Exercising with a Heart Rhythm Disorder
This weeks blog is from Mary Ward and Eyes-Free Fitness list member.
I have been blind all my life. I was part of the crop of premature babies with what is now called retinopathy of prematurity (ROP), and which used to be called retrolental fibroplasia (RLF). I grew up at a time when physical education for blind people was spotty at best. My recollections of physical education consist mainly of feelings of pain, such as being hit with a volleyball or basketball. I felt shame because I knew that my movements were somehow different from those of other children my age, and I was both afraid to move around and unwilling to try, mostly for fear of being laughed at. I have even extended my fear of being laughed at to dancing in front of others, an activity which brings joy to so many of my family and friends. So as an adult, I did not wreap the benefits of a healthy body image or a good, sound exercise program. Exercise was associated with pain, humiliation and shame. I wanted no part of it.
But as a young adult, I began to enjoy walking, and I often walked to help me work out my problems and figure things out. In middle age, my husband bought me a stationary bicycle, and I would cycle for over an hour while listening to my favorite music. Finally, I came across Eyes-Free Fitness, and I gradually introduced myself to exercise routines that I could follow after a small amount of practice. I began working out at the gym, first using cardio equipment, and then starting to work on the circuit. I thought I was on the way to a happier, healthier life. I knew I might have a heart condition, but it hadn’t been diagnosed yet, so I could just go about my daily life and pretend it wasn’t there.
But then I wound up in the heart hospital, hooked to all kinds of monitors, having my veins filled with who knew what frightening concoctions. Right after the first EKG, the doctor pronounced the two words I had been dreading, words I had heard in my nightmares, “atrial fibrillation.”
Atrial fibrillation is the most common type of heart rhythm difficulty, especially in people over 55. It is different from a heart attack and it has many different causes. But it can be made worse by obesity, stress, poor eating habits, insufficient sleep, and lack of exercise. My atrial fibrillation is mostly caused by heredity. Atrial fibrillation can be managed with various medications, and if these fail to work, there are more invasive procedures that can be done.
In atrial fibrillation, the top part of the heart sends bad electrical signals to the bottom part, which pumps the blood to the rest of the body. Instead of a strong, steady rhythm, the heart shakes, seizes up, and flaps around, causing the blood to pool instead of flowing freely throughout the body. And everyone knows what happens to blood when it pools: it clots. This is why atrial fibrillation is dangerous. It can lead to stroke, heart attack, or blood clots in other parts of the body, especially the lungs.
So what was I going to do about my new-found interest in exercise? Was I just doomed to fail? I began reading and asking people: my doctors, the physical trainer at my gym, and ordinary people who exercise. What I learned was encouraging.
According to my cardiologist, exercise is very unlikely to trigger an attack of atrial fibrillation. This means that it should be safe to exercise. Both cardio and strength training are helpful in giving the heart some reinforcement so it can do its job normally without the over-work of atrial fibrillation. However, some patients also experience some backwards flow from our heart valves. This can cause us to have more severe shortness of breath and ankle swelling than other people might experience. Therefore, we have to take this into account when exercising.
Everyone from the doctor to the trainer at the gym told me to forget about the numbers for maximum and optimum heart rate. Both atrial fibrillation and the medications used to control it have an impact on heart rate, whether at rest or during exercise. The best way for someone with atrial fibrillation to judge the effectiveness of cardio exercise is that it feels like the right level. Perception of effort, not numbers from a formula, is the best way to gauge the proper level of exercise. If you are working fairly hard but can carry on a relatively normal conversation, you are doing cardio. If the exercise feels more intense, perhaps during strength training, then the intensity is more than aerobic.
I have decided that I would continue with both cardio and strength training. I feel at this point that doing many reps of a smaller weight may meet my needs better than doing just a few with a heavier weight. I have also decided that gasping loudly for breath does not need to be part of my fitness routine.
Finally, I am going to use the new Apple Watch Series 4 to track my atrial fibrillation. I do not think I have had any fluttering since starting the new medications, but the Apple Watch will help me determine this. It will also give me a good idea of what my heart is doing when I exercise, even though I don’t really need these numbers.
My new diagnosis is bringing me along my journey away from self-condemnation and self-blame, helping me move toward a happier, healthier relationship with my body. I am having to give myself permission to get out of breath while climbing the stairs. I have permission to not reach a certain speed on the treadmill. If I eat too much salty food, I can accept what the consequences will be the next morning without a lot of negative self-talk. If I give in and have a sugary drink, I can bypass the sugary drink tomorrow, and the next day, and the next. I am feeling concerned but hopeful.