercising with AFIB.

Is that EP aware that there are people out there who have been in longstanding persistent AF for years and who also run marathons, triathlons, etc. and suffer absolutely no ill effects?

That's the strangest advice I've ever heard come from an EP. Exercise that keeps your HR under 100 can hardly be called exercise for someone who's physically fit and doesn't even approach anything that could be called chronic endurance sports. Personally, I would ignore the new EP's advice and stick with the old one. I'm extremely skeptical that the new EP can cite any credible reasoning behind that advice.

If I drag my hose across my grass yard my hr jumps from low 60s to one teens. Is that consider exercise? Thus I have yet to return to using my treadmill because I can’t image how high my hr would jump with real exercise.

Moving is exercise, but a brief, single event that happens only occasionally doesn't do much for you.

One thing you should consider is that your heart's response to exercise is a very good measure of cardiovascular fitness. For example, I use a hill near where I live as a fitness measure. I know that if I bike up that hill at 10 mph, my HR will hit 140 if I'm seriously deconditioned and 120 if my conditioning is in top shape. Unless you have other issues, a HR in the 110-120 range is perfectly safe and good for you, but you would need to maintain it for at least 20-30 minutes 4-5 times per week to get any real benefit. Get back on the treadmill. It should be perfectly safe for you to get your HR up into the 150s.

Before my first ablation, I had afib for 11 years with well over 200 recorded episodes. Full blown exercise when not in afib was never an issue with heart rates getting very high, and that included a half marathon. However, if in afib, I couldn't do much of anything that elevated my heart rate. A couple of flights of stairs and I was huffing and puffing. So, if in afib, I did not do any exercise or if doing exercise, I would stop. Exercise was never a trigger, except maybe 2 or 3 times out of hundreds of episodes, so more coincidence than trigger.

It is funny - I just went for a walk after having 2 AF episodes in the last month. In between them I did my fastest walking ever. I was born with other stuff... and cardiac exercise is part of my cardiac plan. One of the EPs said.. it can trigger AF but he'd never tell anyone to not exercise (probably that would be different if it always triggered it) . When I was IN afib this last month I asked one of my docs if I could go for a walk to try and get out of it.. he said no dice. So I wonder if that is what your doc was talking about. I gotta start bookmarking these topics because this is one of the questions I have for docs when I meet with them next.

I think that's specific advice for you and your unique situation. It's good that you're following that advice, but the following is for everyone else:

There are people out there who can terminate their AF with exercise. I could never terminate my AF with exercise but I could terminate my flutter with it. I did so regularly by jogging up and down stairs, walking briskly up steep hills, etc. It didn't always work but it often did.

For uncomplicated AF (formerly known as "lone AF"), there is no exercise restriction whether in AF at the time or not. I think some people view their AF as a disability that makes them fragile even if they've had it terminated with ablation. But they're mistaken and doing themselves no favor by avoiding exercise. Exercise is not a risk for them. There are plenty of people out there running marathons, swimming, playing basketball, etc. while in AF. Unless you've been told to avoid it (as Betty has), go for whatever you can handle. You will live longer because of it.

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Carey
Moving is exercise, but a brief, single event that happens only occasionally doesn't do much for you.

One thing you should consider is that your heart's response to exercise is a very good measure of cardiovascular fitness. For example, I use a hill near where I live as a fitness measure. I know that if I bike up that hill at 10 mph, my HR will hit 140 if I'm seriously deconditioned and 120 if my conditioning is in top shape. Unless you have other issues, a HR in the 110-120 range is perfectly safe and good for you, but you would need to maintain it for at least 20-30 minutes 4-5 times per week to get any real benefit. Get back on the treadmill. It should be perfectly safe for you to get your HR up into the 150s.

I couldn’t run if forced. My treadmill is at 1 since I am not conditioned. The limit high is a medium walk 2.2. If higher I get dizzy. Losing my balance on the machine dizzy. During cardiology treadmill tests they can’t get my hr up past 110 (someone helping me from falling) and had to discontinue... yet now with recovering I can get my hr up to one teens by dragging a hose ten feet...stopping and watering for five minutes and repeat another ten minutes.

So is my heart response to dragging for ten seconds considered a good measure of cardio fitness? I doubt it. I can lift a gallon bottle of water and raise my hr as well.

Over the years I have never had an EP tell me I should limit my heart rate to any specific number. Other than in more recent years when I was in persistent afib. They wanted to keep it below 120 using metoprolol to achieve this.

As has been mentioned. Keeping your rate below 100bpm is going to be near impossible if you are going to exercise in the current way you described. Spin classes for one can be demanding. And running is also most likely going to push your rate above 100bpm unless your in some incredible shape.

If one has leaking valves, some cardiologists want the HR to remain lower at resting- as well as least 3 separate cardiologists I’ve seen for for small vessel disease and leaking valves.
Beauty of this site. Everyone is different and thus advise from cardiologists differ according to the variety of each diagnosis



Edited 1 time(s). Last edit at 10/18/2020 10:56PM by susan.d.

