Atrial Fibrillation, Exercise & Health

Hunter Bennett

One of the biggest issues we modern society has to deal with is a decline in cardiovascular health and function. To be honest, it is seriously at near epidemic proportions.

Within this, the biggest culprit is unquestionably general cardiovascular disease. However, there are several lesser-known cardiovascular issues that are becoming increasingly common – one of which is atrial fibrillation.

What is atrial fibrillation?

Atrial fibrillation (or AFib for short), is a common type of arrhythmia – which is simply the term we use to describe when your heart beats in an irregular manner (Amin, 2016).

You see, your heart relies heavily on a consistent rhythm that comes from an electrical pattern within its own chambers. However, in people suffering from arterial fibrillation, this electrical pattern doesn’t occur in the same organized way as everyone else.

As a result, the heart’s upper chambers (known as the atria) don’t contract in a normal rhythmic manner, but rather quiver (or fibrillate).

It is this physical mechanism that the words ‘atrial fibrillation’ is derived.

While not life-threatening on its own, the presence of Afib does suggest that your heart won’t pump blood around your body as effectively as it should – which can cause some issues.

Moreover, it is important to note that some people suffering from Afib may only ever have a single episode of atrial fibrillation, whereas for others it can come and go sporadically (also known as paroxysmal atrial fibrillation), or even be a permanent occurrence.

What are the causes of atrial fibrillation?

Although some people may develop atrial fibrillation without any apparent rhyme or reason, there is some evidence to suggest that it can also be caused by certain cardiovascular dysfunctions. These include:

Chronic high blood pressure
Long term coronary artery disease (also known as blocked arteries)
Physical abnormalities within the valves of the heart.

Interestingly, there is also some evidence to suggest that atrial fibrillation can be caused by a hyperactive thyroid gland.

Related Article: How HIIT Can Improve Cardiovascular Function

What are the symptoms of atrial fibrillation?

As I am sure you can imagine, atrial fibrillation is not without its side effects. In fact, it has several known symptoms that can become quite apparent if you know what to look for. These Afib symptoms include:

The sensation of a ‘fluttering’ heartbeat
An irregular pulse
General feelings of fatigue and weakness
Chest pains
Fainting spells
Being unexplainable tired and lethargic
Dizziness

Given the increasing commonality of Afib, if you find yourself experiencing any of these symptoms on a regular basis, then we strongly recommend you get yourself checked out by a health professional.

Does atrial fibrillation have any triggers?

Amazingly, many of those individuals who suffer from atrial fibrillation periodically (paroxysmal atrial fibrillation) may experience episodes brought on by a trigger. Some of the more common Afib triggers can include:

Caffeine
Alcohol
Fatigue and illness
A heightened emotional state (such as anger, sadness, or grief)
Extremely high-intensity exercise
Certain medications
Dehydration

With this in mind, being able to recognize your triggers to better manage (and even avoid) the onset of fibrillation can have a huge impact on your ability to manage Afib effectively.

Who is at risk for atrial fibrillation?

Over time research has established that there are certain individuals who are at a much higher risk of developing atrial fibrillation than the rest of the population. These individuals tend to have a combination of unchangeable physical factors, and changeable lifestyle factors, that predispose them to the issue.

Afib factors include:

Advanced age
High blood pressure
Underlying heart disease
Excessive alcohol consumption
A family history of atrial fibrillation
Suffers from sleep apnea
Is a high-level athlete

Typically, individuals who have one or more of these factors will be at a higher risk of the abnormality.

Exercise and atrial fibrillation

When it comes to exercise and Afib, things start to get a little interesting.

You see, it is well established that exercise has the potential to cause vast improvements in most cardiovascular risk factors.

In fact, there is even some evidence to suggest that implementing lower intensity aerobic exercise in sedentary individuals who suffer from Afib can markedly reduce their symptoms and improve their quality of life (Drca, 2014).

However, at the extreme end of this spectrum, we see a different story entirely.

High-level endurance athletes who participate in an extremely high volume of exercise are thought to be up to seven times more likely to develop Afib than someone from the general population (Molina, 2008).

Seven times.

So, what in the world does this all mean?

Well, to simplify it as much as possible, it ultimately confirms what we kind of already knows – that too much of a good thing is rarely a good thing.

Most high-level endurance athletes push their body to the absolute limit week in week out. Their cardiovascular system is under a degree of stress that most normal people would not experience within their lifetime.

Over time, the accumulation of this stress can then result in the development of atrial fibrillation.

However, if exercise is maintained at a tolerable level (within the physical activity guidelines) and adequate recovery is ensured between sessions, it ultimately does the opposite.

In this manner, it improves the health and function of the cardiovascular system, which can have a preventative effect against atrial fibrillations.

