Rethinking Exercise Advice for Atrial Fibrillation: The Importance of Cardio-Respiratory Fitness

If you have atrial fibrillation (AFib) and are looking for exercise advice, you have probably come across the recommendation to aim for 150 minutes of moderate-intensity aerobic exercise per week. However, this advice may not be the most effective way to improve your cardio-respiratory fitness, and consequently, your AFib management. In this blog post, we will discuss why this advice may not be the best for AFib patients and explore alternative training approaches that can lead to better outcomes.

The Problem with 150 Minutes of Moderate-Intensity Exercise

When it comes to cardio-respiratory fitness, athletes, and coaches typically follow time-tested training methods that differ from the general guidelines. For those with atrial fibrillation, the recommendation of 150 minutes of moderate-intensity exercise per week might not be the best approach. In fact, two studies (linked below) have shown that better cardio-respiratory fitness can improve the chances of successful ablation and lower the risk of all-cause mortality after ablation.

For example, the ACTIVE-AF Randomized Controlled Trial compared the standard 150-minute recommendation with a group that participated in supervised high-intensity interval training and home-based lower-intensity training, totaling up to 3.5 hours of exercise per week. The group that combined high-intensity workouts with lower-intensity training had significantly better outcomes for AFib management.

Real Training Plans for Cardio-Respiratory Fitness

To understand the best approach for AFib patients, let's examine the two main training philosophies used by athletes to improve cardio-respiratory fitness: 80/20 and base building.

80/20 Endurance Training

The 80/20 training principle states that 80% of training should be performed at low intensity, while the remaining 20% should be at moderate to high intensity. This approach has been proven effective for athletes of nearly all fitness levels and closely resembles the protocol used in the ACTIVE-AF trial.

An example program would look like this

80% Low Intensity:

  • 4x easy runs per week, maintaining a conversational pace
  • 1x longer run at an easy pace, gradually increasing the distance

20% Moderate to High Intensity:

  • 1x weekly interval training session (e.g., 6x 800m with 2-min rest)
  • OR 1x tempo run (e.g., 20-30 minutes at threshold pace)

Cardio Base Building

Base-building programs focus on high-volume, low-intensity exercise to improve aerobic capacity, endurance, and overall fitness. This approach prioritizes easy effort over long periods to build cardio-respiratory fitness in a safe and injury-free manner.

An example base-building program for running may look something like this

  • 5-6x easy runs a week, maintaining a conversational pace
  • Gradually increase weekly mileage by 10% each week
  • 1x weekly long run at an easy pace, gradually increasing the distance
  • Optional: 1-2x weekly recovery runs at an even slower pace

Choosing the Right Approach for AFib Patients

Before deciding on a training plan, consult your doctor to ensure you have medical clearance to exercise. If your doctor approves high-intensity training, you can choose between the 80/20 or base-building approach based on your preferences and available time.

For those with limited exercise time, the 80/20 approach may be more suitable. However, a base-building program can be a great option if you have more time and prefer lower-intensity workouts.

Remember that if you fear triggering your AFib, base-building may be a safer choice until you gain more confidence.

In conclusion, the standard recommendation of 150 minutes of moderate-intensity exercise per week may not be the most effective approach for managing AFib. By exploring alternative training methods, such as 80/20 endurance training or base-building programs, you can improve your cardio-respiratory fitness and potentially achieve better outcomes in your AFib management.

See my recent video on this very topic!