I'm able to exercice while in afib, but it doesn't get me back to NSR. I'm very symptomatic, so I really dislike exercice while in afib. It's frightening for me, but I know I'm not really disabled, physically. Maybe very slightly, but I don't know for sure. It's mental.
Before my PVI, I was strongly disabled while in afib. And when I was taking meds (BB or/and AA), I was disabled all the time.

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bettylou4488
It is funny - I just went for a walk after having 2 AF episodes in the last month. In between them I did my fastest walking ever. I was born with other stuff... and cardiac exercise is part of my cardiac plan. One of the EPs said.. it can trigger AF but he'd never tell anyone to not exercise (probably that would be different if it always triggered it) . When I was IN afib this last month I asked one of my docs if I could go for a walk to try and get out of it.. he said no dice. So I wonder if that is what your doc was talking about. I gotta start bookmarking these topics because this is one of the questions I have for docs when I meet with them next.

Before my ablation (10 months no afib since), I used moderate cardiac training to get myself out of afib. I was going into afib maybe once every few months. Getting my heart into a quick (call it 150s) beating pattern (I was 46 years old at the time) would often kick it into NSR. My very experienced EP had no problem at all with this as long as I hadn't been in afib longer than 18 hours. That's my experience.

Run.

I did it plenty of times in full-blown AF. It’s harmless. That’s very strange advice from an EP.

To clarify, is this requirement imposed by the EP to limit to 100 bpm to apply only when you are IN AFIB. Or is it to apply to a person who has been diagnosed with paroxysmal Afib even when in NSR?

I am in NSR most of the time and I do sprints up stairs and get my heart rate as high as the beta blocker will allow and if anything it only seems to be doing me good? And I was advised I could exercise as hard as I liked. Or is that the wrong advice?

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And I was advised I could exercise as hard as I liked. Or is that the wrong advice?

No, that was not wrong advice. There is no general contraindication for exercise, even intense exercise, just because you have afib.

This notion that afib is debilitating or renders you an invalid, and especially the notion that exercise is dangerous for you needs to be squashed right now. If you don't have other problems your doctor has told you that limits your exercise, and your afib doesn't cause you to faint, then there's no reason why you can't do any exercise you choose. It's probably better if you don't engage in hard-core endurance sports, but everything else is on the table. Just go by your own personal limitations.

I'm with Carey and Wolfpack on this. Seems like really strange advice. I too spin, lift weights and do lots of other exercise daily. Like you, it is regular, solid workouts which keep me going.

I was diagnosed with AFIB just a couple months ago when undergoing a pre-surgical EKG in preparation for knee replacement surgery. I was pretty shocked since I'm 67, have undergone a lifetime of strenuous workouts and physical activity with never had a hint of AFIB. So, I asked my Cardiologist if I could continue working out and he said "absolutely yes". Never a qualification on beats per minute. Never really any qualification at all.

I'm not a physician and have zero knowledge about this. Still, I question it.



Edited 1 time(s). Last edit at 10/26/2020 05:45PM by the_next_michael_jordan.

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the_next_michael_jordan
I was pretty shocked since I'm 67, have undergone a lifetime of strenuous workouts and physical activity with never had a hint of AFIB. So, I asked my Cardiologist if I could continue working out and he said "absolutely yes". Never a qualification on beats per minute. Never really any qualification at all.

I'm not a physician and have zero knowledge about this. Still, I question it.

Drs Peter Attia & James O'Keefe (a preventative cardiologist) discuss exercise & arrhythmia in this podcast (at about 21:15) One of the quotes was that excessive endurance exercise could increase the risk of afib by a factor of 7x.

From this paper on the topic [www.ncbi.nlm.nih.gov]


From the section on arrhythmias in the paper. "Similar to many other health outcomes, moderate doses of physical activity are effective in preventing AF, whereas both low and high volumes of exercise are associated with increased risk of AF. As compared to more fit subjects, those with < 6 METs exercise capacity showed elevated incident rates of AF, and after adjustment each 1 MET gain in fitness was associated with a 7% lower risk of incident AF (hazard ratio 0.93, 95% confidence interval 0.92–0.94, P<0.001).24 In regards to weekly dose of physical activity, even small doses of exercise, such beginning with 5 MET-hours/ week appear to reduce risk of AF, with maximal benefits seen at 20 MET-hours/week (Figure 2).25 Above 55 MET-hours/week, which is approximates to 10 hours of vigorous exercise/week, the risk of developing AF begins to exceed that of the sedentary cohort, displaying a J-curve relationship.25"

This Harvard study [www.nejm.org] showed that the people who exercised the most lost 38% of the longevity benefit compared to those who exercised more moderately

I can say, from personal experience, that the product of intensity and duration, above a limit, are a trigger for me. I'm sure this limit is individual. For me, HIIT (short duration high intensity) is OK. Long duration high intensity is a trigger. Long duration moderate intensity is OK. I attempted to quantify these limits in the advice I gave my afibber son-in-law, linked above.

We've been discussing this for years (I've been on this forum for over 16 years), and many endurance athletes show up not understanding why exercise might be part of their problem.

