Guest Blogger Patrick Bailey – Why Athletes with Atrial Fibrillation Should Not Depend Only on Wearable Tech

Thanks so much to Patrick Bailey for writing this interesting and timely article.

Based on the available data from the Centers for Disease Control and Prevention (CDC), there are about 2.7 million to 6.1 million people in the US who experience atrial fibrillation (AFib): sometimes the heartbeats either are too fast or too slow.

That’s a lot of people and experts from the government’s health agency is expecting the number to increase since the US population’s average age is rising.

The prediction is that around 6 million to 12 million people in the US and 17.9 million people in Europe will be affected by atrial fibrillations in the next 30 or 40 years.

Currently, the condition contributes to around 750,000 hospitalizations each year and an estimate of 130,000 deaths.

Exercise may contribute to the onset or progression of AFib. There have also been studies about increased risks of AFib due to sports supplements and performance-enhancing drugs prohibited by the World Anti-Doping Agency.

AFib is often undiagnosed since the condition doesn’t always have symptoms that are immediately noticeable. The symptoms of AFib may include shortness of breath, chest pain, weakness, palpitations, lightheadedness, or confusion, but there are also people with AFib who sense no symptoms at all.

Thanks to recent technological breakthroughs, AFib patients, particularly athletes, are finding comfort through modern gadgets that can actually help them detect their condition.

Apple Heart Study

Dr. Mintu Turakhiathen, a principal investigator on Stanford Medicine’s Apple Heart Study, reported in March that preliminary findings showed promising results on the use of the Apple Watch to detect irregular heartbeats. The study, funded by the tech giant, was conducted virtually and involved more than 400,000 participants.

The goal was to find out if Apple’s ECG app can identify AFib with the use of the pulse sensor that measures the heart rate. The sensor is built-in electrocardiography found on the crown of the Apple Watch. Participants placed a finger on the watch’s crown to record their pulse rate for 30 seconds. Data from the watch was synchronized on a phone and then sent to the patient’s doctor for monitoring purposes.

Interestingly, the researchers found out that the gadget could help detect AFib before it happens.

Based on their findings, 0.5% of participants who receive notifications for irregular pulse rate, which could be indicative of an AFib. The researchers viewed this as an important finding since they are concerned with the possible over-notification of the gadget. Thirty-four percent of those who got notifications for irregular heartbeat did have AFib. The researchers also found out that 57 percent of those who got an irregular pulse alarm went to their doctors for proper medical attention.

Apps and Athletes

These latest findings are welcome news for athletes who are suffering from atrial fibrillation. Being the most common cardiac arrhythmia experienced by athletes, particularly those who are cyclists or runners, AFib is definitely a concern for endurance sports enthusiasts.

One of the challenges faced by these athletes is the management of the agents that control the rate and anti-arrhythmic medications that are linked to impairment of the athlete’s performance.

The latest findings of the Apple Heart Study, on the other hand, showed that a wearable can have a role in affecting a person’s behavior.

For instance, a 2018 article in Forbes gave a glimpse of how gadgets are being used to monitor student-athletes for heat exhaustion and other potential issues. Experts see that the study shows the potential of wearables on people’s wellness.

Wearables are usually used to track temperature, steps, metabolism, heart rates and even the athlete’s location. They are very convenient and they can be synchronized through the software’s cloud system.

Data can be viewed instantly and shared with coaches and even doctors. They don’t just come in the form of watches. Wearables can also be a compression shirt, a sports bra, a vest, or a belt.

The use of this technology has been viewed as critical in boosting athletes’ performance and pushing the athlete’s boundaries. They also are convenient to carry around.

Limitation of wearables

However, while the potential of wearable digital technology in preventive care was highlighted in the Apple Heart Study, some critics view it as too limited since it is not actually conducted in a randomized controlled trial. That is, it included no significant number of individuals not wearing the Apple Watch.

Some people have also expressed concern that it would be too risky to rely too much on wearables and not consulting health care providers.

This actually makes sense.

For instance, people who do not have AFib but receive alerts of irregular heartbeats might think they have a risky heart condition. While It would be best to seek medical attention, such false positives could cause panic, take a physician’s precious time away from other patients who truly need medical attention, and could even result in unnecessary catheterizations.

Properly minding wellness

No one is claiming that Apple’s smartwatch is medical grade, not even the study’s researchers. With that said, it’s still up to the individuals to take responsibility for their health. How?

