Arterial Fibrillation and Exercise
Before going into the details of the effect exercise has on the condition Arterial Fibrillation it is important to have a basic understanding of what AF is.
What is Arterial Fibrillation?
Arterial Fibrillation is an irregular heart beat.
It can be caused by a faulty heart valve, Thyroid disease, high blood pressure, heart failure and heart disease but in some cases there is no defined cause and this is called lone arterial fibrillation.
When a heart beats normally the walls of the heart contract (squeeze together) and force blood around the body. The heart then relaxes allowing it to fill up with blood ready to repeat the process.
In AF the atria, the upper chambers of the heart contract irregularly and sometimes so fast that the heart muscle cannot relax properly between contractions causing the hearts efficiency to be reduced.
Types of Arterial Fibrillation
The condition can present itself in different forms
Paroxysmal atrial fibrillation – this comes and goes and usually stops within 48 hours without any treatment.
Persistent atrial fibrillation – this lasts for longer than seven days (or less when it is treated).
Long standing persistent atrial fibrillation – this usually lasts for longer than a year.
Permanent atrial fibrillation – this is present all the time and there are no more attempts to restore normal heart rhythm.
Symptoms and Complications
Symptoms include tiredness, dizziness, breathlessness, nausea and chest pain. Some people have no symptoms and that is why it is being suggested in the UK that everyone who visits their doctor should have their pulse tested because there is 2-5 times more likely hood of a stroke (depending on existing conditions such as high blood pressure, diabetes and heart disease) in people with this condition.
Because the atria is not pumping blood efficiently blood clots can form and if they drop down into the lower chambers (ventricles) they can be pumped into the blood supply. These clots can then block the arteries to the brain causing a stroke.
The first thing is to lower the heart beat and correct the rhythm and this is done by drugs such as beta blockers and anti arrhythmic drugs. Blood thinners are also part of the treatment such as aspirin and warfarin to help prevent the formation of blood clots. Surgery is an option in severe cases.
Exercise and Arterial Fibrillation
It was found in a study that began in 1982 that long term vigorous exercise may cause arterial fibrillation.
16,921 healthy men answered questionnaires that included questions on vigorous exercise, which was defined as exercise that makes the exerciser “break a sweat.”
During a follow up 1661 men developed AF.
The analysis showed that compared with participants who participated in no vigorous exercise, vigorous exercise 5 to 7 days per week increased the odds of atrial fibrillation by 20 percent.
It occurred in men under 50 years of age and strangely in regular joggers. The risk of AF increased by 74% in men who participated in various vigorous exercise and 53 percent in joggers.
The researches pointed out that this was an observational study and did not prove that vigorous exercise was a direct cause, however the link was strong and further study could prove the case.
In 1998 an article in the British Medical Journal told of a similar study and conclusion. The study was carrier out in Helsinki, Finland and found the same surprising outcome. Researches at the Central Military Hospital and the University of Helsinki found that men who engage in long term vigorous exercise have a five times greater risk of developing lone atrial fibrillation than do less active men. The researches studied 300 top rank orienteers against a control group of 495 healthy less active men. All were aged between 35-59 years of age.
As expected the orienteers had a lower overall mortality than the control group. (1.7 percent to 8.5 percent respectively) and fewer cases of heart disease (2.7 percent against 7.5 percent)
Nevertheless lone arterial fibrillation was diagnosed in 12 out of 228 orienteers (the youngest being just 52 years old) and only 2 out of 212 men in the control group. However it was later found that the two men in the control group had also participated in vigorous exercise.
The researches speculate that arterial enlargement and vagal (nerve) tone found in the heart of endurance athletes may predispose them to AF.
The conclusion of the study was that although long term vigorous exercise protects against premature death and heart disease it does increase the risk for arterial fibrillation.
If This Is The Case Is Exercise Good For You After All?
Without doubt exercise is beneficial. The lower incidence of heart disease and premature death in the orienteers proves this. Plus it helps prevent other disease and conditions such as high blood pressure, diabetes, high cholesterol and obesity that all contribute to heart disease.
However it may be more beneficial to mix the intensity of workouts instead of trying to achieve a high intensity at every training session. If competitive sport is not your aim then moderate exercise may be a more sensible approach.
Can You Exercise With Arterial Fibrillation?
According the American College of Sports Medicine there is no reason why you should not exercise with AF. The key to maximizing the benefits of exercise is to follow a well-designed program that you can stick to over the long-term.
This is their recommendations:
1) Talk with your cardiologist about integrating regular exercise into your treatment plan. If you are able, it can be very helpful to join a local hospital-based cardiac rehabilitation programme.
2) Take all medications as recommended by your physician.
3) The goals of your programme should be to improve your fitness and ability to perform activities of daily living, increase muscle strength and endurance, improve range of motion, and reduce your risk of injury.
4) Choose activities that involve large muscles groups and can be done continuously. If your fitness level is low, start with shorter sessions (10 to 15 minutes) and gradually build up to 30 to 45 minutes, three or more days per week.
5) Perform low-resistance, high-repetition strength-training exercises (heavy weights are not advised) three days per week and whole-body range of motion exercises three to five days per week.
6) Take frequent breaks during activity if needed. Your workouts should be comfortable and not strained.
1) If you also have ischemic heart disease, chronic heart failure or valvular heart disease, the exercise programming considerations for these conditions should take precedence over those for atrial fibrillation.
2) Atrial fibrillation can be intermittent, which means your heart rhythm may be normal one day and irregular the next. It is a good idea to adjust how hard and how long you exercise based on how you feel and be aware that some days you may feel more fatigued and have a lower tolerance for exercise.
3) Stop exercising immediately and contact your physician if you experience chest pain, labored breathing or extreme fatigue.
Your exercise program should be designed to maximize the benefits with the fewest risks of aggravating your health or physical condition. Consider contacting a certified health and fitness professional* who can work with you and your health care provider to establish realistic goals and design a safe and effective program that addresses your specific needs.
Sources: ACSM’s Guidelines for Exercise Testing and Prescription and other ACSM publications.