Q: "I have an arrhythmia that sometimes causes palpitations when I'm physically active. Is this dangerous? Should I stop exercising?"
Answered by Scott Brancato, M.D., cardiologist/electrophysiologist, Providence St. Vincent Heart Clinic-Heart Rhythm Consultants
Exercise is an important part of a healthy lifestyle, and most people who have heart rhythm disorders – also known as arrhythmias – should not avoid exercise because of their condition. There are only a few, genetic types of arrhythmias for which exercise is discouraged, and those are very rare. For the vast majority of people with arrhythmias – including atrial fibrillation, the most common arrhythmia – exercise is not only acceptable, it's encouraged.
To make sure that exercise is OK for you, the first thing you should do if you haven't already is to see your doctor to confirm that you have an arrhythmia (because not all palpitations are caused by arrhythmias) and to identify what type it is. Wearing a portable heart monitor for a few days or weeks can help confirm your diagnosis by recording what your heart is doing during an arrhythmia.
It also may be helpful to undergo an exercise treadmill stress test, with or without imaging of the heart. A stress test can help determine whether you have an arrhythmia brought on by exercise, or whether you have any significant blockages in the heart arteries. It also can gauge what level of physical activity you are able to tolerate.
Once you've had these tests, work with your doctor to develop a safe exercise plan. If you have a history of other heart problems, your doctor may recommend participating in a cardiac rehabilitation program so you can start your exercise program in a safe and monitored environment. Otherwise, start a little slower, monitor how you feel, and build up your exercise tolerance over time. If exercise is something fairly new to you, start with just five or 10 minutes of walking and gradually increase your time and distance. The current recommendation is to build up to 30 to 45 minutes of aerobic exercise five days a week. Once you get to that level, focus on increasing the intensity of the exercise – again, doing so gradually. If you are walking on a treadmill, for example, start nudging up your speed and incline a bit each week to get your heart rate up a little more.
As long as you increase your activity level gradually, you should be able to push your comfort zone as you become accustomed to more intense exercise. Palpitations, dizziness, lightheadedness and chest pain are signs that you should back off and slow down. Speak to your doctor about these symptoms if they occur. Passing out during exercise is a sign of a dangerous heart rhythm and should always be evaluated by a physician.
As long as you are keeping these symptoms at bay, keep it up. Exercise has been shown in many studies to benefit overall cardiovascular health. It is also proven to reduce heart risks such as high blood pressure, diabetes and obesity. Some arrhythmias, including atrial fibrillation, are associated with these conditions, so it's possible that mitigating these risk factors also will reduce the frequency and duration of arrhythmia episodes. In addition, people who exercise regularly are at lower risk of sudden death from an arrhythmia than people who don't exercise.
If your palpitations continue and are so bothersome that they prevent you from exercising, then the appropriate next step is to look into fixing the problem. Many arrhythmias can be treated or cured with medications, catheter ablation or implanted devices that help regulate the heartbeat, allowing you to resume a normal exercise program and a normal, healthy life.