Exercise and INR

[Bionic Orange]

Has anyone found that increased exercise decreases their INR?

 

[dick0236]

No.

 

[Superman]

I do find the more fit I am overall, the higher my maintenance dose. But we’re talking maybe a couple milligrams a week.

 

[pellicle]

Yes, then you make a small adjustment to the dose.

Then after a week or two of the consistency of the new training regime the body adjusts itself and typically I find my INR response returns to where it was before.

The same thing occurs at the end if the season

This becomes clearer with a good recording system. Reach out if you want to show you.

 

[Bionic Orange]

Yes, then you make a small adjustment to the dose.

Then after a week or two of the consistency of the new training regime the body adjusts itself and typically I find my INR response returns to where it was before.

The same thing occurs at the end if the season

This becomes clearer with a good recording system. Reach out if you want to show you.

Thank you. I will reach out.

 

[carolinemc]

Has anyone found that increased exercise decreases their INR?

Increase physical activity can raise the INR, if you are just getting active.

 

[carolinemc]

No.

Yes.

 

[Chuck C]

Yes, this has been my experience.

It seems that the type of exercise also matters for me. When I increase my cardio exercise level for several days/weeks, my INR drops, leading to needing an increase in dosage in warfarin to stay in INR range.

A few months back I started incorporating more zone 2 cardio training. For me, zone 2 is keeping my HR at about 115 to 130. Compared to the type of training I had been doing previously, this represented a more sustained cardio output, vs the relatively high intensity short bursts of output I had been engaging in doing jiu jitsu. The additional work load represented about 6 days per week, sustaining my cardio in this pulse range for about 60 to 70 minutes per day.

My INR dropped slightly out of range and I made a small adjustment. A few more adjustments over the next few weeks followed. Ultimately, to stay in range I had to up my warfarin dose from 6.5 to 7.5mg/day.

This was similar to a few previous times in which I added more sustained cardio to my workouts, such as daily hikes up a local mountain. Interesting though, after months of maintaining this new level of exercise, my required dosage of warfarin slowly came back down to what it is typically for me. I'm now at 6.75mg per day, which has been my sweet spot for most of my time on warfarin.

This is the benefit and importance of self testing and testing often. If I went 30+ days between tests, my INR could have stayed low for weeks before adjustments were made, which is not a good thing. But, weekly testing allowed me to make little tweeks in a timely manner and stay in range. This enabled me to limit my time out of range to just a few days and stay mostly out of the danger zone.

 

[Bionic Orange]

My INR dropped slightly out of range and I made a small adjustment. A few more adjustments over the next few weeks followed. Ultimately, to stay in range I had to up my warfarin dose from 6.5 to 7.5mg/day.

Thanks for all of your info Chuck. I'm finding the same thing with increasing my cardio exercise. How often were you testing when you went from 6.5 to 7.5 mg?

I'm now at 6.75mg per day, which has been my sweet spot for most of my time on warfarin.

How many times per week are you testing at your sweet spot? When you go out of range, how often do you test at that time?

How are you getting 0.25 mg? Splitting 1/4 twice from 1 mg? Or do you dissolve 1 mg in 10 ml of fluid and take 2.5 ml to be more accurate? I have heard of people doing that successfully with other types of drugs but I don't know if you can do it with Warfarin?

This is the benefit and importance of self testing and testing often. If I went 30+ days between tests, my INR could have stayed low for weeks before adjustments were made, which is not a good thing. But, weekly testing allowed me to make little tweeks in a timely manner and stay in range. This enabled me to limit my time out of range to just a few days and stay mostly out of the danger zone.

Absolutely.

 

[Chuck C]

Thanks for all of your info Chuck. I'm finding the same thing with increasing my cardio exercise. How often were you testing when you went from 6.5 to 7.5 mg?

A little more often than once per week. I normally test once per week, but when my INR seemed to be moving, I was testing probably every 4 or 5 days, until it stabilized.

How many times per week are you testing at your sweet spot? When you go out of range, how often do you test at that time?

As indicated above, I test about once a week. If I'm stable for several weeks, I sometimes will let it go 9 or 10 days before testing. But, I try not to get complacent like that and try to stick to weekly as the ideal. If I am out of range, I test more often. I might test again after 2 to 4 days, depending on a view variables. Ideally, I like to make my adjustments when I get to the upper or lower edge of my range, rather than wait until I go out of range. It also depends whether I am high or low. If I get a reading of 1.8, I'm more likely to test after about 2 days, to make sure that my adjustment got things going in the right direction. On the other hand, if I find myself at 3.2, I am not as concerned about it, and might adjust, then wait 4-5 days before re-testing.

