Exercise and AF

“I think exercise is a trigger for my AF. I used to exercise frequently but I’’m worried if I do it again, I’ll make things worse.”

There are 2 things to consider here:

Point 1. can exercise trigger AF?

Point 2. does exercise make AF worse?

Point 1

This question more commonly comes from people who have ‘paroxysmal’ (intermittent episodes rather than continuous) AF.

Sometimes this concern arises because patients say they have previously had an AF episode that came on during exercise. This can put them off doing any further exercise until the AF is treated, especially if they have a prolonged AF episode.

This is an area where we have studies we can analyse and some evidence to look at. It was not strong enough to lead to any official Guidelines or hard recommendations about physical activity and exercise but some points we can take.

So far, three randomised controlled trials (the highest quality of research study in which a group of randomly allocated participants are compared to others receiving a different treatment) have studied effects of exercise in patients. These studies included both patients with paroxysmal or persistent AF.

They divided patients into two groups: either to continue their normal activity (or a light exercise regimen) versus following a recommended exercise programme. So trying to measure the effect of doing exercise whilst trying to control for other variable factors by allocating people randomly.

One study used aerobic fitness exercises whereas the other two used high intensity interval training.

Headlines:

🫀 All three studies found that the exercise groups had a greater improvement in their exercise capacity compared to usual care.

🫀 There were no AF-related adverse events related to the exercise.

🫀 One of the studies suggested that in patients with paroxysmal AF. those who did high intensity exercise had a greater reduction in the number of AF episodes they experienced than the group who did lighter exercise.

I’ve put the 3 studies at the bottom if you want to read them in more detail but its very important to remember that everyone’s AF experience is different and so just because you hear of AF triggering exercise in someone else, doesn’t mean it will happen to you. AF is an umbrella term for the pattern we see on the ECG- but we know some people are more sensitive to adrenaline trigge.rs (stress, exercise, infection) whereas others are triggered by ‘vagal’ triggers (sleep, big meals). Sometimes its neither and there is no clear trigger.

So that’s why its important to try and keep a symptom diary so you and your medical team can try and identify any patterns and personalise the treatment strategy for you.

1. Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O et al (2016) Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial. Circulation 133:466–473
   
2. Skielboe AK, Bandholm TQ, Hakmann S, Mourier M, Kallemose T, Dixen U (2017) Cardiovascular exercise and burden of arrhythmia in patients with atrial fibrillation—a randomized controlled trial. PLoS One 12:e0170060
   
3. Risom SS, Zwisler AD, Rasmussen TB, Sibilitz KL, Madsen TL, Svendsen JH et al (2016) Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation: Results of the randomized CopenHeartRFA trial. Am Heart J 181:120–129

Point 2

The relationship between exercise and mortality (the risk of death) hasn’t been studied in this ‘randomised’ way, but we do have a large registry in Europe that recorded the exercise levels of patients with AF. This is the EORP-AF registry and again I’ve included a link to a publication about it below. It found that patients who did more exercise had a lower risk of heart attacks and death. Note because this is a registry, we can’t be sure that that the exercise that was the cause of the better outcomes but it suggests that it could be and has led to some interesting trials being proposed- so watch this space!

Proietti M, Boriani G, Laroche C, Diemberger I, Popescu MI, Rasmussen LH et al (2017) Self-reported physical activity and major adverse events in patients with atrial fibrillation: a report from the EURObservational research programme pilot survey on atrial fibrillation (EORP-AF) general registry. Europace 19:535–543

Summary

We know exercise is good for us overall. Putting the AF to one side, the benefits to your overall heart health gets better and the risk of heart attacks, stroke and death significantly reduces. If exercise was a tablet, there is probably no better medicine that could be prescribed.

So it’s important you try and maintain some activity even if you have AF. If you repeatedly get AF triggered by exercise each time, some medicines may be better than others at suppressing this type of AF, so keep your symptom diary and discuss it with your medical team,