Exercise guide
For most people with atrial fibrillation (AF, or AFib), exercise is safe and helps. In trials, exercise programmes reduced how often AF came back and eased symptoms, and the European Society of Cardiology (ESC) now recommends a tailored exercise programme for AF that comes and goes or is persistent. The NHS suggests at least 150 minutes of moderate exercise a week, but not exercising too much or too hard, which can trigger AF.
This guide covers how to judge effort when your pulse is irregular, what to do if AF starts while you exercise, rate-control medicines, blood thinners and contact sport, getting back to exercise after ablation or cardioversion, and why long-term endurance athletes get more AF. Exercise works alongside your treatment, including the medicines that lower your stroke risk.
The British Heart Foundation (BHF) says it's unlikely that exercise will make your AF worse. The ESC's 2024 guideline recommends a tailored exercise programme for AF that comes and goes or is persistent, to improve fitness and reduce AF coming back.
Aim for at least 150 minutes of moderate exercise a week, like walking, bike riding or gardening. The NHS says avoid intense exercise, and try not to exercise when you're having symptoms of AF.
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If your AF comes and goes, exercise when you're not in AF. If you're in AF all the time, exercise when your heart rate is under control, you're stable on your treatment and you feel well.
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With an irregular pulse, heart rate can't measure your effort, and wrist watches can show a lower heart rate than your real one during AF. Use the talk test or the Borg scale, and warm up and cool down gradually.
On a blood thinner (anticoagulant), avoid contact sports, because you'll bleed and bruise more if you're injured. After any head injury, get help from NHS 111, or call 999 for the serious signs.
For most people, regular exercise lowers the risk of AF. Very high volumes of endurance sport over many years have been linked with more AF, mainly in men, in observational studies. If that's you, talk to a cardiologist rather than giving up exercise.
Atrial fibrillation is a heart rhythm problem where your heartbeat is not steady. The electrical signals in the top chambers of the heart quiver or twitch, so the heart beats randomly and doesn't pump blood as well as it should.
AF can come in episodes that start and stop, usually on their own (paroxysmal); last more than 7 days and usually need treatment (persistent); continue for a year or more (long-standing); or stay long term, even after treatment (permanent).
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An irregular pulse, palpitations, a heart rate over 100, feeling very tired, finding it harder to exercise, chest pain or tightness, and feeling short of breath, light-headed, dizzy or faint. Sometimes there are no symptoms.
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About 1.7 million people in the UK have been diagnosed with AF. People with AF are up to five times more likely to have a stroke if their risk isn't managed, and anticoagulants are the most effective treatment to reduce that risk.
AF is more likely with age, being male, being overweight, smoking, high blood pressure, heart failure, diabetes, sleep apnoea and endurance sports such as long-distance running, cycling or skiing. Triggers include caffeine, alcohol, stress, dehydration and lack of sleep.
With AF, your heart rate may go up and down more quickly than normal during exercise, which can cause shortness of breath, chest pain or dizziness. That's why a gradual warm-up and cool-down matter.
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Medicines to control the heart rate or rhythm, anticoagulants to lower the risk of clots and stroke, and procedures such as cardioversion (using electricity to reset the heart's rhythm) and catheter ablation. Anticoagulants are often called blood thinners, although they don't actually make the blood thinner.
Most trials were small and short, and several were supervised. Fewer AF episodes coming back is the best-studied result.
In a 2024 Cochrane review of 20 trials (2,039 people), exercise-based rehab probably reduced AF coming back, by about 30% (4 trials, 378 people, moderate-certainty evidence), and eased symptoms. Its effect on deaths and serious problems is uncertain.
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In ACTIVE-AF, 120 people whose AF came and went or was persistent had 6 months of supervised and home exercise, or usual care. A year later, 40% of the exercise group were free of AF without ablation or rhythm medicines, against 20% of the others, and their symptoms were milder.
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The ESC's 2024 guideline recommends a tailored exercise programme for people whose AF comes and goes or is persistent, to improve fitness and reduce AF coming back: class I, its strongest recommendation, based on randomised trials (level B). It also says physical activity should be considered to prevent AF or its return, except excessive endurance exercise.