How are you getting 0.25 mg

Easy. I have 6mg and 1mg pills. I break the 1mg pills in half. Then I dose 6.5mg one day, then 7mg the next day and continue alternating this way through the week. This brings me to 6.75mg/day. I find that it is best to have the daily doses as close as possible to each other. This helps with stability. I think most here would agree that it is best to keep the daily doses as close as possible. Occasionally, members report guidance from their clinics that I can't make any sense of. We've seen people guided to adjust their dose by 50% every other day, for example. 4mg, then 2mg, then 4mg, ect. That is a recipe for INR volatility.

 

[pellicle]

Then I dose 6.5mg one day, then 7mg the next day and continue alternating this way through the week. This brings me to 6.75mg/day.

this is of course easier if your dose is something with a longer half life (warfarin) and your dose isn't something low like 1.25mg

Having a dose of over 5mg makes dosing easier (as does having access to different dose pills like 1, 3 or 5mg). Over time the sizes available have changed so the basics remain.

 

[Woodcutter]

Took me a bit to dig out some older data but some might find this interesting. My hypothesis, based solely on my personal experience, has been that decreasing exercise increases my INR. I was put on warfarin years before I had my mechanical valve. When I had a pulmonary embolism (which turned out to be my second clotting incident) the hematologist told me I'd be on warfarin for life. Did not have a range but over some time my prescription evolved to 3 mg and the general guidance was 'be over 2'.

When I had AFIB a few years later the sentiment was "good, you're already on warfarin". (Ultimately an ablation corrected this.)

MVR was about 10 years ago . . . and my prescription is still 3 mg.

I am a lifelong runner. However, I will say that at 60 (years old) my miles are 1/3 to 1/2 what they were at 40.

At the same 3 mg, my INR now runs about 0.5 higher than when I was 'more active'. I am still fairly active. Ran a half marathon last weekend. But in my 40's that would have been a marathon.

My 'hypothesis' is simply that I am less active now . .. . so I consume fewer calories. That is simply my thinking based on my anecdotal experience. The data below is real and not manipulated. However I did need to pick years where I was a consistent 3 mg as I have had other medications at other times that also shifted things.

Also, I began with an INRatio machine and now use the Coagusense XS. When I switched I did utilize both for a month and never had a difference more than 0.1.

My average this year runs 3.1 and in 2006 it was 2.6.

So, some data . . .. some facts . . . some guesses

 

[V__]

I am a lifelong runner. However, I will say that at 60 (years old) my miles are 1/3 to 1/2 what they were at 40.

My average this year runs 3.1 and in 2006 it was 2.6.

Interesting data. I'm just curious, what's the different in the typical daily miles run in these years?

 

[dick0236]

Great post Woodcutter. Looks very similar to mine this year. Your Doc should be very pleased with your management of your INR.

I noticed that you, like me, need the full 1.0 spread (2.5-3.5 INR) to be considered "well managed". IMO, the Docs that want their patients to maintain a tight .5 spread (2-2.5 or 2.5-3.0 or, God forbid, 1.5-2.0 INR) are asking their patients to do the impossible. No wonder patients new to warfarin get frustrated chasing such unnecessarily tight ranges.

 

[pellicle]

I noticed that you, like me, need the full 1.0 spread (2.5-3.5 INR) to be considered "well managed".

indeed, and while we're measuring here I'll share that when I shared this graph with my cardiologist his first words were "wow, you're really stable"

So, if by chance you are the person who never sees any INR variation then good for you, but don't assume that's what we all get. I'd rather get INR management advice from someone who's INR is variable vs someone who's never had to adjust. Its like when they did analysis of aircraft which returned from battle with all sorts of damage; they made all the wrong conclusions. This is now well recognised:

https://en.wikipedia.org/wiki/Survivorship_bias

 

[Woodcutter]

Interesting data. I'm just curious, what's the different in the typical daily miles run in these years?

As you might guess, it's pretty varied! Runners tend to think in terms of miles/week. When I was younger I'd run 40-60 miles/week all year round. I might peak at 70 during marathon training (spring/summer). Short days were 5 miles and long runs would reach 20.

These days I run 20-30 miles per week. 3-5 per day and my long runs seldom exceed 10 miles.

 

[pellicle]

These days I run 20-30 miles per week. 3-5 per day and my long runs seldom exceed 10 miles.

It gets us all eventually, keep pushing back and pushing on mate

Best wishes

 

[V__]

As you might guess, it's pretty varied! Runners tend to think in terms of miles/week. When I was younger I'd run 40-60 miles/week all year round.

Thanks, the weekly averages are perfectly fine for me. Was wondering about how much of a workout you did. (If indeed the exercise was the sole explanation for the INR difference... in which case I doubt the effect is relevant for the vast majority of people.)

These days I run 20-30 miles per week. 3-5 per day and my long runs seldom exceed 10 miles.

It's more than what I've ever run, to be honest Seems like quite a good workout!

 

[Bionic Orange]

Thanks for all of you responses, they were helpful. I do see that increasing cardio decreases INR.

 

[carolinemc]

Thanks for all of you responses, they were helpful. I do see that increasing cardio decreases INR.

or it can increase, depending on the activity and intensity.