What is the best exercise for atrial fibrillation?
First, it is essential to understand atrial fibrillation (AF) ‘s the underlying mechanism to choose an exercise program to improve cardiac health. AF is the most common sustained cardiac arrhythmia and affects 2-3% of the general population, but this number increases to ~35% among adults over 80 years old.
AF can cause significant morbidity due to fatigue, decreased functional capacity, and potentially severe complications such as thromboembolism and heart failure. It may lead to sudden death from ventricular fibrillation or hemodynamic collapse in some cases.
Exercise has been shown to protect against developing AF in those otherwise healthy, so choosing a cardiac-targeted exercise program may help prevent it.
The exact cause of AF is unknown; however, most cases are associated with an underlying heart condition such as hypertension, coronary artery disease, and cardiomyopathy. The most common causes in the general population include:
1) rheumatic fever
2) mitral valve prolapse
3) high-output heart failure
4) presence of a patent foramen ovale (PFO).
AF can also develop due to cardiac arrhythmias such as atrial flutter or paroxysmal supraventricular tachycardia (PSVT). It has also been known to develop after cardiac surgery in some instances. There is no evidence that an exercise-related stimulus can initiate AF, so one of these underlying sources is the only way to acquire it.
The most common symptom associated with AF includes rapid heart rate, particularly at rest or during exertion (i.e., pulses). Other symptoms may include shortness of breath, lightheadedness, fainting spells, and fatigue; however, some people may not experience any noticeable symptoms at all.
When the rhythm is irregular, there will typically be a loss of coordination between contractions of the atria and ventricles, resulting in diminished blood flow throughout the heart—this leads to stagnation of blood in the chambers and enlargement of both the atria and ventricles.
The medical treatment for AF typically involves rate or rhythm control through pharmacological means, including beta-blockers, calcium-channel blockers, digoxin, amiodarone, or electrical cardioversion if drug therapy fails or is contraindicated. Anticoagulants are also typically administered to prevent blood clots that lead to stroke.
Another option includes catheter ablation of the heart’s electrical conduction system by inserting a probe into the heart via the femoral artery; this is usually only an alternative to antiarrhythmic drugs if the symptoms are intolerable without any improvement after three months of treatment with medication.
Exercise interventions for those with AF have their roots in preventing a recurrence of AF after a cardioversion procedure. Early studies in this area suggest that exercise reduces the risk of developing AF by 30% and recurrent AF by 50%. The data was obtained from relatively small clinical trials, but it suggests that exercise training can also be an effective treatment for those who already suffer from AF.
The Exercise Prescription
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Participation in regular exercise may be protective against new-onset or recurrent atrial fibrillation (AF), so regularly including some form of cardiac-specific exercises is recommended. Cardio-respiratory fitness can be improved with aerobic activities such as walking, jogging, cycling, and swimming. However, any activity that elevates the heart rate for 20 minutes or more on most days of the week can be beneficial.
Precautions for Exercise in Individuals with AF
Some individuals may need to avoid exercise entirely if their symptoms are too severe. Still, it is generally safe for those who have had cardioversion treatment and are not taking any antiarrhythmic drugs or using a pacemaker. As always, it’s essential to talk to your doctor before beginning an exercise plan so you know what activity limits you should follow based on your condition.
Due to recent evidence suggesting that intense non-weight-bearing exercises have the potential for destabilizing blood clots, people with AF should probably avoid these types of activities until further research is conducted.
Other precautions include checking pulse periodically during aerobic activity when resting heart rate exceeds 100 beats per minute, suspending exercise if pulse exceeds 120 beats per minute while at rest, or exercising in a supine position for prolonged periods.
Summary AF is a common form of arrhythmia linked to many possible underlying sources, although it typically develops spontaneously and has no apparent cause. Symptoms include a rapid heart rate, particularly at rest or during exertion (i.e., vibrations), shortness of breath, fainting spells, and fatigue; however some people may not experience any noticeable symptoms.
The medical treatment for AF includes rate or rhythm control through pharmacological means, including beta-blockers, calcium-channel blockers, digoxin, amiodarone, or electrical cardioversion if drug therapy fails or is contraindicated.
Anticoagulants are also typically administered to prevent blood clots that lead to stroke. Exercise interventions for those with AF have their roots in preventing a recurrence of AF after a cardioversion procedure.
Participation in regular exercise, particularly aerobic activities, may be protective against new-onset or recurrent AF; however, certain precautions should be considered for individuals with AF (i.e., exercising in the supine position, checking pulse periodically while exercising at high heart rates).