Can a patient with new onset atrial fibrillation on Eliquis (apixaban) do stationary biking?

Exercise for Patients with New Onset Atrial Fibrillation on Apixaban

Patients with new onset atrial fibrillation on Eliquis (apixaban) can safely engage in stationary biking as part of their regular physical activity, with appropriate rate control monitoring.

Understanding Exercise in Atrial Fibrillation

Atrial fibrillation (AF) management involves two key strategies: rate control and anticoagulation. For patients on Eliquis (apixaban), exercise considerations should address both aspects:

Rate Control Considerations

• The European Society of Cardiology recommends a rate control strategy using beta-blockers, non-dihydropyridine calcium channel blockers, or digoxin as first-line agents for most AF patients 1
• Target heart rate should be <110 bpm for lenient rate control during exercise 1
• Medications commonly used for rate control include:
  • Beta-blockers (metoprolol, bisoprolol, carvedilol, nebivolol)
  • Non-dihydropyridine calcium channel blockers (diltiazem, verapamil)
  • Digoxin (less effective during exercise, should be second-line) 2, 1

Exercise Benefits and Safety

Research has shown that exercise training significantly improves exercise performance in cardiac patients with AF. A study comparing patients with and without AF found that:

• Exercise training increased peak oxygen uptake by 31% in AF patients 3
• AF affects exercise performance but does not impair the beneficial effects of training 3
• Patients with chronic AF should not be dissuaded from participating in exercise training 3

Practical Recommendations for Stationary Biking

1. Start gradually: Begin with low-intensity sessions (10-15 minutes) and gradually increase duration and intensity

2. Monitor heart rate:

   • Use a heart rate monitor during exercise
   • Maintain heart rate below target rate (typically <110 bpm for lenient control)
   • Stop exercise if experiencing unusual symptoms (dizziness, chest pain, severe shortness of breath)

3. Medication timing: Consider timing stationary biking sessions when rate-controlling medications are at peak effectiveness

4. Stay hydrated: Maintain adequate hydration before, during, and after exercise

5. Regular follow-up: As recommended by guidelines, follow up with healthcare provider within 10 days of discharge, then at 6 months, and at least annually thereafter 1

Lifestyle Considerations

The European Society of Cardiology recommends that patients with AF engage in:

• Regular moderate physical activity (150-300 min/week) 1
• Weight management
• Limited alcohol consumption
• Blood pressure monitoring
• Smoking cessation if applicable 1

Stationary biking fits well within these recommendations as a controlled form of moderate exercise that can be easily monitored.

Important Caveats

• Individual assessment: Exercise capacity should be assessed before starting a regular exercise program
• Rate control adequacy: Ensure rate control medications are optimized before beginning regular exercise
• Warning signs: Patients should stop exercise if experiencing palpitations, dizziness, unusual shortness of breath, or chest pain
• Anticoagulation: Continue apixaban as prescribed; exercise does not affect the need for anticoagulation therapy

Conclusion

Stationary biking is a safe and beneficial form of exercise for patients with new onset atrial fibrillation on apixaban, provided that rate control is adequate and patients monitor their symptoms. Regular physical activity is actually encouraged as part of comprehensive AF management, with stationary biking offering a controlled environment to exercise safely.