If you have just been told you have atrial fibrillation, one of the first questions is usually whether it is still safe to exercise, and what you should be careful with. For most people the answer is yes, with the right supervision. This guide walks through what is safe, what to be careful with, and how an Accredited Exercise Physiologist works alongside your Cardiologist and GP.
01 . What it is
What atrial fibrillation is, and what an Exercise Physiologist can and cannot do
Atrial fibrillation is an irregular heart rhythm caused by chaotic electrical signals in the atria, the upper chambers of the heart. Instead of one steady beat, the atria quiver out of time, and the lower chambers respond with an irregular and often rapid pulse. It is the most common sustained heart arrhythmia in adults.
Atrial fibrillation comes in three patterns. Paroxysmal atrial fibrillation starts and stops on its own within seven days. Persistent atrial fibrillation lasts longer and usually needs medical or electrical treatment to return to a normal rhythm. Permanent atrial fibrillation is the pattern you and your medical team have agreed to manage long term rather than try to reverse. The exercise side of the plan is broadly similar across all three.
Allied health sits inside a bigger plan. An Accredited Exercise Physiologist does not diagnose atrial fibrillation, does not order an ECG or a Holter monitor, and does not change your medications. Diagnosis, rhythm control, rate control, and blood-thinning medication stay with your Cardiologist and GP. What an Exercise Physiologist does is build the supervised exercise side of your plan and feed information back to your medical team along the way.
02 . Is it safe
Is it safe to exercise, and does it help?
For most people with atrial fibrillation, exercise is safe once a Cardiologist has cleared them to start, and being active is good for general heart health and fitness. The honest picture on what exercise does for the rhythm itself is worth understanding, because it shapes a sensible plan.
The clearest atrial-fibrillation-specific evidence is for weight management. In a large Adelaide study of people with atrial fibrillation and a higher body weight, those who lost at least 10 per cent of their body weight and kept it off had a much higher chance of staying free of atrial fibrillation over five years than people who did not lose weight or whose weight went up and down. Where weight is part of the picture, this is one of the strongest levers available.
Exercise itself is the second part. Reviews of exercise-based cardiac rehabilitation in atrial fibrillation show that supervised exercise reliably improves fitness and exercise capacity. What is still being studied is the effect of exercise on the rhythm itself, on hospital admissions, and on how long people live, because the trials so far have been small and short. So the fair message is this: exercise is good for your fitness and your wider heart health, managing weight has strong atrial-fibrillation-specific evidence, and a supervised program does not reverse atrial fibrillation or replace your Cardiologist’s care.
03 . What to avoid
What to be careful with, and what a program looks like
The most common question people ask is what kinds of exercise to avoid. A few things are usually held back, especially early on.
- Heavy maximal lifts (lifting the heaviest weight you can manage for one or two repetitions) are usually avoided, because they spike blood pressure.
- Breath-holding under load, known as the Valsalva manoeuvre, is avoided for the same reason. Your Exercise Physiologist will coach you to breathe out through the effort of a lift rather than hold your breath.
- If you are on a blood thinner, contact sports and activities with a high risk of falling are planned differently, because a fall or knock carries more risk while you are anticoagulated.
None of this means stopping resistance training. It means doing it at a sensible load, with good breathing, and building up gradually. Here is what a supervised program usually looks like.
The assessment. Your Exercise Physiologist reviews your Cardiologist’s clearance, any recent ECG or echocardiogram findings, your medications (especially rate-control agents and blood thinners), and what you can currently do without symptoms. The starting dose sits below your symptom threshold and inside any limits your medical team has set.
The aerobic foundation. Most people work towards the Australian physical activity guideline of around 150 minutes of moderate activity a week, built up over time. For someone newly diagnosed, sessions often start at five to ten minutes of walking, stationary cycling, or pool work, and build by small steps each week. Because rate-control medication changes how the heart rate responds, intensity is judged using a mix of heart rate, how hard the effort feels, and a simple “can you talk in short sentences” check.
