“The relationship between exercise and atrial fibrillation isn’t straightforward,” notes Ayman Hussein, MD, a cardiologist and heart rhythm disorder specialist at the Cleveland Clinic. While most forms of exercise are beneficial to heart health and protective against afib and its symptoms, “exercise is not always protective,” says Dr. Hussein. “Whereas mild- or moderate-intensity exercise is typically protective, intense exercise typically carries a higher risk of atrial fibrillation.” Here’s what you should know about the link between exercise and atrial fibrillation and what exercises are generally considered safe for people with the condition.

How Exercise Affects Atrial Fibrillation

According to the best available information, the relationship between exercise and atrial fibrillation follows what’s known as a J curve, where in a type of J-shaped diagram, the curve initially falls and then rises above the starting point much like the shape of the letter “J.” This means that the more you exercise, the lower your risk of afib — up to a point. But if you exercise more than a certain amount, your risk rises. (3,4) This trend applies primarily to men, according to Hussein. Women appear to have a lower atrial fibrillation risk with more exercise, even at the highest intensity. High-level athletes are 4 to 8 times more likely to develop atrial fibrillation than the general population, according to a 2017 study. (5) Researchers suspect that years of intense exercise performed by lean, healthy athletes may cause changes in the nervous system and even the structure of the heart itself, leading to an increased risk of the condition. (3) A 2018 article notes that while high-level athletes have the highest risk of afib out of any group based on activity level, people who engage in regular, time-limited exercise have the lowest risk. (4) Within a real-life group of people with afib, more strenuous exercise doesn’t appear to increase the risk of symptoms or adverse outcomes, according to a 2017 study. (6) In that study, 76 people with atrial fibrillation were assigned to a 12-week exercise regimen performed at either 50 or 80 percent of maximal perceived exertion. Daily electrocardiography showed no significant difference in afib symptoms between the two groups, and no serious adverse events were reported. Both groups showed improved cardiovascular fitness. (6) Still, Hussein says, it’s a good idea for people with atrial fibrillation to not push themselves too hard when they exercise. “We typically ask them to do it in moderation, not to push their limits,” he notes.

Finding the Right Exercise for Your Heart

If you’re not accustomed to regular exercise and you’ve been diagnosed with atrial fibrillation, it’s very important to ease your way into an exercise routine, Hussein emphasizes. People in this situation “need to progressively build strength and endurance,” he says. Eventually, Hussein says, you’ll want to build up to about 30 minutes of physical activity performed at least five days a week, or about 2.5 hours of mild to moderate exercise each week. Regardless of how new you are to exercise, it’s a good idea to keep track of your pulse when you’re exercising, according to Hussein — both at peak activity and while you’re recovering. Your doctor can advise you about the acceptable heart rate range. Here are six types of exercise that may be beneficial if you have atrial fibrillation:

  1. Cardiac Rehab Training with a specialist in a medically monitored setting may be a good way to start exercising if you’ve been hospitalized for your afib, Hussein says. In a 2017 study, researchers concluded that based on six trials involving exercise-based cardiac rehab for people with afib, the programs appeared to improve exercise capacity. (7)
  2. Walking Even though walking might seem like a very low-risk activity, “typically, we ask patients up front, at least, not to do any brisk walking,” says Hussein. If you’re just starting out, Hussein recommends walking 5 to 10 minutes daily at first, then adding a minute or two to your walks every week or so.
  3. Swimming Swimming and other pool-based aerobic exercises can be a good way to work out “but not at a competitive level, from an afib-risk standpoint,” says Hussein. And if you find yourself out of breath or feel like you’re otherwise struggling, it’s important to get out of the pool and sit down for a while, Hussein says.
  4. Bicycling Using a stationary or regular bicycle can be a good form of activity, but make sure to keep the intensity moderate. Stay away from settings that encourage heavy exertion, such as a Spin class.
  5. Physical Chores Physical activity doesn’t have to mean doing exercise separately from your daily tasks. In addition to walking to go on errands, you can count gardening, digging, raking, or hoeing as exercise, as long as it gets your heart rate up. (8)
  6. Yoga In a study from 2013, a 60-minute yoga program done twice a week for three months was found to reduce afib episodes and symptoms, reduce depression and anxiety, and improve heart rate and blood pressure in people with atrial fibrillation. (9) Remember that no matter what activity you’re doing, if you experience any symptoms related to atrial fibrillation — like lightheadedness or chest pain or pressure — you should stop and rest for a while, says Hussein. And if you have more serious symptoms like intense chest pain, visit a hospital emergency room. In most cases, though, you should be able to accomplish moderate exercise without any risk of causing or aggravating your symptoms. “Aerobic activity is good,” says Hussein, but “don’t push your limits.”