Before 66-year-old New Jersey resident Ellen Webner had a stroke six years ago — which doctors believe may have been prompted by undiagnosed atrial fibrillation (AFib) — she thought her exercise routine was pretty solid.
"I'd walk on the treadmill a few times a week, but the fact is that I was answering emails at the same time," she tells LIVESTRONG.com. "I had no idea about the importance of getting my heart rate up or changing intensity at all. But that's definitely changed."
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Although she's recovered from the stroke, the AFib has become symptomatic, she says. In many ways, it's also turned into a natural heart rate monitor, because she can tell when to dial back on her workout — yoga and strength training are her favorites now — because her palpitations become too strong for other forms of exercise. That's also an indication she needs to build in more recovery days, she says.
"For me, that stroke was a wake-up call, and knowing I'd have AFib for the rest of my life led me to ask: What can I change and how can I feel more in control?" she says. "[The answer] was nutrition and exercise, with a focus on being more aware of my body and, literally, listening to my heart."
AFib involves an irregular and sometimes rapid heart rhythm (called arrhythmia), and it's estimated that about 12 million people in the U.S. will have AFib within the next decade, according to the Centers for Disease Control and Prevention (CDC).
Although it's not considered life threatening on its own, it can increase risk of stroke, like it did in Webner's case. Treatment usually involves medication to control the heart's rhythm and rate, as well as blood thinners, and lifestyle changes — especially exercise, as long as it's done the right way.
For example, a December 2015 research review in the journal Canadian Family Physician suggests low- and moderate-intensity physical activity can reduce AFib incidence, and AFib symptoms might actually increase with high-intensity exertion.
That doesn't mean never dropping into a HIIT class or always taking a low-intensity approach to all activity. But it does require a thoughtful approach. Here are some expert tips to keep in mind if you have AFib and want to get more active.
1. Work With Your Cardiologist
The most important starting point is to consult with your cardiologist and to ensure that any fitness trainer or physical therapist is in communication with your health team, according to Lalitha McSorley, PT, owner of Brentwood Physiotherapy Clinic in Calgary, Alberta, Canada.
"Collaboration among these professionals is essential because your exercise recommendations should be tailored to your needs, and those needs may change over time," she tells LIVESTRONG.com. "When I work with clients who have AFib, it requires a cautious, individualized approach with a great deal of proper planning and communication."
For example, she says some people may be able to modify the amount of medication they take based on the effectiveness and consistency of their exercise. But of course, that modification needs to be done by your doctor, not on your own, so make sure everyone on your medical and exercise team is updated about your progress. That will help keep your momentum going and improving your fitness, McSorley says.
2. Start Slow
Even if you get the green light from your cardiologist to start a training plan, make sure to ease into activity rather than ramping up your intensity too quickly, according to Jesse Grund, CSCS, owner of Unconventional Strength in Orlando, Florida.
Ideally, it's best to work with a personal trainer or physical therapist who is experienced with AFib, but if you're on your own, understand you can't rev up your heart rate too much at the beginning, Grund says.
"Instead, start with slow doses of work," he says. "Look at your work-to-rest ratios, so there is adequate rest to go with your exercise. That ratio might be 1:3 or 1:5 for higher intensity work. Also, increase the quality of your rest time by taking deep breaths, which will often lower your heart rate faster."
Another tip when starting with a gradual approach is to exercise in an environment where you can get help if needed. Rather than taking a long walk on your own outside on an unpopulated trail, for example, choose a gym where a defibrillator is on site and there are staff members around. Hopefully you won't have to draw on these resources, but knowing they're close can provide a sense of comfort.
3. Wear a Heart Rate Monitor
The best way to track variations in heart rate is with a monitor, preferably a chest strap, Grund says. But even a wristband fitness tracker can give you an indication of when your heart rate is increasing and let you see the effects of your recovery period.
Another option that may be recommended by a cardiologist is a pulse oximeter, which measures oxygen saturation of the blood. For reference, a normal pulse oximeter reading for most people is an oxygen saturation level between 95 percent and 100 percent, according to the Cleveland Clinic.
Pulse oximeters are available over the counter at most drugstores, and this device can be handy if you tend to feel short of breath when working out and you're not sure if it's exercise-related or a concern.
Melissa Egts, who has AFib and also needs supplemental oxygen at home, uses a pulse oximeter when walking or running on her treadmill.
"In my case, I use [the pulse oximeter numbers], but I also stop if I'm just feeling really uncomfortable," she tells LIVESTRONG.com.
It's best to check with your doctor to know what oxygen saturation levels are normal for you and keep them in the loop if you have any concerns.
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4. Know Other AFib Symptoms
Arrhythmia is a major part of AFib but it's not the only indication that the heart is working in an irregular way. Using heart rate is helpful, but also listen to your body for other common symptoms that might indicate AFib is becoming an issue while you exercise.
These symptoms include lightheadedness, anxiety, weakness, extreme fatigue, confusion, shortness of breath and chest tightness or pressure. Your heart may also feel like it's quivering or fluttering even if the beat is steady, according to the American Heart Association (AHA).
Chest pain should get checked out immediately to rule out a heart attack, and if you're experiencing any of the signs of stroke, call 911 right away.
In general, Webner recommends challenging yourself, but still staying very aware of how your body is reacting — and if symptoms come up, act on that information by dialing down or stopping your workout and taking a recovery day.
"You have to see workouts as a long-term effort that strengthens your heart, and the rest of your body, for years to come," she says. "Learning to listen to what your body is telling you goes a long way toward exercising safely."
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