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In a Norwegian trial of 51 people whose AF wasn't permanent, four 4-minute hard intervals 3 times a week for 12 weeks cut the time spent in AF from 8.1% to 4.8%, while it rose from 10.4% to 14.6% in the comparison group. Symptoms, fitness and quality of life improved too.
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In 49 people with permanent AF, 12 weeks of aerobic training improved exercise capacity, walking distance and quality of life, and lowered resting heart rate. In 30 people with long-term AF, 24 sessions of cardio and strength training improved exercise capacity by 41%.
In a single-centre study with no control group, twice-weekly yoga for 3 months cut symptomatic AF episodes from 3.8 to 2.1 on average, and eased anxiety and depression, in people whose AF came and went.
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In 308 people with AF who were overweight, those who were fitter, or who gained the most fitness, stayed free of arrhythmia for longer. This was an observational study, so fitness may not be the only reason.
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In 13 trials (1,155 people), supervised training reduced AF coming back and improved fitness, with no more side effects. A 2025 review found similar effects across types of training, home or centre settings, ages, sexes and types of AF.
Women made up only 29% of people in AF training studies with separate results for each sex. Fitness gains were similar, but AF symptoms improved a little less in women: a finding that still needs testing.
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Anticoagulants are the most effective treatment to reduce the risk of stroke in AF, and medicines, cardioversion and ablation control the rhythm and symptoms. Exercise programmes are recommended alongside them, not instead.
Doses are starting points, not prescriptions. Check with your doctor if you're not sure what exercise you can do.
At least 150 minutes a week of moderate exercise (your breathing and heart rate are faster than usual, but you can still have a conversation), in smaller chunks if you like. A brisk walk suits almost everyone. If you become breathless quickly, reduce the intensity.
The trial's registered protocol built towards about 210 minutes a week of moderate exercise, mixing supervised sessions with an exercise physiologist (weekly for 3 months, then every 2 weeks to 6 months) with exercise at home, an exercise diary and diet advice.
The ESC recommends a tailored exercise programme, while the NHS says avoid intense exercise. Both agree that moderate activity is the base. Hard intervals were tested in one small trial, so build up to 150 minutes of moderate activity first, and talk to your cardiologist before hard intervals or races.
Walk, cycle or swim at a pace where you can talk in sentences for 10 to 20 minutes on most days, building over 6 to 8 weeks towards 150 minutes a week, plus strength work on 2 days. After a few months, if you're well and your cardiologist agrees, you can build further, towards the 3.5 hours a week in ACTIVE-AF's protocol.
Once AF has been assessed and treated, the AF Association says doctors generally encourage people to return to full and normal activities, including exercise classes, and jogging for those who are able.
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The British Association for Cardiovascular Prevention and Rehabilitation (BACPR) lists AF among the conditions that may benefit from cardiac rehab, though it says the evidence is less strong than for its priority groups. A 2025 review describes barriers to getting rehab for AF, such as referral and transport. Ask your GP (general practitioner), cardiologist or AF nurse whether it's available near you.
Because your pulse is irregular, checking your heart rate won't accurately measure a workout's intensity, so think about how you're feeling, the BHF says. European sports cardiology guidance agrees: in AF, judge effort by how hard it feels, or by power on a bike.
Moderate means you can still hold a conversation. On the Borg scale, which runs from 6 (no effort) to 20 (the hardest you could manage), cardiac rehab aims for 11 to 14. Our heart rate zone calculator explains the scale.
In a study of 102 people in hospital, measured at rest, smartwatches matched an electrocardiogram (ECG) well in a normal rhythm but read heart rate too low during AF: by 8 beats on average for one watch and 28 for another, with wide variation. Don't rely on a watch's heart rate to judge your effort while you're in AF.
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Slow down and stop, then sit and rest. Call 999 for chest pain, fainting, severe breathlessness or the other signs in the warning signs below. If it settles and you feel well, don't exercise again that day, and tell your doctor or AF nurse (our suggestion, in line with the NHS advice not to exercise when you have symptoms).
Start exercise gradually and decrease the intensity gradually, so your breathing returns to normal before you stop. With a heart condition, the BHF suggests a warm-up of at least 15 minutes and a cool-down of at least 10.
