Physical Exercise

CIEDs patients (carriers of either pacemaker or ICD devices) are usually discouraged to resume or to undertake physical activity or recreational sports. Although it is generally advisable to avoid any competitive sport, as this may predispose to tachyarrhythmias onset, it is otherwise recommended to maintain an active lifestyle and a recreational physical activity to limit heart disease progression or to prevent its onset. Caution shall be exercised when planning the resumption of physical training after a CIED implantation, especially with respect to the underlying heart disease. A general approach can be recommended:

  • Discuss with your GP and the cardiologist in charge of device therapy what are the limits posed by the heart disease and the arrhythmia under treatment;
  • Define a planning of exercise resumption with your doctor (number and duration of training sessions per week, type of exercise, recognition of normal/abnormal symptoms, goal to reach every month);
  • Be careful to avoid all the activities that might threaten lead/s integrity: leads are the most vulnerable part of the implanted system;
  • Physical improvement and well being are achieved at 75% of the maximum exercise capacity, hence it is unnecessary to sustain heavy workloads, to engage into competitive activities, or to face dangerous situations.
When can I resume exercise after a CIED implantation?

It is recommended to stick to strolling/brisk walking within the first month. Careful use of the arm is advised to prevent lead dislodgement in this early phase. Gradual increase of other activities may be undertaken after the first month.
What about CIED replacement ?
Resumption of physical activity may occur within the first week but for transient surgical issues (submuscular placement may be slightly painful).

Which activities should be discouraged or exercised carefully ? 

Strong and long-lasting muscular contractions of the shoulder and the arm at the implantation side should be avoided to limit the possibility of a progressive damage the implanted lead/s. Some sports can threaten lead integrity, due to the specific athletic effort: tennis, squash, country skiing, back-stroke swimming, boxing, karate, volley, basket , baseball, body building, heavy rowing….

What exercise should be preferred?

Aerobic exercise not requiring heavy muscular shoulder/arm work at the implantation side. For instance: brisk walking, trekking, running, bike riding, skating, downhill skiing, table tennis …

What about device programming ? 

Pacemaker: remember your physician that you are going to resume physical exercise, and seek advice about the target you are aiming at, based on your individual clinical status. Cardiac output needs to increase during exercise: the main mechanism to increase cardiac output is the increase in heart rate. Default device programming provides a maximum heart rate of 130bpm, that is appropriate for septuagenarians on average, but may not meet the requirement of younger or very active subjects, who may need to achieve 150-160bpm. The resting heart rate should be lowered to 40-50 bpm, such as to allow tracking of the normal sinus rate when it becomes normally “slower” owing to physical conditioning.

ICD: A heart rate increase above the Tachyarrhythmia detection cut-off should be avoided because it could be misclassified as a ventricular tachyarrhythmia, and inappropiately trigger therapy delivery. ICDs have automatic Discrimination Algorithms, that can distinguish between supraventricular rhythms (no therapy required) from ventricular tachyarrhythmias (those requiring therapy): nonetheless, 5-10% subjects experience inappropriate therapy delivery. These algorithms need to be turned ON and individually “tuned” to minimize the risk of an unpleasant therapy delivery during physical activity.