Exercising With Atrial Fibrillation (A-Fib)

Atrial fibrillation

Atrial fibrillation can cause heart flutters

However, for those who play sport or are looking to get fitter and lose some weight, there are more serious health considerations. In recent years we have seen several athletes suffer sudden heart attacks and celebrities suffering strokes – while performing intensive exercise. Is intensive exercise safe for all? The answer appears to be no, and especially so for those who suffer from Atrial Fibrillation or have a history of cardiovascular problems.

Main Symptoms of AF

AF can be present without any symptoms. However, most people are diagnosed after one of the following symptoms persists for a while:

  • Lethargy
  • Rapid and irregular heart beat
  • Shortness of breath
  • Dizzyness and Faintness
  • Anxiety
  • Confusion
  • Sweating
  • Chest pains

Atrial Fibrillation can be classified into 3 main types which are based on the duration of the condition / symptoms.

  • Paroxysmal fibrillation is an acute form of the condition where a person will have isolated incidents that rectify themselves. Often people will report a few episodes a year.
  • Persistent AF is when an irregular rhythm continues for 48 hours or more and requires medication to return the heart rhythm to normal.
  • Permanent AF is the most severe case and cannot be treated with any form of medication. The condition is chronic and must be managed through healthy lifestyle and careful monitoring by the patient. Avoiding situations that make the problem worse, such as stressful circumstances, is important.

Several things can trigger AF in those who suffer from paroxysmal fibrillation. Typical triggers include:

  • Alcohol
  • Caffeine
  • Being overweight
  • Some medicines
  • Stress and Anxiety
  • Surgery

Sometimes a person can start with paroxysmal fibrillation, but after several years the condition can appear more often and eventually chronic.

Does Exercise Cause AF?

One dilemma is that long-term intensive exercise may actually be a causal factor of A-Fib.

“Long-term vigorous exercise may predispose to atrial fibrillation.” – Mont et al (2001)

In his study it was found that athletes tend to be more likely to suffer from atrial fibrillation at a younger age. So, once again, it appears a that too much exercise can be bad for the heart. However, this needs to be weighed up against the increased risk of heart attack, stroke, diabetes and cancer caused by not exercising at all.

Stroke Risk

A major risk when suffering from AF is increased risk of stroke, and this may be increased further if you do intensive exercise. In 2012 UK television presenter Andrew Marr had a stroke after he  “gave it everything I had“. While regular exercise is important in preventing strokes, intensive exercise by people with certain medical conditions including AF, high blood pressure, obesity, stress.

The NHS reiterate that the best form of exercise is the slow, steady exercise such as cycling, jogging and walking briskly as this improves cardiovascular fitness, aids weight loss and minimises risk of injury or developing severe medical conditions (strokes, heart attacks etc.).

How Much Exercise is Safe?

Dr. Gerche (2007) suggested that raised the point that too much exercise may be detrimental to health in those who suffer from arrhythmic complications.

“Case reports and circumstantial evidence raise the possibility that more extreme exercise may have some detrimental effects. In effect, exercise may have a typical dose–response curve with a plateau or even toxicity at more extreme levels” Gerche (2007).

The graph below shows a predicted decline in the health benefits of exercise in those who have arrhythmic complications.

Gerche 2007 Ideal amount of exercise

Graph of the amount of habitual exercise against cardiovascular outcomes. Black line represents observed outcomes and the dashed line represents a possible reduction in health benefit due to arrhythmic complications.

In this short video Dr. Francisco Gonzalez, a cardiologist from University of Texas, provides the following advice on exercise:

Patients should receive the same quality of life if they are in A-fib or not in A-fib. If you have A-fib and you like to exercise or do heavy lifting or different stuff, working in the garden, stuff like that, then your heart rate is typically going to go up, just like anything, just like any time you exert yourself. And that being said, if your heart rate remains up, outside of normal, or it doesn’t come down like it should, then maybe you need to be on other therapy to help slow it down a little, because it will tire your heart out.