Build towards 150 minutes a week at a pace where you can still talk, 10 to 20 minutes at a time to start (our editorial starting point, from the NHS advice). Jog only once brisk walking feels easy, and keep most runs conversational.
3D demoTreadmill walkingBeginner · Cardio machine
3D demoStationary cyclingBeginner · Cardio machine
3D demoElliptical trainerBeginner · Cardio machine
3D demoIndoor rowing (rowing machine)Beginner · Cardio machine
3D demoTreadmill joggingIntermediate · Cardio machine
3D demoStanding marchBeginner · No equipmentStrength work on 2 days a week, as for everyone: 2 or 3 sets of 8 to 12, breathing out on the effort and never holding your breath. Choose weights you can lift with control.
The yoga study used 60-minute classes twice a week. Stand near a wall if rate-control medicines make you light-headed, and skip hot yoga (our suggestion: heat and dehydration can trigger AF).
3D demoMountain pose (Tadasana)Beginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoWarrior II (Virabhadrasana II)Intermediate · No equipment
3D demoChild's Pose (Balasana)Beginner · No equipment
3D demoSupine spinal twist (Supta Matsyendrasana)Beginner · No equipment
3D demoSlow breathing (6 breaths a minute)Beginner · No equipmentNever stop or change a medicine because you've started exercising. Ask your doctor, AF nurse or pharmacist.
Beta blockers slow your heartbeat and may make you feel more tired or less energetic. Use the talk test or the Borg scale rather than heart rate. If a beta blocker makes you dizzy, the NHS says not to drive, ride a bike or use machinery until the dizziness stops. Talk to your doctor if you want to change your exercise routine, and don't change your dose yourself.
Side effects of beta blockers such as bisoprolol usually happen when you first start or when your dose is increased, and often get better over time. Go easier on exercise for those first days (our suggestion).
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NICE (the National Institute for Health and Care Excellence) usually offers a beta blocker, or diltiazem or verapamil, first to control the heart rate. In a small trial, verapamil and diltiazem reduced exercise capacity less than beta blockers did. If a medicine leaves you too tired to exercise, tell your doctor or AF nurse: there may be other options.
NICE keeps digoxin on its own for people whose AF doesn't come and go and who do no or very little physical exercise, or when other medicines aren't suitable. If you're becoming more active and your heart races when you exercise, tell your doctor. Don't stop taking digoxin suddenly.
Some people with occasional episodes take a medicine only when AF starts. Ask your team how long to wait before exercising after taking it.
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If you take anticoagulants, you're more likely to bleed and bruise badly if you have an accident, so the BHF says avoid contact sports. The NHS says your GP or anticoagulant clinic may advise this, and to use protection when playing sports. European sports cardiology guidance agrees.
Walking, cycling with a helmet, swimming, rowing machines, gym work and yoga are all fine. Leave out rugby, football, boxing, martial arts sparring and other contact sports unless your team says otherwise. With cycling and skiing, a fall is the risk to think about (our suggestions).
Get help from NHS 111 if you've had a head injury and take medicine that thins your blood. Seek immediate medical attention after a major accident, a significant blow to the head, or bleeding you can't stop. If you're told to go to A&E (accident and emergency), don't drive yourself there.
Severe or repeated bleeding needs medical attention straight away: call 111 or go to A&E. The NHS lists these signs of too much bleeding:
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For most people, regular exercise lowers the risk of AF. The ESC recommends an active lifestyle, 150 to 300 minutes of moderate activity a week, to prevent AF, and in pooled studies an inactive lifestyle was linked with more AF in both women and men.
In observational studies, athletes had about 2.5 times the odds of AF of non-athletes, and in a study of 52,755 long-distance cross-country skiers, men who had finished the most races had more AF. The link is seen mainly in men: in pooled studies, vigorous exercise went with lower odds of AF in women but higher odds in men. These studies show a link, not cause, and their results vary.
Talk to a cardiologist, ideally one with sports experience, about your training, controlling your heart rate in races, and whether ablation suits you: European sports cardiology guidance says ablation is an option for people who exercise and keep having symptomatic AF. The ESC's 2024 guideline lists excessive endurance exercise as the exception to its advice to stay active.
