Returning to Pickleball After a Heart Event: Getting Back in the Game
Pickleball has exploded in popularity over the past decade—especially among adults over 50. What started as a niche pastime is now the fastest-growing sport in North America. And it’s easy to see why. With smaller courts, lighter paddles, shorter matches, and a welcoming learning curve, pickleball offers a uniquely accessible way to stay active. But the real magic is its social and welcoming atmosphere. Whether you’re rallying with friends, joining a local league, or simply chatting between games, pickleball creates connection—a powerful motivator for anyone recovering from a health scare.
That’s why so many people recovering from heart events—whether it’s a stent, bypass surgery, or a diagnosis of heart disease—ask the same question: “When can I play again?” They’re not just looking for exercise. They’re looking to return to something that feels joyful, familiar, and social.
The good news? Most people with cardiovascular conditions can safely return to pickleball. This blog will walk you through how to know when you’re ready, what symptoms to watch for, and how medications and healing timelines factor in. Whether you’re just off the sidelines or planning your comeback, this guide is for you.
Medical Clearance
Before returning to pickleball—or any unsupervised sporting activity—it’s important to obtain medical clearance from your cardiologist or cardiac care team. The goal of medical clearance is to ensure that your cardiac condition is stable and your heart can tolerate the physical demands of returning to pickleball.
As we previously covered in the blog regarding returning to running following a cardiac event (onlineexerciseclinic.com/blog/running-after-a-heart-attack) left ventricular function, presence of arrhythmias, residual coronary artery disease, and symptoms all factor into the decision to return to any sport following a heart event.
One of the most effective ways to evaluate your readiness is to undergo an exercise stress test or cardiopulmonary exercise test (CPET). These tests provide objective information about how your heart responds to exercise, and can help identify any red flags such as abnormal heart rhythms or blood pressure responses, as well as exercise-induced ischemia (the medical term for a lack of blood flow to the heart muscle). The test will also determine if you have any activity restrictions, as well as assess your current fitness level to determine if playing pickle ball is within your current abilities, and help set exercise training targets. Getting this information upfront ensures you can return to the court safely, confidently, and with a plan that’s tailored to your condition.
Understanding Surgical Recovery
If you’ve had open heart surgery such as bypass or a valve replacement sternal healing is one of the most important factors in deciding when to return to a racket sports. Swinging a pickleball paddle involves torque, twisting, and arm elevation—all of which place stress on the chest wall.
From a sternal healing perspective, return to play is typically ok when all of the following have been met:
It’s been at least 12 weeks post-surgery
No residual chest wall discomfort, including while coughing, sneezing, twisting, reaching overhead, and with daily pushing and pulling such as open and closing doors
There is no lingering shoulder stiffness or pain. Some people experience decreased range of motion in one or both shoulders following cardiac surgery and if this is present it should be addressed before swinging a pickle ball paddle.
That said, following cardiac surgery it is important to ease gradually back into play. This is not the time to dive for balls or crash into the net. Your sternum may still be in the final stages of healing (can ultimately take 3 to 6 months) and sudden, forceful upper body movements can place unnecessary strain one the chest wall. Also, following surgery there is certainly a loss of upper body strength. A cautions, progressive approach allows you to rebuild strength, coordination, and confidence while minimizing the risk of injury or setbacks.
Angioplasty (Stenting)
If you’ve had a stent placed, rest assured: your stent is not going to move. Most people can return to light activity within days and more vigorous activity within a few weeks, depending on overall recovery and ensuring that their cardiac condition is stable.
How Fit Do You Need to Be to Return to Pickleball
One of the most common questions patients ask is, “How do I know when I’m ready to play again?” The typical fitness requirements to participate in pickleball vary depending on the level of play. Are you a recreational or competitive player? Do you want to play doubles or singles? What expectations do you have for your own games?
While there’s no one-size-fits-all answer, in the absence of an exercise test and assuming that you have been asymptomatic since your event, one evidence-based approach is to compare the estimated metabolic demands of pickleball to other activities that you may already be doing during your recovery such as walking or stationary cycling.
So what does this mean? Well, we use oxygen for fuel and your peak fitness level is determined by how much oxygen you can deliver to your working muscles during exercise. This is determined by your ability to breath in the oxygen and diffuse into your blood stream, your heart’s ability to pump the oxygen down to your working muscles, and your muscles ability to extract the oxygen from the blood. Exercise training significantly increases your heart ability to pump and your muscles ability to extract oxygen resulting in increased exercise capacity.