That being said, if a patient was a couch potato and didn’t do anything, and your heart rate is in the 70’s and 80’s and you don’t really do anything, and that’s your quality of life, then I think that will be fine. Every patient is different. If you are an active individual and it prevents you from being active, then I would say that you need to have your therapy fine-tuned a little bit.

The NHS (2010) publication states that the increased risk of AF  “seems to be confined to serious athletes who train most days of the week for decades.”

So in short, exercising a few days a week to a moderate intensity does not appear to pose any major long term risks.

Dr. Bill Sukala says that when it comes to exercise and AF the only advice on type of exercise is “it depends“. As AF does not tend to be an isolated condition, each person should be prescribed exercise individually. For example, somebody with Persistent AF may be safe to do some intensive exercise, such as circuit training or martial arts. However, if they also have high blood pressure then it may be wise to prescribe more gentle exercise, such as swimming, jogging or cycling.

“To follow some random exercise program off the internet could leave you face down and unconscious on the pavement while taking your afternoon walk!” Dr. Bill Sukala (2011).

That is pretty sound advice – if you have a medical condition (or conditions) always check with your doctor before starting a new exercise program. As new research is always being carried out, there may be new findings and warnings which are not known to the general fitness forums.

Exercise Tips

Start slow with 5-10 minutes of walking a day. Build this up over a course of a month or two until you are comfortable doing 30 minutes of exercise a day, 5 days a week.

While exercising check your pulse and slow down if it starts to reach dangerous levels. Also when exercising look out for symptoms – if you feel faint, appear to be sweating more than normal, are more breathless, then you may be having an episode and may need to rest and recover.

Set yourself exercise goals that you can work towards. This really applies to everybody who exercises. Aim to get fitter and stronger – exercise for longer and at a greater intensity – without over-exerting yourself.

You should be extra careful when weight training. Use resistance machines or a squat rack / cage, or have a good spotter. Also, do not lift a weight that is so heavy that you need to growl and grunt to lift it – this puts a lot of pressure on your  blood vessels and heart, putting yourself at greater risk.

Also remember to stay well hydrated. Too little water and your blood will thicken, which increases risk of stroke.

How To Improve Exercise Tolerance

Research by Torbjörn Lundström (1990) from Department of Cardiology, Central Hospital, Skövde, Sweden found that patients with chronic atrial fibrillation have modestly improved exercise tolerance with calcium channel blockade therapy.

Also, Lipkin (1988) found that the restoration of sinus rhythm (regular heart beat) was associated with a delayed improvement in exercise capacity that may in part be due to a slow improvement in atrial contractility and peak cardiac output after cardioversion.

References and Further Reading

What are the Symptoms of Atrial Fibrillation (AFib or AF)? – American Heart Association, Mar 22,2013.

Long-lasting sport practice and lone atrial fibrillation by Lont et alEuropean Heart Journal Volume 23, Issue 6Pp. 477-482.


Is exercise to blame for Andrew Marr’s stroke? NHS Choices, April 15 2013

Exercise – Is it Possible to Have Too Much of a Good Thing? by Andre La Gerche, MBBS, , David L. Prior, FRACP, PhD. Heart, Lung and Circulation. Volume 16, Supplement 3, 2007, Pages S102–S104

Ventricular control and exercise performance in chronic atrial fibrillation: Effects of diltiazem verapamil by Torbjörn Lundström and Lars Rydén. Journal of the American College of Cardiology. Volume 16, Issue 1, July 1990, Pages 86–90

Delayed improvement in exercise capacity after cardioversion of atrial fibrillation to sinus rhythm. By Lipkin et al. British Heart Journal 1988; Volume 59, Issue 5 > Article

The athlete’s heart,AF and exercise:Good, bad ortherapy?  (pdf) Dr Andreas Wolff. NHS 2010.

Tips for Safe Exercise With Atrial Fibrillation (AF or A-Fib) by Bill Sukala,PhD, May 31, 2011

Exercise and Atrial Fibrillation by R. Morgan Griffin. WebMD Feature. August 02, 2012.

7 Steps to Reduce Stroke Risk by Bill Gottlieb, Mens Health.

Heart image by JHeuser.

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