Understand your body, speak up, and seek medical care. Wearables are not 100% accurate and cannot assess serious medical conditions.

Even the president of American College of Cardiology, C. Michael Valentine, said that although wearables hold promise to help patients and their health care providers in improving heart health, they “should be approached with caution.”

Valentine said information and data should be used responsibly and in coordination with evidence-based guidelines and tools.

Another limitation is cost. Unlike smartphones, not everyone has a smartwatch already, and they sell for more than $300 each. Not everyone could afford it.

AFib has been known to increase the chances of stroke by five-fold and a patient’s mortality by two-fold. Even too much physical activity can aggravate an AFib’s patient’s condition. It would be good to be able to track down one’s heart rate, but it would be best to know our body’s limitation.

The best way to reduce the risk of AFib, according to the American Heart Association, is to promote a healthy lifestyle. Get regular physical activity. Manage high blood pressure.

If diagnosed with AFib, get proper medication and maintain a healthy weight. If you suffer from substance abuse, get proper rehab drug treatment.

While tech companies are keen on creating gadgets that will be part of the people’s lifestyle including for those with health concerns, the public should always keep in mind the basic needs to get healthy.

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Patrick Bailey

http://patrickbaileys.com/

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Bariatric Surgery Lowers the Risk of Atrial Fibrillation

Bariatric Surgery Lowers the Risk of Atrial Fibrillation

I’m not sure how much this applies to endurance athletes, but I found this interesting. As, I think, everyday knows, obesity increases the risk of cardiovascular disease, and that includes atrial fibrillation. Researchers in Sweden recently published a study where they followed 4200 obese individuals with normal sinus rhythm (ie. not in a fib at the beginning of the study) for an average of nineteen years. During that period approximately half of the subjects had had bariatric surgery – basically various surgical procedures to rearrange the internal organs to force the patient to eat less and absorb less resulting in significant, life-changing weight loss.

The study found that 12.4% in the surgery/weight loss group experienced atrial fibrillation compared to 16.8% in the non-surgical/still obese group. That’s a 29% lower rate of developing atrial fibrillation for the surgery/weight loss group. Furthermore the study also concluded that, “Compared with usual care, weight loss through bariatric surgery reduced the risk of atrial fibrillation among persons being treated for severe obesity. The risk reduction was more apparent in younger people and in those with higher blood pressure.”

(Citation is HERE)

Other studies have shown that weight loss can be helpful in reversing atrial fibrillation and that ablation success rate is improved with weight control. I don’t have literature citations but I read this here.

So what does this have to do with endurance athletes with A fib? All endurance athletes are already thin, right? Well, obviously that isn’t true; but probably very few endurance athletes would meet the criteria for bariatric surgery. So we should be in the low risk group to begin with – so why do so many endurance athletes end up in a fib?

Well, as everybody knows distant runners and other endurance athletes often gain weight when they have to quit or reduce exercises because of, say, atrial fibrillation. These studies suggest better outcomes with weight control regardless of method.

As to why endurance athletes have a higher rate of A fib – I’ll address that in next weeks post.

Thanks for reading – please feel free to post comments below.

Quick Link: Wounded Heart Project

shane

This isn’t an atrial fibrillation link, per se, but I think it will be of interest to readers of afibrunner.com. In Wounded Heart Project Shane describes his journey from having a myocardial infarction at age 42 (and subsequent obesity) to changing and regaining his health via improved diet (whole food plant based diet – yeah!) and exercise eventually becoming a sub-four hour marathoner even though his ejection fraction remains at 37%! That’s inspiring to me – is it inspiring to you?

Atrial Fibrillation and Weight Loss or How To Lose Forty Pounds

As I stated previously, when I first discovered that I was in persistent atrial fibrillation I decided that I needed to lose about 40 pounds, and I did.

It just makes sense that if my cardiac output is reduced by atrial fibrillation then I needed to jettison some excess weight.

My days of being a 235 pound marathon runner were over. My way range over the last twelve years has actually been between 220 and 250 pounds. People were so used to see me that my “normal” weight that when I started to get under 200 pounds they would ask me if I was ill, or even if I had cancer.

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Pre-race

Losing weight is easier than one would think. There are a lot of methods that work, but the most important thing is to make up your mind. It’s like quitting smoking cigarettes – it’s extremely difficult if your heart isn’t in it, but if you have truly make the decision there’s no stopping you.