Metabolic equivalents or METs is a score that estimates how much oxygen we consume during a given activity. 1 MET is defined as the amount of oxygen your body consumes while sitting awake and at rest—approximately 3.5 mL of oxygen per kilogram of body weight per minute. This baseline reflects the minimum energy your body needs to sustain essential functions like breathing and circulation. As you begin to move—standing up, walking, or exercising—your muscles require more oxygen to generate energy. This increases your breathing and heart rate as your cardiovascular system works to deliver that oxygen to your working muscles. Activities that are more vigorous demand more oxygen and therefore have higher MET values. For example, an activity with a MET level of 4 requires four times more oxygen than required at rest.
In general, participating in leisure pickleball requires that you can sustain at least 3.5 To 4.0 METs which is equivalent to being able to comfortably walk walk at a speed of about 3.5 mph. For competitive pickleball the MET requirements are understandable higher and average between 5.5 and 7.0 METs which translates to a walking/jogging speed of 4.5 mph.
It should be noted that the walking speeds provided are only references and assumes that no cardiac symptoms or other contraindications are present. Also, someone who is taller or has a longer gait may walk faster with less cardiovascular effort. Conversely, someone shorter may expend more energy at the same pace.
Medications
Medications are a crucial component of treatment, however, cardiac medications can have significant effects on the body and influence how one should approach activities like pickelball.
Beta-Blockers
Often prescribed after cardiac surgery, Beta-Blockers, are also used to manage irregular heart rhythms, heart failure, and angina (chest pain). They also have a blood pressure lowering effect. Beta-Blockers work by lowering the amount of oxygen your heart needs by lowering your heart rate. The heart, like all muscles, needs more oxygen to support higher levels of work and Beta-Blockers limit how fast he heart can beat. When it comes to pickleball, fatigue is the most common complaint. It is very important that you engage in a warm-up and prior to playing to allow time for your heart to keep pace with your activity level and limit excessive fatigue.
Ace-Inhibitors
These medications relax blood vessels and lower blood pressure. Ace-Inhibitors are typically prescribed to lower blood pressure but also help the heart muscle recover following a heart attack. They have a neutral effect on exercise tolerance however dizziness and lightheadedness can become a real concern during physical activity including while playing pickleball.
When we walk, arteries in our legs dilate to deliver more blood flow to the active leg muscles. The contraction of the leg muscles along with the actions of our veins is usually sufficient to re-circulate the blood back up to the heart against gravity. Ace-Inhibitors, however, enhance the natural arterial dilation which can result in excessive blood pooling in the legs potentially resulting in significant dizziness. The start-stop nature of pickleball play can predispose you to symptoms of dizziness and lightheadedness and a gradual cool-down is important to help prevent symptoms.
Dehydration and quick postural changes, such as bending over to pick up the ball after an intense rally, can also exacerbate the issue. Be aware of your symptoms and take breaks and hydrate if you note any symptoms of dizziness of lightheadedness.
Statins
Statins are cholesterol lowering medications that act on the liver to reduce the amount of cholesterol that it produces. Statins do not influence your exercise response, however, in rare cases are known to contribute to excessive muscle pain, discomfort, and fatigue that may be most apparent when exercising. Otherwise, taking a Statin should not interfere with your game. Any suspected Statin-induced muscle pain should be reviewed with your physicians.
Antiplatelets
Platelets are small cells that help your body form blood clots to stop bleeding. As the name suggests, Antiplatelets, also known as blood thinners, lower the risk of blood clots by stopping platelets from sticking together. ASA is commonly prescribed to individuals with heart conditions, however, more potent Antiplatelets are especially important following angioplasty (stenting) procedures to avoid clots where the stent was placed. Antiplatelets increase the risk of bruising and bleeding and therefore contact sports or activities where there is a substantial risk of falling or impact are generally off limits. Antiplatelets generally do not limit your ability to play pickleball, however if you are prone to blisters on your racquet hand you should take precautions. Also, it is generally not advised to dive for the ball and try to avoid running into your partner during a doubles match.
Diuretics
Often prescribed for hypertension and heart failure, diuretics help reduce fluid buildup in the body. They can, however, lead to dehydration and electrolyte imbalances. While playing pickleball you should stay well-hydrated and monitor for signs of dehydration, such as dizziness or muscle cramps.
Returning to pickleball after a cardiac event can be a rewarding part of your recovery, but it’s important to approach it with the right preparation and guidance. Everyone’s cardiac history is unique, and this blog is intended to offer only a general overview of key considerations. A comprehensive review of your medical history, current fitness level, and any cardiac limitations should always be completed in consultation with your healthcare team before resuming play. If you have questions about how to safely return to pickleball or want support designing a tailored plan, the exercise physiologist at the Online Exercise Clinic can help guide you through the process with evidence-based advice and individualized care (onlineexerciseclinic.com/services).
The information in the blog is provided for informational and educational purposes only and does not constitute medical advice. The information is not a substitute for professional medical advice, diagnosis, or treatment. For questions please follow up with your healthcare professional.