{edit} also this "Sinus node disease and arrhythmias in the longterm follow-up of former professional cyclists" [watermark.silverchair.com]



Edited 1 time(s). Last edit at 10/27/2020 04:58PM by GeorgeN.

One issue not clearly defined above is exercising while IN afib, or exercising with afib, but not while IN an episode. Strenuous exercise when not in an episode seems to be fine to do.

Any exercise when I was in an episode was totally unrealistic. O2 debt big time if doing any moderate exercise. However, normal daily activity was not impacted in any way when in afib, but exercise was not an option.

So, what to EPs say about exercising while IN an episode of afib?

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Ken
So, what to EPs say about exercising while IN an episode of afib?

If you can tolerate it and you don't have other conditions that preclude it, there's no reason not to. As I've pointed out before, there are afibbers out there running marathons, competing in triathlons, professional basketball players, professional cyclists, and so on.

https://www.everydayhealth.com/atrial-fibrillation/living-with/world-class-athletes-with-atrial-fibrillation/

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Carey

If you can tolerate it and you don't have other conditions that preclude it, there's no reason not to. As I've pointed out before, there are afibbers out there running marathons, competing in triathlons, professional basketball players, professional cyclists, and so on.

[www.everydayhealth.com]

Except for Bird and West, it seems that competing while having an afib episode is not common and happened because they didn't know they were in afib. I agree, there are lots of afibbers out there competing in lots of endurance and tough sports, but I doubt that many compete while having an episode. The reduced blood flow has a significant impact on performance.

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Ken
The reduced blood flow has a significant impact on performance.

For some people but not everyone. I know several runners and cyclists who compete during AF. And I once had to pedal home 5 miles in hilly terrain with a heart rate of 250. I was a bit slower, and it sucked doing it, but I was able. Most people are on the floor gasping and thinking they're going to die with a rate like that, but for whatever reason it didn't do that to me. I used to jog up and down stairs to break episodes. But then again I also know people who can barely get off a couch when they're in AF, and some people even faint. So I think how much it limits your athletic abilities is really individual.

In terms of competing or hard exercise during afib, question I ask, "is it optimal?"

During my 2 1/2 month episode 16 years ago, I did everything I'd always done. Later, I decided it was likely suboptimal for me long term and took it easy during episodes. I was concerned it would accelerate fibrosis and remodeling. I also never take a beta blocker with PIP flec. At one point Dr. Mandrola noted he would stay mostly prone after PIP flec to mitigate aflutter risk. I've followed his lead. I can't say I'm correct, but it is the approach I've taken and fortunately episodes don't last long. Not sure what I'd do if I were in permanent afib. I'm happy with a life mostly in afib remission and not sorry with the decisions I've made.

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Carey

The reduced blood flow has a significant impact on performance.

For some people but not everyone. I know several runners and cyclists who compete during AF. And I once had to pedal home 5 miles in hilly terrain with a heart rate of 250. I was a bit slower, and it sucked doing it, but I was able. Most people are on the floor gasping and thinking they're going to die with a rate like that, but for whatever reason it didn't do that to me. I used to jog up and down stairs to break episodes. But then again I also know people who can barely get off a couch when they're in AF, and some people even faint. So I think how much it limits your athletic abilities is really individual.

Somewhere between those two extremities, there are people like me: not really disabled while in afib, but afraid to push their heart to its limits in those conditions.
Even knowing I'd be fine, I'm really anxious with this flip-flopping sensation in my chest and in my throat.

I'm curious as to those that can excercise in afib. With reduced blood flow, lactic acid will surely accumulate faster. At least that has been my experience.

Also, long sustained efforts rarely if ever triggered my afib. It was short efforts and the recovery in-between that would set me off.

I know everyone is different.......🤷‍♂️

I'm nearly always fine while riding my bicycle, problems may appear later, in the following night.
Just 1hr at an avg speed of 20 km/h (it's really not fast, isn't it ?) in the afternoon would likely trigger afib between 1 and 3 AM.
I may ride the whole afternoon with my wife, at a quieter pace (15-18 km/h), chatting and with short stops to take pictures, and I'm sure to have a quiet night.

I always care drinking enough in both cases but, obviously, riding 1hr with my heart beating between 90-120 bpm has bad effects for me. Sustained exercise seems to bring afib while resting.

As you said, everyone is different.

As a side note. And being a huge Van halen fan. A better title for this thread might be "Running With The Devil".

I’ve found a balance of pacing my exercise (mostly resistance training) that does not aggravate my a-flutter. I push to a certain intensity, rest in between sets and let my heart rate come down the do another set. For cardio, I can do very low intensity work on an elliptical or bike.

I could do higher intensity and make it fine through the workout. But, what I find is that it triggers a-flutter episodes for days after. If I don’t push my cardio very much, then I am fine. No episodes.

But, it I do, then I have nagging episodes that will be bothering me through the day for days on end and will disrupt my sleep.

I really want to be able to do more cardio because I feel like I am not really getting any good cardio exercise at all. But, the dilemma is that I sacrifice it because I don’t want any of the flutter episodes that will follow. So, it’s kind of forcing me to treat it like a disability and I hate that