Beyond medication: Using diet and exercise to improve your AF burden

Matthew Thompson and Alice Fawke 

Atrial fibrillation (AF) management typically involves a medical procedure in the form of a cardioversion or ablation, or pharmacological interventions that prevent blood clots and control heart rate and rhythm.

It is commonly believed that non-clinical interventions, such as diet and exercise, will only help AF sufferers indirectly by reducing the overall strain on your heart and by reducing other cardiovascular risk factors like blood clots and strokes.

In fact, good nutrition and structured exercise can improve both the electrical conductivity and structural health of your heart via better control of your autonomic nervous system (the heart’s brake and accelerator pedals) and improved heart muscle quality (less inflammation, fat, fibrosis and stretch). These benefits can be evidenced using ECG’s and Echocardiogram tests, however, also more conveniently by a lower heart rate and better cardiovascular fitness (stronger, more efficient heart muscle).  We specialise in cardiac rehabilitation, helping many people living with AF to improve their quality of life by inspiring them to enjoy a prescribed exercise, nutrition and lifestyle model. After a 12-week CP+R programme, on average, individuals achieve a 10% increase in predicted VO₂max (cardiovascular fitness), which is equivalent to a 13% decrease in the risk of AF recurrence, independent of weight loss.

The below shows a CP+R athlete’s heart rate when performing the same walking exercise before and after 9 weeks of a programme. Controlling heart rate is an important part of treating AF medically and exercise can be used to encourage good control if done using simple principles.

16^th April 2017: Image shows poor heart rate control and a large amount of variability despite the same exercise intensity.

29^th April 2017: Image shows that after two weeks heart rate is less erratic and has better control and efficiency

1^st June 2017: Image shows excellent heart rate control and efficiency. Heart rate and rhythm is very consistent and responsive to exercise intensity.

As well as improving AF directly, quality nutrition and exercise also vastly improves related cardiovascular disease risk factors such as blood pressure, body fat and psychological health. After 12 weeks of a supervised CP+R nutrition and exercise programme, on average AF sufferers reduce their blood pressure by 9% (systolic) and 6% (diastolic), body fat by 9%, waist circumference by 4%, confidence and exercise confidence by more than 15%. Their anxiety and depression scores reduce by 14%.

7 ways you can help yourself after your AF diagnosis

1: Perform 30-60 minutes of moderate intensity exercise on most days of the week

• Aim for an intensity that you can do for 30 minutes whilst maintaining a proper conversation. Vigorous intensity exercise and exercise with sudden bursts can increase risk for AF sufferers if unsupervised.

2: When exercising, gradually increase the intensity and your heart rate

• Incorporate a 10-15 minute warm up at the start of exercise. For shorter, less intense walks, 10-minutes will suffice, if you’re going for longer or at a higher intensity, aim for 15 minutes.

3: Don’t come to a sudden stop after exercising

• Incorporate a 10 minute cooldown period at the end of exercise, gradually return your body to a resting state. This will help your recovery and help remove any circulating adrenaline and minimise your risks of AF.

4: Reduce your intake of things that affect your heart rate and blood pressure

• Salt: avoid table salt, ready meals, processed meats, canned soups
• Alcohol: aim for guidelines of <14 units per week, however, even less is better
• Caffeine: switch to decaff or from coffee to herbal tea

5: Manage your weight (and body fat) by eating regular meals comprising:

• 2 handfuls of vegetables (as many different colours as possible)
• 1 palm size of protein (oily fish, chicken, eggs)
• 1 fist of complex carbohydrates (whole wheat rice, sweet potato, beans/legumes)
• 1 thumb of good fats (olive oil, avocado)

6: Try to manage your stress and anxiety levels

• Take just 20 minutes away from your desk each day to walk outside without looking at your phone

7: Perform some muscular strengthening exercises twice per week

• Perform everyday movements such as squats, pulls and pushes in a controlled manner focussing on technique and breathing. Use no weights or light weights unless supervised by a specialist with experience in cardiac conditions

If you’re more committed, you might want to seek the help of a clinical exercise specialist to perform a supervised routine incorporating prescribed resistance and cardiovascular exercise, nutritional monitoring and guidance and daily activity targets. CP+R is partnered with the London AF centre and specialises in the advice, support and education of those living with AF.