Rest for a few days. One NHS hospital asks people to avoid any lifting, stretching or strenuous exercise for 1 to 2 weeks, because it raises pressure in the groin where the catheter went in, then to start gentle exercise. The BHF says avoid heavy lifting for at least 2 weeks, and that you may feel tired for days or weeks.
Palpitations and short episodes of arrhythmia are very common for up to 12 weeks after an ablation, and don't mean it has failed. Call 999 for the warning signs below.
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Build up from gentle exercise over the following weeks, and ask your team when you can return to hard training or competition. Follow your hospital's leaflet on caring for the groin wound.
In the first 24 hours, don't drink alcohol, drive or operate heavy machinery, and ask your team when to start exercising again. We found no fixed timeline, so follow your hospital's advice.
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Anticoagulants are the most effective treatment to reduce the risk of stroke in AF, and untreated, AF can make a stroke up to five times more likely. Keep taking yours: exercise works alongside it, not instead.
The ESC's 2024 guideline recommends losing 10% or more of your body weight if you're overweight, to reduce symptoms and AF burden, and cutting alcohol to 3 drinks a week or fewer, to reduce AF coming back. Our weight loss guide can help.
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High blood pressure and sleep apnoea make AF more likely, and stress and lack of sleep can trigger it. Our high blood pressure, sleep and anxiety guides have more.
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Start with the walking and low-impact sessions. The Norwegian 4x4 session follows the interval structure of the AF trial above: do it only with your cardiologist's agreement, and judge it by effort rather than heart rate.
A steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 10-minute routine for straight after a meal: an easy walk, a few simple standing moves from blood sugar trials, then a short walk to finish.
10 minBeginner6 movesCardio machine, A bench or boxA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA 40-minute walk alternating 3 minutes fast and 3 minutes easy, five times over: the interval walking tested in Japanese trials, built up from three rounds.
40 minBeginner3 movesCardio machine, A wallA 25-minute walk with short faster bouts: notice your heart and breathing speed up, then settle. A gentle way to get used to the feelings of effort.
25 minBeginner5 movesCardio machine, A wallA 30-minute beginner run-walk session: a brisk walk, then 1-minute jogs with 1-minute walks, building to 3-minute runs over your first three weeks.
30 minBeginner5 movesCardio machine, A wallA 45-minute home session built like a UK cardiac rehab class: a 15-minute warm-up, 20 minutes of cardio mixed with light strength, and a 10-minute cool-down.
45 minBeginner14 movesA wall, A bench or boxA 25-minute gentle yoga class for complete beginners and over-50s: slow breathing, a warm-up, supported standing poses, floor poses and a closing rest.
25 minBeginner14 movesNo equipmentA gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.
20 minBeginner11 movesA bench or box, A wallA 20-minute full-body dumbbell workout: two supersets of squats, rows, Romanian deadlifts and push-ups. Twice a week covers the minimum dose.
20 minBeginner8 movesA dumbbell, A bench or boxThe Norwegian 4x4, a well-studied interval session for raising VO2 max: four 4-minute hard efforts with 3 easy minutes between, on a bike, rower or treadmill.
40 minIntermediate3 movesCardio machine, A wallThe walking plan builds towards 150 minutes a week; the couch to 5K plan uses run-walk intervals for people who want to run.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA 9-week beginner plan with the same walk-to-run shape as Couch to 5K: three run-walk sessions a week, from 1-minute jogs to 30 minutes of running.
3 training days35 minBeginnerGTN is glyceryl trinitrate, the spray or tablets used for angina.
Call 999 (911 in the US) if:
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Don't drive yourself to A&E. Sit and rest on the floor with your knees bent and your back supported. Take a 300 mg aspirin if you have one and aren't allergic to aspirin, and use your GTN if you have angina. If someone stops responding and stops breathing, start CPR (cardiopulmonary resuscitation).
The person you speak to at 999 will give you advice about what to do.
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Call 999 or go to A&E if palpitations don't go away, or come with chest pain, shortness of breath, feeling faint or fainting. With a fast or irregular heartbeat, the NHS also lists sweating, feeling or being sick, dizziness, a severe headache, weakness or numbness on one side, blurred vision, and confusion or difficulty speaking as reasons to call 999. If palpitations have stopped, ask for an urgent GP appointment or call NHS 111.