I have loved drinking beer for my entire adult (and teenage) life, but three years ago I decided to completely quit drinking any form of alcohol. As a matter of fact I try not to take in any calories via liquid. Just quitting drinking beer was good for a ten or fifteen pound weight loss. But even as a teetotaler I could find myself drifting up into the 230s.

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Beer Drinking

Over the years I’ve used various methods to lose weight and I’d like to briefly discuss them, and then discuss what I’m doing now, which seems to work the best.

Before I actually tried it I had always thought that a low-carb/Atkins diet was a sort of parlor trick. People on it just deplete their glycogen stores (glycogen also holds a lot of water in the muscles) and have a weight loss that wasn’t really true fat loss. But I started seeing patients who were losing a hundred pounds and more on a low-carb diet – eating a lot of meat and high-fat foods like coffee drinks loaded with heavy cream.

As a person who has been reading Bicycling magazine and Runner’s World for the last several decades I was stuck on the fact that athletes need a lot of carbohydrates in order to train properly. But I decided to try the Atkins diet for two weeks, using my body as an experimental laboratory, fully expecting that it would affect my training and that I would quit after two weeks.

That particular Summer I wasn’t running very much but had been training for some centuries (100 mile bicycle rides) in the Fall. I doubted I would be able to get up any of our mountains without carbohydrates. I was wrong. I found I was able to train normally on a low-carb diet and the sheer amount of weight loss was astounding. Different people, obviously, have different metabolisms – but I found I was able to lose about 30 pounds in six weeks utilizing a low-carb diet.

But there were definitely problems with a low-carb diet for me personally. Intuitively I could tell it was not healthy. You can eat bacon for lunch and think “this is great,” but you can’t honestly believe “this is healthy.” It changes, in an unpleasant way, the smell of your breath, the smell of your sweat, and the smell of your bowel movements.

Another big problem was that I was never able to stay on an low-carb diet for more than six weeks at a time. I didn’t crave carbohydrates – I just got bored. I grew so weary of eating steak that I would sometimes just skip meals.

I also found that while I could train for long-distance bicycling on a low-carb diet, running on a low-carb diet was definitely different. I could still go out and complete long training runs, up to 20 miles, but I was totally wrecked afterwards. My recovery was terrible and sometimes I would come home from a long run, take a shower, and just go to bed.

These are the things I discovered by using my body as an experimental lab.

After abandoning low-carb diet once and for all, I tried the guidelines outlined in Racing Weight by Matt Fitzgerald. This is great if you are already at a good weight, or just need to lose a couple of pounds – but it really isn’t calorie restrictive. It’s all about the quality of the food you eat. That book was interesting because it had a long section of a day in the (diet) life of quite a number of endurance athletes.

I made my own modifications to his points system and printed up little daily tally sheets to keep in my pocket and keep track of my points each day. I would try for thirty points per day. The main problem with this diet is that you can actually eat a lot of good, healthy food, but still can eat a lot of calories.

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Trail Lunch

A couple of years ago I discovered, for me, absolutely the best way to actually lose weight. I used an iPhone/Internet app called Lose it! There are several similar applications including My Fitness Pal, Weight Watchers Mobile, etc.

With these applications you simply enter your age, gender, and weight – and then you enter how much weight you want to lose per week. The app then tells you exactly how many calories you can eat per day, and efficiently helps you keep track. It doesn’t matter what you eat, you just need to log everything, and nearly every type of food seems to be pre-entered into the application (including foods from specific restaurants). If you eat or drink something that has a barcode on it, like a Clif Bar for example, just scan it. If you log your exercise the program adds more calories to your day.

I think just utilizing an application like Lose it! makes it worthwhile getting a smart phone.

Some pitfalls, obviously, include miscalculating how much food you actually ate. At first I wasn’t very good at figuring out what one tablespoon actually means. For example – a tablespoon of peanut butter doesn’t mean actually scooping out as much peanut butter as possible with a tablespoon. That’s more like four tablespoons.

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Peterson Ridge Rumble

The exercise aspect of it, I felt, was extremely good. But calories for running are based on your weight, time spent running, and your pace. It really does not take into account whether or not the run was hilly, however. As a big, slow endurance athlete I was able to burn up a lot of calories just by being out there for several hours on any given work out.

