Features August 2013 Issue

Vigorous Exercise Still Possible If You Have a Cardiac Device

New research emphasizes the benefits and safety of many kinds of physical activity among patients with ICDs.

If you have a cardiac device, such as an implantable cardioverter defibrillator (ICD) to control an abnormal heart rhythm, you were probably given a set of guidelines or precautions to take to better ensure a healthy outcome with the device. Along with medication adherence, keeping up with doctor appointments and other behaviors, exercise is also a keep aspect of a heart-healthy life, even among those with ICDs.
But the types of exercise and their intensity is an especially individualized matter, though a recent study has found that in general, vigorous exercise is healthy for most patients with devices. The study, published in the American Heart Association journal Circulation, found that many people with ICDs can safely participate in activities such as running, tennis, skiing and even basketball, soccer and volleyball.

More than just walking
In the past, many physicians encouraged ICD patients to greatly limit the intensity and physical demands of their leisure activities.

Bruce Wilkoff, MD, Director of Cardiac Pacing and Tachyarrhythmia Devices at Cleveland Clinic, explains that the advice to patients is always very dependent on the physician and the nature of the physical activity. “Patients have generally been encouraged to be active, but have sometimes been discouraged particularly from competitive sports,” he says. “This prohibition has been on theoretical concerns, and has not had any data to support that advice.”

He adds that a patient’s overall health and fitness level should be considered when deciding what activities are okay to pursue.

What to avoid
So if running and tennis get a green light, what activities should be avoided?
Contact sports are usually off limits, as are certain types of heavy weight-lifting. For example, isometric and certain other types of resistance exercises should be avoided if the patient has hypertrophic obstructive cardiomyopathy, Dr. Wilkoff says.
Also on the no-no list is the use of a rifle or shotgun on the side of the implanted device. Dr. Wilkoff says it’s also important to follow the guidelines associated with whatever heart condition led to the need for an implant.

Exercise and ICD risks
While it may seem logical that vigorous exercise might induce an erratic heartbeat in someone already dealing with an abnormal rhythm, Dr. Wilkoff says there is no evidence to suggest that exercise increases the risk of an ICD shock, as long as the ICD is properly programmed to avoid detecting the normal increase in heart rate that occurs with exertion.

He adds that, in general, sports aren’t likely to increase the rate of ICD lead problems, though leads that are more vulnerable to failure have been more likely to fail in younger and more active patients.
When to get moving

As with the recovery from any procedure, getting active after ICD implantation should be done carefully and slowly, according to your doctor’s guidance. Recommendations vary, but Dr. Wilkoff says that usually driving shouldn’t be done for at least a week. Arm movement on the side of the implant should begin within a couple of weeks, just long enough to make sure the incision has healed. Restricting the motion of the shoulder can lead to pain and a condition known as “frozen shoulder,” Dr. Wilkoff explains.
Running can begin after two weeks and more vigorous exercise can start after a month.

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