Exercising with AFib

Dear Friend,

as so many of my blogs this one too was inspired by the work with one of my current clients. He has experienced an increasing number of episodes of AFib during and outside of our training meetings. Rather than going into the details of his situation I would rather address the general issue of exercising when suffering from AFib.

Atrial Fibrillation (AFib) or paroxysmal atrial fibrillation (PAF) are characterized as irregular and often rapid heartbeats that cause a reduced blood flow to the body. Atrial fibrillation effects the upper two chambers of the heart where the blood is pooled that is returning from the body's periphery and moved on into the two lower chambers called ventricles, that pump blood back into the body's circulation. When you experience AFib the Atriums are beating out of sync with the Ventricles causing heart palpitations, weakness and shortness of breath.

The causes of Afib aren't exactly known and understood but we do know that hypertension, heart failure, coronary artery disease and pulmonary disease are major contributors in the development of this condition. A natural cause of AFib can be the hearts age. An aging heart does not respond the same way as a young heart and that can lead to PAF.

Frequent episodes of AFib can significantly increase ones risk of stroke and heart failure. Due to the chaotic atrial contractions blood remains longer in these chambers increasing the chance of blood clotting also known as thrombosis. As these clots start moving through the body they can cause blockage of blood vessels supporting vital organs (i.e. brain) with oxygen resulting in a stroke. Heart failure is caused by the increased work load on the ventricles, which have to work much harder when trying to keep up with irate and rapid atrial contractions and cause the heart over years to wear out.

AFib is most commonly found in people over the age of 65 and as our senior population grows, so does the number of people dealing on an ongoing basis with AFib. Initially AFib may occur infrequently, but over time most commonly episodes appear more and more often and in some cases becoming a permanent state. Patients are commonly treated with medications that regulate the frequency of heart beats and anti-coagulants (blood thinners) to reduce the risk of thrombosis.

Just like any other heart condition or cardio-vascular disease AFib too benefits from exercising regularly as long as the training intensity meets the state the client is in. Mild to moderate intensities when participating in aerobic activities and weight lifting can help with body weight control, enhance mental outlook, help prevent other health problems and maintain strength and mobility necessary to perform activities of daily living.

• If you are suffering from AFib, please have your Cardiologist determine your maximum heart rate while exercising and after cool down. I personally like the use of heart rate monitors when training clients with AFib as it provides constant work-out intensity feedback.

• Be aware and recognize symptoms of AFib. If your work-out causes chest pain, extreme shortage of breath or extreme exhaustion stop immediately and reconsult with your doctor.

• If you are a novice to fitness training make sure you ease in to it gradually starting with 15-20 minutes sessions rather than going straight for a full hour. As Atrial fibrillation is intermittent adjust your work-out intensity and duration in accordance with the situation at time of training.

• If you are dealing with other problems i.e. ischemic heart disease, chronic heart failure or valvular heart disease the exercise considerations of these diseases take precedence over those for AFib.

Regular exercising  can be beneficial for individuals living with AFib as it positively effects the contributing factors to heart disease and improves the overall quality of live. The key to maximizing the benefits of exercising is to follow a well designed and supervised program that the individual can follow long term.

Hopefully this article is helping you to understand better the risks and benefits of exercising with AFib. Should you have any questions or comments please let me know.

A Sante,
Hartmut

Sources: www.WebMD.com, www.livestrong.com, Medscape, Mayo Clinic, American College of Sports Medicine.

Chest Pain: Indigestion or Angina?

In today's blog I would like to share a recent experience I  had with one of my clients, hoping that sharing this story with you and elaborating on it will help you recognize the symptoms of coronary artery disease and prevent heart attack and possible death for yourself and others.

I recently started working with a new client, a male in his 70's, with a history of an ischemic brain infarct/stroke. At the start of our work-outs he had pretty much fully recovered from the event other than some lingering short term memory problems. His physician recommended a regular work-out regimen to reduce his elevated cholesterol levels, improve his stamina and help with the prevention of future strokes.

Three weeks into our relationship my client complained during a work-out session about frequent problems with heart burn or indigestion causing pain behind his sternum. He was experiencing these episodes several times during the day, but they never lasted very long. Lately the same episodes plagued him during our work-outs. When asking him whether he felt any acidic reflux he declined. Alarmed by his prior stroke and his elevated cholesterol levels I urged him and his daughter to schedule a stress test to eliminate the possibility of Angina. His primary care physician prescribed Anti Reflux medication and ordered a stress test ECG (better be safe than sorry). The stress test unfortunately confirmed my concerns. My client was indeed experiencing Angina, a common symptom of coronary artery disease caused by a reduced blood flow to the heart muscle. Angina is fairly common and often described as pressure in the chest or someone standing on the chest, but often mistaken for other health problems just like in this case.

Cardiologists differentiate between three types of Angina that I would like to introduce, and discuss their symptoms and characteristics.

• Stable Angina
• Unstable Angina
• Variant Angina (Prinzmetal's Angina)

The symptoms of all three types can vary and include:

1. Chest pain or discomfort
2. Pain in your arms, neck, jaw, shoulder or back accompanying chest pain
3. Nausea
4. Fatigue
5. Shortness of breath
6. Anxiety
7. Sweating
8. Dizziness

Commonly the perception is that Angina only effects the left arm, left side of jaw or left shoulder. That is a myth I would like to debunk. Both sides of the body can exhibit symptoms.

Stable Angina is the most common form of Angina and typically occurs during periods of elevated physical and/or emotional stress (Exercise, stair climbing, mental stress etc.).
Other Characteristics:
Predictable (patient knows how to and what triggers an event)
Consistent (chest pain is at least similar each time)
Short term (passes usually within 5 minutes or less)
Responds well to rest and Angina medication
Can feel like indigestion
Can spread to arms, back or other areas of the body (see above)

Unstable Angina is considered a medical emergency.
Characteristics:
Occurs even when resting
Change in the pattern of previously experienced Angina
Unpredictable/Unexpected
Long term (often 20 minutes or more)
Might not respond to rest and medication
Could indicate Heart Attack

Variant Angina is a very rare form of Angina accounting for only 2 percent of all Angina cases. This form is caused by a temporary coronary artery spasm reducing blood flow to the heart muscle.
Characteristics:
Occurs often during rest
Can be very severe
Might respond well to Angina medication

Your Cardiologist will order the right tests to diagnose your problem and develop a treatment plan that might include lifestyle changes, medications, medical procedures and surgery if needed.

I hope this information won't cause unnecessary panic or worry, but rather help saving lives. If you or someone else you know, or train, does experience any unexplained chest pains or other aforementioned symptoms please see a health care provider for further testing. If chest pain lasts longer than a few minutes and does not respond to rest and Angina medication don't hesitate to call 911 as it might indicate a heart attack.

In good health,
Hartmut

Source: Mayo Clinic Staff @ MayoClinic.com