By Nicholas Tullo, MD

Atrial fibrillation (AF) is a common heart rhythm disturbance that can increase the risk of stroke, heart failure, and even death.  AF can be treated with medications, but there is evidence that lifestyle changes can help AF and should be included in any healthcare plan to improve outcomes in affected patients.

Most people with atrial fibrillation have symptoms like palpitations, weakness, lightheadedness, shortness of breath, and exercise intolerance.  AF can adversely affect the quality of life in the majority of people who get it, and patients with severe symptoms are often motivated to do almost anything to feel better. Medical therapy can help control this arrhythmia, but the fact is that atrial fibrillation occurs more commonly in patients with underlying risk factors. These risk factors include hypertension, diabetes, vascular disease, and sleep apnea. Many patients have developed these conditions in part due to lifestyle choices they have made.  Overeating, smoking, excessive alcohol, and lack of exercise are common habits that can lead to deterioration in the health of the individual, giving rise to an increased risk of AF.

Unfortunately, many patients are reluctant to change their habits. They may be addicted to cigarettes, or they feel unmotivated to exercise or to reduce their food intake in order to lose weight. However, a report was published in the American Journal of Cardiology that underscores the importance of these lifestyle changes in anyone who suffers from atrial fibrillation. The investigators reviewed over 1800 research articles published on the subject, and they found 10 studies that seemed to be well-designed and scientifically sound. Among these publications were three studies on weight loss programs and four studies that evaluated the impact of moderate physical activity.

atrial fibrillation demonstrated from EKG

Image via RNCeus

One large study of weight loss compared the outcome of 150 patients with AF who were randomized to receive an intensive program of dietary restriction with a low-carb diet and a moderate exercise program. These patients were also encouraged to pursue treatment for their hypertension, high cholesterol, diabetes, sleep apnea, and were encouraged to decrease their alcohol and tobacco use. A second group of patients received just basic dietary “counseling.”  The group who received the intensive program lost over 30 pounds over 15 months and had significant reduction in the AF symptoms and improved heart monitor results compared to the other group. Their heart measurements were even improved on an echocardiogram done a year after starting the program.  Several other studies showed similar beneficial results of weight loss.

Fitness training alone was also associated with a significant reductions in the amount of AF and the symptoms associated with this arrhythmia. In one study, among those who succeeded in improving their cardiovascular fitness significantly, 61% were free of AF, compared with only 18% of patients who improved their exercise tolerance only a little. The evidence for weight loss and moderate exercise was quite convincing, with patients consistently having less AF, not to mention having improved muscle strength, endurance, and overall improved quality of life.

There was also one study on yoga and two studies on acupuncture that appeared to show benefit as well. Yoga was associated with less symptomatic AF episodes and an improved quality of life. Though it was a small study of only 52 patients, it seemed to show benefit in many patients after 3 months of yoga classes taken at least 2 to 3 times a week. Acupuncture also seemed to be associated with reduced AF recurrence, though both of these studies came from the same center. One study demonstrated that the rate of AF attacks with acupuncture was similar to patients who received medical therapy, and it was lower than patients who received neither treatment.

In summary, lifestyle changes, including exercise, weight loss, eating right, reducing alcohol intake, and quitting smoking all seem to have beneficial effects on patients with atrial fibrillation. Even yoga and possibly acupuncture may have positive effects in the overall management of this common problem. If you have AF, you should make a commitment to include these lifestyle changes as a compliment to your medical therapy. If you are successful and your AF improves, perhaps your need for medications might decrease.  Who wouldn’t want to take fewer pills? It’s definitely worth pursuing, for your heart health and for your life!

Feature image via Mayo Clinic

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