Can I exercise with a pacemaker or ICD? 

Yes, you can safely exercise with a pacemaker or an implantable cardioverter defibrillator (ICD). In fact, regular physical activity is highly encouraged to strengthen your heart and improve your overall well-being. Modern cardiac devices are designed to adapt to your body’s needs during exertion, often speeding up your heart rate as you become more active. 

In this article, you will learn about the clinical recovery timelines, which sports are safe or should be avoided, and how to manage your heart rate to prevent inappropriate device shocks. We will also discuss the importance of cardiac rehabilitation in helping you regain confidence in your physical abilities. 

What We’ll Discuss in This Article 

• Initial movement restrictions during the first six weeks of healing. 

• Safe types of aerobic exercise and strength training. 

• Activities and sports that are generally discouraged for device safety. 

• Understanding your device shock threshold and heart rate zones. 

• The risk of electromagnetic interference from gym equipment and wearables. 

• Warning signs and triggers to watch for during physical exertion. 

• The benefits of structured cardiac rehabilitation programmes. 

The first six weeks: Initial recovery 

During the first six weeks after your device is implanted, your primary clinical goal is to allow the lead wires to settle securely into the heart tissue and the surgical wound to heal. You must avoid any strenuous activity or heavy lifting such as nothing heavier than a half filled kettle during this period. Overextending the arm on the side of the implant can pull on the leads, potentially causing them to dislodge. 

You are encouraged to keep the arm mobile with gentle, low level movements to prevent a frozen shoulder, but you must not lift your elbow above shoulder height. Walking is the ideal exercise during these early weeks. Start with short, five to ten minute walks on flat ground and gradually increase your distance as you feel more comfortable. 

• Avoid lifting the arm on the side of the device above shoulder level. 

• Do not carry heavy bags or lift weights for the first six weeks. 

• Walking is safe and recommended immediately after discharge. 

• Avoid vigorous activities like vacuuming or golfing during this initial phase. 

Safe exercises and aerobic activity 

Once you have passed the six week milestone and your clinical team has cleared you, you can return to most forms of aerobic exercise. Brisk walking, cycling, and swimming (once the wound is fully dry and healed) are excellent choices. Many pacemakers have a rate responsive sensor that detects movement or breathing changes and increases your heart rate to match your activity level. 

It is important to start at a moderate intensity. A useful clinical guide is the talk test: you should be able to hold a conversation while exercising. If you are too breathless to speak, you are likely pushing too hard. Aim for 150 minutes of moderate activity per week, spread across at least five days, as this provides the best protection for your heart health. 

• Aerobic activities like dancing, cycling, and walking are highly beneficial. 

• Always include a 10 minute warm up and 10 minute cool down to help your heart adjust. 

• Swimming is safe once the surgical site is completely healed. 

• Use the Borg Scale of Perceived Exertion to keep your effort at a moderate level. 

Avoiding inappropriate shocks and lead damage 

If you have an ICD, a key concern is avoiding an inappropriate shock. This happens if the device misinterprets a very high exercise heart rate as a dangerous arrhythmia. Your device is programmed with a specific shock trigger rate. It is vital to stay at least 10 to 20 beats per minute below this threshold. You can ask your cardiac physiologist for your specific trigger rate during your follow up appointment. 

You should also avoid activities that involve repetitive, forceful arm movements or high impact to the chest. While the devices are robust, a direct blow can damage the pulse generator or the leads. Similarly, activities that involve extreme stretching of the chest muscles, such as heavy bench presses or certain yoga poses, should be approached with caution to prevent long term wear on the lead wires. 

• Avoid contact sports like rugby, boxing, or martial arts. 

• Be cautious with sports involving forceful swings, such as tennis or squash. 

• Know your ICD trigger rate and monitor your heart rate during intense workouts. 

• Avoid holding your breath during strength training. 

Gym equipment and wearable technology 

Most standard gym equipment is safe to use. However, you should avoid leaning directly over machines with large motors or magnets, such as some rowing machines or high powered alternators. Most modern exercise machines do not produce enough electromagnetic interference to affect a cardiac device, but it is always best to maintain a small distance between the machine motor and your implant. 

Regarding wearable technology, most smartwatches are safe, but some devices use bioimpedance technology which sends a tiny electrical current through the body. This has the theoretical potential to interfere with your device sensing. It is recommended to check the manufacturer guidance for any fitness tracker or smart scale before use. 

• Keep mobile phones and trackers at least six inches away from the device site. 

• Avoid using body fat scales that utilize bioimpedance technology. 

• Most treadmills and stationary bikes are perfectly safe to use. 

• Carry your device ID card in your gym bag at all times. 

The role of cardiac rehabilitation 

In the UK, cardiac rehabilitation is highly recommended for anyone with a new pacemaker or ICD, especially if the device was fitted following a heart attack or heart failure diagnosis. These sessions provide a safe environment where you can exercise under the supervision of specialists who understand how your device works. 

They can help you understand your heart rate response and provide the psychological support needed to overcome any fear of the device firing. Many patients find that their confidence in exercising is significantly higher after completing a structured rehab programme. It also provides an opportunity to meet others in a similar situation and share recovery tips. 

• Supervised sessions help you find your safe exercise limits. 

• Clinical staff can monitor for any heart rhythm changes during exertion. 

• Provides education on managing your heart condition alongside your device. 

• Helps reduce the anxiety often associated with ICD shocks. 

Differentiation: Pacemaker vs ICD exercise needs 

It is helpful to distinguish between exercising with a pacemaker compared to an ICD. A pacemaker is primarily there to stop your heart from going too slow. It will not prevent your heart from beating fast during exercise. The main focus for pacemaker patients is protecting the leads and the wound site while enjoying an active lifestyle. 

An ICD has the added job of stopping dangerously fast rhythms with a shock. Because of this, ICD patients must be more mindful of their maximum heart rate and the risk of inappropriate shocks. While both groups can enjoy a wide range of activities, ICD patients require a more tailored approach to high intensity training and should always prioritize staying below their device programmed therapy zone. 

Conclusion 

Exercising with a pacemaker or ICD is not only possible but a key part of maintaining your cardiovascular health. By respecting the initial healing period, avoiding high impact contact sports, and staying within your clinical heart rate zones, you can return to a full and active life. Regular movement ensures your heart remains efficient and provides the long term stamina needed for daily activities. 

If your ICD delivers a shock during exercise, stop immediately and follow your clinical team emergency protocol. If you feel unwell, dizzy, or experience multiple shocks, call 999 immediately. 

Authority Snapshot 

This article was written by Dr. Rebecca Fernandez, a UK trained physician with an MBBS and extensive experience in cardiology, intensive care, and emergency medicine. Dr. Fernandez has managed patients through acute cardiac events and supported their long term recovery and device management within the NHS. This guide is based on current clinical standards from the British Heart Foundation and NICE to provide safe, accurate information on exercising with cardiac devices.