It is common and perfectly understandable for anyone with AF to experience a lack of confidence regarding exercise. The good news is that exercising with AF can be perfectly safe. Even those with other underlying cardiac risk factors can still exercise and enjoy the benefits that come with it.
Exercise is incredibly beneficial to the heart muscle and the body in general; however, the thing to remember is that exercise does not have to mean pushing your body to the limit and most importantly exercise must be tailored to you as an individual. Whether you are an active individual with a history of sport and exercise or someone less familiar with physical activity, exercising with AF can increase the efficiency of your heart and therefore improve your symptoms.
The key is to use forms of exercise that do not cause sudden and extreme changes in heart rate. Simply using a gentle walk outdoors, starting slowly and gradually building up the intensity, is a great place to start. Alternatively, you can structure your exercise in the gym environment using a treadmill, or similar piece of CV equipment, using features such as incline (treadmill) and resistance (bike, cross-trainer etc.) to control intensity. 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.
Some key principles to apply when exercising with AF are as follows:
An efficient warm up should last for 10-15 minutes, gradually increasing the intensity and therefore heart rate. It is crucial to avoid sudden changes in intensity when exercising as this will make your heart rate fluctuate, both increasing the pressure placed on your heart and the risk of further arrhythmias. Furthermore, it allows time for the coronary arteries (the arteries that supply oxygen and nutrient rich blood to the heart muscle) to fully dilate (open). The more blood you can supply to the heart prior to exercise the more efficiently it should work whilst exercising at more intense levels.
RPE (Rate of Perceived Exertion)
People with AF may find that their heart rates fluctuate quite dramatically during exercising due to the sporadic electrical activity of the atria (upper chambers of the heart). It can therefore be difficult to track heart rate for the whole session. RPE is a simple scale that is used to monitor intensity, simply 1 – 10. 1 would be the easiest intensity and 10 would be the hardest. Using a benchmark of 6 as an intensity you could perform for 30 minutes whilst holding a conversation, use this to ensure you are getting sufficient oxygen into your system and therefore ensuring the heart is not being put under unnecessary pressure. Use the RPE scale during your warm up to regulate that gradual increase in intensity.
Just as important as a warm up, an efficient cool down should last 10 minutes and allow the heart rate to reduce gently. When we exercise chemicals such as adrenaline and nor-adrenaline are released into our system, acting as a stimulant to affect heart rate. Allowing the body time to naturally ‘flush’ these chemicals away will reduce the risk of further arrhythmia.
Our working muscles act as a pump, pushing blood back up to the heart, reducing the amount of work the heart has to do (known as venous return). If we suddenly stop exercising we remove this mechanism and this puts more pressure on the heart, which can also increase the risk of further arrhythmia.
Lastly, sudden stopping of exercise can also cause a sudden drop in blood pressure as the heart no longer has to meet the demands of exercise. Heart rate can often drop quickly, before your arteries have a chance to constrict (narrow) back to normal and leave you feeling light headed or dizzy.
The key message regarding AF and exercise is that the physiological changes that come with it can have a tremendous benefit to your heart and your confidence. However, it is important to add that before taking part in exercise you should always seek advice from your Cardiologist or Clinical Nurse Specialist to understand any considerations and contraindications. Moreover, seeking the advice of a Clinical Exercise Specialist with experience in cardiac conditions is worthwhile, in order to gain a better understanding of your body and the best training for you as an individual.
Clinical Prevention and Rehabilitation (CP+R) have partnered with London AF Centre, at London Bridge Hospital, and specialise in lifestyle and exercise guidance. The team includes a Clinical Nurse and Clinical Exercise Specialists who can help provide practical advice, support and education for those with AF. For more information or to make an enquiry please visit