palpitations exercise guidance

Overview

Palpitations are the feeling that your heart is pounding, fluttering, skipping a beat, or beating too fast. They can happen at any time, but many people notice them during or after exercise. This article explains how to exercise safely when you experience palpitations, and when you should get help.

Yes. Nearly everyone feels their heart race or skip a beat at some point. Palpitations during or after exercise are especially common.

People of any age can have palpitations. They may be more noticeable in people who are anxious, stressed, or who drink a lot of caffeine. Some people with heart conditions also have them.

Symptoms

Common symptoms

• A fast or pounding heartbeat that seems to come on suddenly
• A fluttering or 'butterflies' feeling in your chest
• A sensation that your heart skipped a beat or added an extra beat
• Palpitations that start when you exercise and ease when you rest
• A brief feeling of dizziness or light-headedness

Symptoms in children

• In children, palpitations may feel like the heart is fluttering or racing. A child might also say their chest feels funny or that they feel weak during exercise.

Symptoms in older adults

• Older adults may feel palpitations as a fast, irregular, or slow heartbeat. They might also notice shortness of breath, fatigue, or light-headedness during activity. These symptoms should always be checked by a healthcare provider.

Causes

Main causes

• Strenuous exercise, which makes your heart work harder
• Caffeine, energy drinks, or some cold and asthma medicines
• Dehydration, low blood sugar, or anaemia
• Stress, anxiety, or panic attacks
• Alcohol or tobacco use
• Underlying heart conditions, such as arrhythmias or valve problems

Risk factors

• A family history of heart rhythm problems
• A history of heart attack, heart failure, or heart surgery
• High blood pressure, diabetes, or an overactive thyroid
• Habitual use of caffeine, alcohol, or stimulant drugs
• Taking certain medicines that can affect the heart (always ask your doctor or pharmacist)

When to see a doctor

See a doctor urgently if:

• You have palpitations for the first time during exercise
• Your palpitations are becoming more frequent or stronger
• You have fainted or almost fainted during exercise
• You have heart disease or a family history of heart rhythm problems and notice palpitations

Book a routine appointment if:

• You notice occasional palpitations but have no other symptoms – mention them at your next routine check-up
• You are planning to start a new exercise programme and you want to know how to do it safely

Diagnosis

Your doctor will talk with you about your symptoms, check your pulse, and listen to your heart. They may also ask you to keep a record of your palpitations and describe exactly what you were doing when they happened.

Tests that may be done

• Electrocardiogram (ECG) – a quick test that records your heart's electrical activity
• Holter monitor – a portable device you wear for 24 to 48 hours to record your heartbeat during daily activities, including exercise
• Exercise stress test – you walk on a treadmill or ride a bike while your heart is monitored
• Echocardiogram – an ultrasound scan that creates a picture of your heart
• Blood tests – to check for anaemia, thyroid problems, and other conditions

What to expect at your appointment

Your doctor may ask you to keep a symptom diary. They will also want to know if anything triggers your palpitations. Based on the results, they can tell you whether it is safe to exercise, and what level of activity is best for you.

Treatment

Treatment for palpitations depends on what is causing them. If they are harmless, the best approach may be to make simple lifestyle changes. If they are caused by a heart rhythm problem, your doctor will talk with you about the safest treatment plan.

Self-care at home

• Drink water before, during, and after exercise to stay hydrated
• Limit or avoid caffeine, energy drinks, alcohol, and tobacco
• Warm up for at least five minutes before you start intense activity
• Cool down gradually after exercise instead of stopping suddenly
• Try slow breathing or relaxation exercises to manage stress
• Note your palpitations in a diary and look for patterns, such as certain foods or times of day

Medical treatments

When an underlying condition is found, doctors may recommend medicines to help control your heart rhythm or rate. They may also suggest a procedure such as catheter ablation, which treats a small area of heart tissue that causes abnormal rhythms. Your doctor will discuss the options that are right for you. Do not stop or change any medication without speaking to your doctor.

When is surgery considered?

Surgery is rarely needed. In some cases, a device like a pacemaker or an implantable defibrillator may be recommended for a serious rhythm problem. This is always a shared decision between you and your heart specialist.

Living with this condition

With palpitations, you can still live an active life. The key is to understand what is normal for you and to know when to get help. If your doctor says exercise is safe, keep moving. Regular activity is one of the best things you can do for your heart.

Lifestyle tips

• Do moderate exercise most days, such as brisk walking, cycling, or swimming
• Increase the length and intensity of your workouts gradually
• Include rest days to let your body recover
• Try stress-reducing activities like yoga, meditation, or deep breathing
• Avoid exercising in very hot or very cold weather, which can strain the heart

Diet and exercise

Eat a balanced diet and stay hydrated. Try not to eat a large meal right before exercising. If you notice palpitations after drinking coffee, tea, or energy drinks, try cutting back and see if it helps. Always tell your doctor about any changes you make.

Mental health and emotional wellbeing

It is natural to feel anxious about palpitations, and anxiety can sometimes make them worse. If you feel nervous about exercising, talk to your healthcare team. They can reassure you and help you build confidence. A counsellor or therapist can also support you.

Prevention

You cannot always prevent palpitations, but you can lower your risk by staying hydrated, avoiding triggers like caffeine and alcohol, managing stress, and keeping up with regular, moderate exercise.

Vaccines

There is no vaccine for palpitations. However, staying up to date with recommended vaccines, such as the flu vaccine, can help protect your overall heart health.

Screening programmes

No routine screening is needed for palpitations in most people. If you have risk factors, a family history, or an existing heart condition, your doctor might recommend regular heart check-ups.

Complications

If left untreated

• Most palpitations do not lead to any complications
• If a serious heart rhythm problem is left untreated, it can increase the risk of fainting, blood clots, stroke, or heart failure
• Exercise with an untreated heart condition could be dangerous, so it is important to see a doctor first

Long-term outlook

The outlook for palpitations is usually very positive. Most people live full, active lives with no problems. Even when a heart condition is found, treatment can be very effective. With the right support and a sensible exercise plan, you can feel confident about your heart health.

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