Exercise and lifestyle with atrial fibrillation

The BHF lists palpitations, chest pain, finding it harder to exercise, tiredness, shortness of breath and dizziness or feeling faint. The NHS adds that some people have no symptoms at first and that the pulse feels irregular rather than steady.

The BHF describes paroxysmal AF as one or more episodes in 7 days that usually stop without treatment, persistent AF as lasting more than 7 days and needing treatment, long-standing AF as continuous for a year or more, and permanent AF as ongoing despite treatment. The pattern affects how treatment and exercise advice are tailored.

The NHS advises aiming for at least 150 minutes of moderate exercise a week, and warns that intense exercise can trigger episodes. Brisk walking, cycling, swimming and similar activities are typical examples of moderate effort, where you can talk but not sing.

If episodes begin during exercise, stop, sit down and follow your care plan. Ask your cardiologist or specialist nurse about heart-rate targets, because rate-control medicines such as beta blockers change how your pulse responds to effort.

The BHF lists alcohol, caffeine, smoking, recreational drugs, emotional stress and spicy food as possible triggers. Triggers differ widely, so keeping a diary of episodes, what you had to drink and how you slept can be more useful than blanket rules.

The NHS advises avoiding smoking, drinking too much alcohol, caffeine, stress and dehydration. Of these, alcohol reduction is one of the changes most likely to make a noticeable difference for some people.

• Note the time, activity and any drinks before each episode.

• Share the diary with your GP or cardiology nurse.

• Review over-the-counter decongestants and energy drinks with a pharmacist.

The BHF lists eating healthily, physical activity, stopping smoking, reducing alcohol, controlling blood pressure and cholesterol, and managing diabetes among recommended lifestyle changes. The NHS also advises maintaining a healthy weight and eating balanced meals.

These steps matter as much as the rhythm itself because high blood pressure and excess weight help drive AF. Cardiac rehabilitation is not routine for AF alone in every area, but a practice nurse or community programme can support the same changes.

The BHF says having AF makes you five times more likely to have a stroke and that anticoagulants, including DOACs, are the most effective way to reduce that risk. The NHS says anticoagulants lower the risk of blood clots and stroke.

Exercise and lifestyle changes do not replace anticoagulation when your clinician has advised it. Take tablets as prescribed and report any bleeding that is heavy or does not stop.

The BHF lists medication such as beta blockers and anti-arrhythmic drugs, ablation, cardioversion and a pacemaker as options. Many people find exercise tolerance improves once their rate or rhythm is controlled.

After ablation or cardioversion, your team will give specific restrictions for the first period. Follow those rather than general guidance.

The NHS says to call 999 for a fast or irregular heartbeat with chest pain, shortness of breath, sweating, nausea or fainting, or with sudden stroke features such as a severe headache, facial weakness, vision changes or speech difficulty. The BHF also says to call 999 for chest pain or symptoms that could be a heart attack.