Call 999 if someone has fainted while exercising, or while lying down. After any other faint, see a GP.
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The BHF says stop immediately and contact your GP if you feel unwell, very short of breath, or get chest pain, dizziness or palpitations while exercising. Call 999 for the signs above. The NHS advises not exercising while you have symptoms of AF.
After a head injury, get help from NHS 111, or call 999 for the serious signs in the blood thinners section above. For severe or repeated bleeding, call 111 or go to A&E straight away.
The BHF says this is unlikely. Exercise programmes reduced AF coming back and eased symptoms in trials, and the ESC recommends them.
Very high volumes over many years are linked with more AF, mainly in men, in observational studies. For most people, regular exercise lowers the risk, and athletes with AF can talk to a cardiologist about treatment, including ablation, rather than stopping.
With AF, your pulse is irregular, so heart rate can't measure effort, and watches read too low during AF. Use the talk test or the Borg scale.
You can: avoid contact sports, use protection, and get any head injury checked.
Anticoagulants are the most effective treatment to reduce the risk of stroke in AF, and untreated AF can make a stroke up to five times more likely. Exercise works alongside them.
Hospitals advise no strenuous exercise or heavy lifting for 1 to 2 weeks or more, then a gradual build-up; ask your team when you can train hard again. Palpitations in the first 12 weeks are common.
Usually, yes: the British Heart Foundation says it's unlikely to make AF worse, and exercise programmes reduced AF coming back in trials. European guidelines now recommend a tailored exercise programme for AF that comes and goes or is persistent. Check with your doctor if you're not sure what suits you.
The NHS says exercising too much or too hard can trigger AF, so avoid intense exercise and don't exercise when you have symptoms. Very high volumes of endurance sport over many years are linked with more AF, mainly in men. For most people, regular moderate exercise lowers the risk.
A brisk walk suits almost everyone; cycling, swimming, gardening and exercise classes all count. Aim for at least 150 minutes a week of moderate activity, plus strength work on 2 days. Yoga eased symptoms in a small study.
There isn't a reliable number: your pulse is irregular, so it can't measure your effort, and watches tend to read it too low during AF. Use the talk test or the Borg scale instead. If you've had an exercise test, your team may give you guidance.
If your AF comes and goes, it's better to exercise when it isn't happening. If you're in AF all the time, exercise when your heart rate is controlled, you're stable on treatment and you feel well. If AF starts while you exercise, stop and rest, and call 999 for chest pain, fainting or the other warning signs.
Yes, for most people: strength work on 2 days a week is part of the guidelines, and trials combined it with cardio. Breathe out on the effort, don't hold your breath, and choose weights you can lift with control. On blood thinners, avoid anything that risks a heavy knock.
Many people can: the AF Association says jogging is encouraged for those who are able, once AF has been assessed and treated. Build up gradually and keep most runs conversational, and talk to your cardiologist before races or long hard training.
Athletes had about 2.5 times the odds of AF in observational studies, and among long-distance cross-country skiers, men who had finished the most races had more. The link is seen mainly in men. These studies show a link rather than proof of cause, and athletes with AF can talk to a cardiologist about treatment rather than stopping.
Yes, but avoid contact sports, because you'll bleed and bruise more if you're injured. Get help from NHS 111 after any head injury, and call 999 for serious signs such as being knocked out or having a fit.
One NHS hospital says no lifting, stretching or strenuous exercise for 1 to 2 weeks, then gentle exercise; the British Heart Foundation says avoid heavy lifting for at least 2 weeks. Ask your team when you can return to hard training. Palpitations in the first 12 weeks are common and don't mean it hasn't worked.
For the first 24 hours, don't drink alcohol, drive or use heavy machinery, and ask your team when to start exercising again. We found no fixed timeline, so follow your hospital's advice.
It can reduce how often it comes back: in one trial, 40% of people were free of AF a year after starting a 6-month exercise programme, against 20% without it. It works alongside your treatment, not instead of it, especially the medicines that lower your stroke risk.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
