AFib: What You Should Know When the Heart Skips a Beat

Geoff Lecovin | Stay Updated with NASM!

Moderately elevating a client's heart rate during physical activity is a goal of most exercise programs, but what about when a client has AFib?

Here's some information on what you should know and do when you are training clients with AFib.

For any physical fitness trainer, this can help prepare you for safe training sessions with AFib clients. 

What is Atrial Fibrillation or AFib?

Atrial fibrillation (AFib) is the most common type of arrhythmia (irregular heartbeat). It is caused by an abnormal firing of electrical impulses in the heart, which causes the atria (the top chambers in the heart) to quiver (or fibrillate).

Common symptoms of AFib include:

  • General fatigue and weakness
  • Rapid and irregular heartbeat
  • Fluttering or “thumping” in the chest
  • Dizziness
  • Shortness of breath
  • Anxiety
  • Faintness or confusion
  • Fatigue when exercising
  • Sweating
  • Chest pain or pressure


  • 7–6.1 million people in the United States have AFib
  • 2% of people younger than age 65 have AFib, while 9% of people aged 65 years or older have AFib
  • African Americans are less likely than those of European descent to have AFib
  • More women than men experience AFib

Risk factors for AFib include:

  • Advancing age
  • High blood pressure
  • High cholesterol
  • Obesity
  • Diabetes
  • Sleep apnea
  • Heart failure
  • Ischemic heart disease
  • Hyperthyroidism
  • Chronic kidney disease
  • Heavy alcohol use
  • Enlargement of the chambers on the left side of the heart

Treatment for AFib can include:

  • Medications to control the heart’s rhythm and rate
  • Blood-thinning medication to prevent blood clots from forming and to reduce stroke risk
  • Medications to manage risk factors such as hypertension, diabetes, high cholesterol and thyroid disease
  • Surgery
  • Healthy lifestyle changes, including: exercise, diet, stress modification, optimizing sleep, quitting smoking and reducing alcohol and caffeine consumption

AFib medications you should be aware of:

  • Anticoagulants (e.g., Xarelto and Warfarin)- These prevent blood clots to reduce the risk of strokes and heart attacks
  • Beta blockers (e.g., Atenolol and Metoprolol and Calcium Channel Blockers such as Verapamil and Diltiazem)- These slow down heart rate in order to lower the number of times the ventricles contract each minute, giving them enough time to fill with blood before pumping it out to your body
  • Cardiac glycosides and anti-arrhythmic drugs (e.g., Digoxin and Amiodarone)- These Control your heart rhythm to help your atria and ventricles work together to pump blood better

Surgical Procedures for AFib:

  • Cox maze procedure (Surgical ablation)- Heart surgery where small cuts create a planned “maze” of scar tissue. The maze guides electrical signals, restoring a regular heartbeat.
  • Mini maze procedure- Surgery that uses a tiny camera and small cuts to create a maze of scar tissue on a beating heart. The maze guides electrical signals and restores a regular heartbeat.

Healthy lifestyle changes to manage AFib risk factors 

As a personal trainer you can be a major player in helping to guide your clients with AFib through exercise, diet and health coaching.

Make sure your client is cleared by their cardiologist, who may suggest a cardiac rehabilitation program first. If your client is cleared you should also be aware of red flags such as chest pain, dizziness, sweating, shortness of breath, anxiety, fatigue and heart palpitations. Keep in mind that certain medications, such as beta blockers, keep the heart rate low and medications, such as anticoagulants, can cause bleeding complications.

Build Up Gradually

Jumping into an exercise program too quickly, exercising with too high an intensity or for long durations could cause or exacerbate symptoms of AFib. Start slowly with 5 to 10 minutes a day of walking and gradually pick up the intensity and duration.

Good exercises for AFib

Start with low-impact walking for about 10 minutes to allow the heart to adjust to the activity. Make sure you’re clients are hydrated and nourished before beginning a workout. Exercises such as power walking, jogging, or hiking are a great way to get in shape without overloading the heart. Riding an exercise bike or using an elliptical machine or treadmill are also safe workouts for people with AFib.

Lifting light weights is a good strategy to enhance muscle endurance, hypertrophy and strength without straining the heart. Weight training is essential for diabetes management as well as weight loss.

Exercises to avoid with AFib

Avoid activities with a higher risk of causing injury, such as high impact activities (e.g., skiing or outdoor biking). These activities can put too much stress on the heart and as mentioned above, if your client is on blood thinner medications they could bleed more heavily if injured.

Diet and AFib

According to the Mayo Clinic, aim to eat a heart-healthy diet, including:

  • Fruits
  • Vegetables
  • Whole grains
  • Low-fat or fat-free dairy products
  • Proteins such as lean meats, nuts, seeds and beans
  • Foods low in salt, added sugars, saturated fat and trans fat

Diabetics will need to control and monitor blood sugar levels. It would be prudent for you to advise your clients with diabetes to have a snack available just in case their blood sugar drops too low while working out.

You should also be aware that while dark green leafy vegetables are regarded as healthy, some clients with A-Fib who are taking anticoagulantes, need to avoid large amounts of leafy green vegetables as these vegetables are high in vitamin K and can interfere with the effects of these medications.

Other lifestyle factors

  • Ensure adequate recovery between exercise sessions
  • Manage stress
  • Aim for 7-9 hours of restorative sleep
  • Limit alcohol consumption
  • Quit smoking
  • Avoid caffeine

Key Points

  • Atrial fibrillation is a common type of arrhythmia caused by an abnormal firing of electrical impulses in the atria
  • As a personal trainer, you should be aware of the signs, symptoms and risk factors of AFib
  • You should also be aware of your client’s health history and the medications that they are on as these can affect exercise, nutrition and lifestyle recommendations
  • Lifestyle factors including: exercise, diet, stress management, optimizing sleep, quitting smoking and reducing alcohol and caffeine consumption can all help to manage and reduce the complications of AFib
  • Make sure to get a client’s doctor’s clearance before starting an exercise program

References and Resources

Ganz, L. I. (2015). Epidemiology of and risk factors for atrial fibrillation. UpToDate versión, 19.

January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Conti, J. B., ... & Sacco, R. L. (2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 64(21), e1-e76.

The Author

Geoff Lecovin

Dr. Lecovin is a chiropractor, naturopathic physician and acupuncturist. He graduated from the Los Angeles College of Chiropractic in 1990 with a Bachelor of Science in Biology and Doctor of Chiropractic, earned a Masters in Nutrition from the University of Bridgeport in 1992, and then went on to complete the Doctor of Naturopathic Medicine and Masters in Acupuncture programs at Bastyr University in 1994. Dr. Lecovin completed another Masters in Exercise Science from California University of Pennsylvania in 2015. He holds additional certifications in exercise and nutrition from the National Strength and Conditioning Association (CSCS), International Society of Sports Nutrition (CISSN), Institute of Performance Nutrition (ISSN Diploma and Performance Nutrition Diploma), International Olympic Committee (Sports Nutrition Diploma), Precision Nutrition (Nutrition Coach) and National Academy of Sports Medicine (CPT CES PES Nutrition Coach), where he is also a Master instructor.


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