Conservative resistance training. Around two sessions a week of moderate-load resistance work, starting light and progressing gradually, is a common target, with the breathing and load rules above.
Safety monitoring. Your Exercise Physiologist watches for shortness of breath out of proportion to the effort, palpitations that do not settle, dizziness, chest tightness, or unusual fatigue. Anything that looks off is fed back to your GP and Cardiologist between visits, not saved up to the end.
A supervised exercise program does not reverse atrial fibrillation. It is one part of a wider plan, and it works alongside your medical care, not instead of it.
04 . The team
How the team works around you
Atrial fibrillation is managed by a small team, each with a clear role.
- Cardiologist. Diagnoses atrial fibrillation, chooses between rhythm-control and rate-control strategies, prescribes the medications, and decides whether you are a candidate for procedures such as cardioversion or ablation.
- General Practitioner. Manages blood-thinning medication and review, checks stroke and bleeding risk, coordinates referrals, and writes the GP Chronic Condition Management Plan that can fund your allied health sessions.
- Accredited Exercise Physiologist. Builds and delivers the supervised exercise program, monitors your response, and feeds session-by-session information back to your GP and Cardiologist.
- Accredited Practising Dietitian. If weight is part of the plan, an Accredited Practising Dietitian turns the weight-management evidence into food you actually eat, and reviews alcohol and caffeine, which can trigger episodes in some people.
- Pharmacist. Reviews your medication list, especially when blood thinners or rate-control medications start or change, and watches for interactions.
At Optimum Health Solutions, Exercise Physiology, Physiotherapy, and Dietetics work from the same clinic spaces across our clinics in New South Wales and Tasmania, so your clinicians can share notes and send one clean summary back to your GP and Cardiologist. For the wider picture, see our post on how a multidisciplinary team supports cardiovascular disease management.
05 . Next steps
How to get started
There are three common ways into supervised exercise for atrial fibrillation in Australia.
The first is a Medicare GP Chronic Condition Management Plan. Your GP writes the plan, names the allied health providers (most often Exercise Physiology and Dietetics for this condition), and sends the referral. You then book in directly with the clinic.
The second is Department of Veterans’ Affairs cover. Gold Card and qualifying White Card holders can be referred for clinically indicated Exercise Physiology. The GP referral letter starts that pathway.
The third is private health insurance. Most Australian extras policies include some cover for Exercise Physiology. Bring your card to your first appointment so the gap can be worked out, or check with your fund in advance.
Wherever you start from, the first appointment is the same. Your Exercise Physiologist reviews your Cardiologist’s correspondence, talks through your history and goals, completes a baseline assessment, and writes the plan with you. For how the same team approach plays out in related care, see our post on resistance exercise and diabetes control.
References
- Risom and colleagues, 2017 (Cochrane review). Exercise-based cardiac rehabilitation for adults with atrial fibrillation. Cochrane Database of Systematic Reviews, 2, CD011197. DOI: 10.1002/14651858.CD011197.pub2. (According to PubMed.)
- Pathak and colleagues, 2015 (LEGACY study). Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort. Journal of the American College of Cardiology, 65(20), 2159-2169. DOI: 10.1016/j.jacc.2015.03.002. (According to PubMed.)
- Reed and colleagues, 2018 (systematic review). The Effects of Cardiac Rehabilitation in Patients With Atrial Fibrillation. Canadian Journal of Cardiology, 34(10 Suppl 2), S284-S295. DOI: 10.1016/j.cjca.2018.07.014. (According to PubMed.)
- Van Gelder and colleagues, 2024 (ESC Guidelines). 2024 ESC Guidelines for the management of atrial fibrillation. European Heart Journal, 45(36), 3314-3414. DOI: 10.1093/eurheartj/ehae176. (According to PubMed.)
- Brieger and colleagues, 2018 (NHFA/CSANZ Australian Guidelines). Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. Heart, Lung and Circulation, 27(10), 1209-1266. DOI: 10.1016/j.hlc.2018.06.1043. (According to PubMed.)
- Heart Foundation. Atrial fibrillation clinical resources. Australian peak body.