Endurance exercise and atrial fibrillation

For a very long time, professionals were hesitant to suggest exercise as a potential treatment for Afib given that high-level athletes were at a greater risk of developing the disease – however, this is no longer the case.

There has been recent evidence clearly demonstrating that the introduction of low-intensity endurance exercise in accordance to the American college of sport medicine (ACSM) physical activity guidelines can reduce fibrillation frequency and intensity.

In one key study, individuals started with a mere 20 minutes of low-intensity physical activity three times per week and gradually progressed to a minimum of 200 minutes of moderate intensity activity per week (Pathak, 2015).

Amazingly, this occurred over a total duration of around 4 years (I know, huge study).

At the end of the study, those individuals who saw the most improvement in cardiovascular fitness saw the greatest improvement in their Afib symptoms – which is pretty cool if you ask me!

HIIT and Atrial Fibrillation

So, what about HIIT and Afib?

In a very similar fashion, high-intensity interval training (HIIT) has also been shown to have a seriously positive effect.

A recent study demonstrated that performing three HIIT sessions per week for as little as four weeks in total duration can cause improvement in cardiovascular health and function while reducing Afib symptoms and burden (Malmo, 2016).

In this study, I should note that they used longer intervals (4 minutes at ~90% max) with a slightly shorter rest period (3 minutes at ~70% max), which is known to elicit more aerobic responses than short HIIT intervals.

These are obviously a great option for those who have very high-intensity exercise as one of their Afib triggers.

Does atrial fibrillation impact exercise tolerance?

In conjunction with the above, there is some older research out there that indicates that individuals suffering from Afib tend to have a lower tolerance for exercise than their healthier counterparts (Lee, 2005).

And to be honest, this makes quite a bit of sense.

Those with Afib are likely to be more cautious about participating in an exercise, as they do not want to cause any severe abnormalities. As a result, their fitness declines, and they actually lower their ability to tolerate exercise as a result.

As simple as it sounds, this may be mitigated by ensuring that if you suffer from atrial fibrillation, you ensure that exercise is part of your weekly routine. In doing so, you will improve fitness, reduce symptoms, and improve exercise capacity.

Like I said – simple.

Related Article: Do Genes Dictate Your Health?

What are the best exercises for atrial fibrillation?

Looking at all the above information, it should become pretty apparent that both low-intensity aerobic exercise and HIIT should hold a place in the management of atrial fibrillation.

With this in mind, the goal should be to achieve the ACSM guidelines for physical activity, which state (ACSM, 2018):

You should do at least 150 minutes to 300 minutes per week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity – or an equivalent combination both.

However, where you commence your training journey is entirely based on you as an individual.

If you have not done a whole lot of exercise in the past, then it would be in your best interest to start your individual exercise journey with some low-intensity aerobic activity. Additionally, think walking, jogging, cycling, or swimming, for extended periods of time (30-60 minutes) a few times per week.

As your tolerance for exercise begins to improve (and you feel fitter), then you can start introducing some HIIT sessions into your weekly routine.

Remember, this needs to be a part of your daily life – so progress slowly and find something that you enjoy.

Take Home Message

In conclusion, atrial fibrillation is one of the more common cardiovascular abnormalities to plague modern society. Typified by an irregular heartbeat, it can increase your risk of experiencing cardiovascular complications, while also coming with some associated side effects.

However, it is not all doom and gloom.

There is a growing body of research demonstrating that exercise has the capacity to improve upon symptoms and reduce the severity of your Afib – which can only be a good thing!

References

Amin, Anish, et al. “The current approach of atrial fibrillation management.” Avicenna journal of medicine 6.1 (2016): 8.

Drca, Nikola, et al. “Atrial fibrillation is associated with different levels of physical activity levels at different ages in men.” Heart 100.13 (2014): 1037-1042.

Molina, Lluis, et al. “Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study.” Europace 10.5 (2008): 618-623.

Pathak, Rajeev K., et al. “Impact of CARDIOrespiratory FITness on arrhythmia recurrence in obese individuals with atrial fibrillation. The CARDIO-FIT study.”. Journal of the American College of Cardiology 66.9 (2015): 985-996.

Malmo, Vegard, et al. “Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial.”. Circulation 133.5 (2016): 466-473.

Lee, Sang Hak, et al. “Exercise intolerance in patients with atrial fibrillation: clinical and echocardiographic determinants of exercise capacity.”. Journal of the American Society of Echocardiography 18.12 (2005): 1349-1354.

American college of Sports Medicine (ACSM) physical activity guidelines, Executive Summary (2018). From: https://health.gov/paguidelines/second-edition/pdf/PAG_ExecutiveSummary.pdf

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