Although I attribute my 40 pound weight loss to this iPhone app, I no longer log anything I eat with Lose it! but I still use it to log calories burned during workouts, as a rough guide.

Ultimately I discovered the documentary Forks Over Knives. The scientist in me found the data very compelling. I then read Eat to Live Joel Furhman – and between the documentary and this book I completely changed the way I eat. Both of these are manifestos, of course, and are manipulative to a certain extent, but I think they are correct.

At this point in time I would call myself a lackadaisical vegan. I say lackadaisical because I really don’t read the ingredients for things such as bread, which I know will contain some dairy or eggs, but for the most part I am a vegan.

Oh, and I also have trouble avoiding pizza or ice cream which I will have about once per week. So I’m really no vegan, but I guess I’m a vegetarian. We make our own pizza and it’s good stuff – kale, onions, mushrooms, broccoli, and green peppers. At this point in time I can maintain my weight with the semi-vegan diet, and no longer need to log food or count calories. If I started gaining weight again I would definitely utilize the Lose it! app in order to get back down to target weight.

So that’s how I did it.

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Peterson Ridge Rumble

Any restrictive diet is effective, no matter which diet, because you end up eating less. For me personally I have found that the low-carb diet clearly allows incredibly fast, significant weight loss – but I didn’t feel that it was healthy. I know that my nearly vegan diet is healthy – I never had high cholesterol to begin with but the last time I checked my LDL cholesterol (a.k.a. bad cholesterol) it was sixty-one. I don’t take any medications except for Pradaxa. I didn’t know LDL cholesterol could even go that low!

I would be interested in hearing from other endurance athletes with atrial fibrillation, especially about changes in diet. Please feel free to leave comments.

Atrial Fibrillation and Performance

I was under the impression that atrial fibrillation had not actually affected my pace that much, and that my slowing down was primarily a consequence of normal aging. I am fifty-three years old now and certainly can’t run at the same pace that I was able to when I was forty. One of my friends, who is approximately the same age as me, and also an endurance athlete, says that “every year is like a dog year now as far as performance is concerned.” In other words, for every year you get older you get seven years slower.

ringo racer

Every Year is Definitely a Dog Year for Ringo

I have always been a Clydesdale runner and at over 6’3″ in height I have spent the last ten years around 235 pounds. I decided when I went into persistent atrial fibrillation that it was finally time to lose the extra weight and have successfully kept my weight around 195 pounds for the past year primarily by means of a vegetarian/pretty much vegan diet. Conventional wisdom states that if you lose 10 pounds you get approximately 30 seconds per mile faster as far as your running pace is concerned. So I figured a 40 pound weight loss combined with persistent atrial fibrillation would mean more or less breaking even as far as pace is concerned.

I discovered that this is certainly not the case.

Last Fall I had a procedure called cardioversion, wherein the heart is zapped back into normal sinus rhythm, and I remained in sinus rhythm for thirty-three days before going back into persistent atrial fibrillation. My electrophysiologist thought it would be worthwhile to try cardioversion with a “one strike and you’re out” philosophy – in other words nobody really expected that I would stay in sinus rhythm, but it would be worth a try.

Video of a Man (not me) Being Cardioverted

It was during those thirty-three days that I realized that atrial fibrillation really does slow me down more than I had thought. Mountain bike rides that were taking me one hour and fifteen minutes in atrial fibrillation, where taking the fifty-five minutes in sinus rhythm – even though I did the exact same trails. I also found I was doing my training runs at a pace approximately 1 to 1 1/2 minutes per mile faster in sinus rhythm. This is a significant difference. When I finally went back into atrial fibrillation I had slowed down again.

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Running With A Fib Feels Like Running in a Foot of Snow

Being in sinus rhythm, by the way, was sort of uncomfortable for me. I am more or less asymptomatic when I am in atrial fibrillation as far as how I actually feel, but my sinus rhythm sucks. If I feel my pulse, while in atrial fibrillation, obviously, I can feel that it is irregular, but I don’t feel all that bad except that certain times – such as getting up to run across room to answer the phone, or right after I get done with a run. (More on that later.) But when I went into sinus rhythm I realized that my sinus rhythm really isn’t that great to begin with – I was having PVCs or PACs about every fifth or sixth beat, and these are noticeably uncomfortable.