Exercising with Pacemakers and Defibrillators: Safety, Benefits, and What You Need to Know
For people living with pacemakers or implantable cardioverter defibrillators (ICDs), exercise can feel intimidating—or even off-limits. But the truth is, when done correctly, physical activity is not only safe for most people with these devices but also vital to long-term health and quality of life. With the proper guidance and understanding of how these medical devices interact with exercise, individuals can build confidence and improve both cardiovascular function and overall well-being.
In this comprehensive guide, we’ll explore the essentials of exercising with pacemakers and defibrillators, why heart rate monitoring is crucial, how equipment and medications can affect your outcomes, and the key safety considerations that every patient—and clinician—should know.
The Importance of Exercise with Cardiac Devices
Cardiac conditions that lead to the implantation of a pacemaker or defibrillator—such as bradycardia, heart block, or certain types of heart failure—can make people cautious about raising their heart rate. However, controlled and progressive physical activity is one of the most powerful ways to strengthen the heart, improve blood pressure, manage weight, and reduce symptoms like fatigue and shortness of breath. Decades of clinical research have demonstrated that structured, moderate exercise is not only safe for most people with these devices but essential to recovery and long-term health.
The presence of a pacemaker or ICD doesn’t remove the need for exercise—it simply requires that you adapt your approach. Working with a knowledgeable healthcare provider such as a Clinical Exercise Physiologist can ensure your activity is both safe and effective.
Know Your Device: Pacemaker
Pacemakers are designed to monitor the heart’s electrical activity and, when necessary, provide electrical impulses to keep the heart beating at a safe rate. Many modern pacemakers include rate-responsive features, meaning they adjust the pacing rate in response to physical activity.
critical to know:
Is your pacemaker always pacing, or does it turn on and off?
What is your pacemaker’s resting rate and maximum tracking rate?
Your maximum tracking rate is the highest rate the pacemaker will allow the heart to reach during activity. If you’re exercising at or above a moderate intensity and your heart rate stays below 100 beats per minute or doesn’t approach your max track rate, the pacemaker may not be responding as needed—or your exercise may not be sufficient to stimulate the device.
But here’s the key: rate-responsive pacemakers need a signal to know you’re exercising and rely on sensors. These sensors detect the body’s movement or vibration and trigger the pacemaker to increase the heart rate to keep up with exercise demands. Pacemakers are very good at sensing walking and running, however, some forms of exercise, such as stationary cycling, may have insufficient vibrational input to trigger the pacemaker to respond.
Some pacemakers use dual sensors (vibration and respiration) or accelerometers positioned in the chest wall, which may improve responsiveness. However, every model behaves differently.
Stationary bikes, particularly recumbent bikes, provide a smooth and low-impact form of cardiovascular training. While this is ideal for joint safety, it often lacks the vibrational input needed for the pacemaker’s sensor to recognize increased physical effort. As a result, the pacemaker might not increase the heart rate as expected, leading to symptoms of excessive fatigue, dizziness, or shortness of breath during exercise.
This doesn’t mean you should avoid cycling—but it does mean you may need to make some adjustments:
Use upright bikes instead of recumbent bikes, as they tend to provide more upper body and core movement, which may enhance sensor input. This however does not always work and I have had numerous patients where upright cycling was insufficient to trigger the pacemaker to respond.
Include arm movement, such as light arm ergometry or rhythmic hand swings, to stimulate the sensor.
Consider interval-based training, where brief bouts of higher effort may be more likely to trigger a response.
If the heart rate does not increase during stationary cycling it may not be a suitable type of exercise for you. However, prior to abandoning it make sure that your heart rate does increase with other activities like walking and jogging.
Discuss sensor settings with your cardiologist, especially if you consistently feel under-paced during workouts.
Know Your Device: ICDs
Implantable cardioverter defibrillators are designed to detect and treat dangerously fast heart rhythms (ventricular tachycardia or fibrillation) by delivering a corrective shock. For people with ICDs, the main exercise concern is avoiding activities that might inadvertently provoke arrhythmias.
That said, studies have shown that moderate-intensity exercise is safe and beneficial for most ICD patients, and in fact, regular training may reduce the frequency of inappropriate shocks. Some considerations include:
You must know your device’s trigger rate.
Your exercise heart rate should always remain at least 10 beats per minute below the trigger rate to avoid inappropriate shocks.
Monitoring is essential, especially during aerobic activities or interval training, where the heart rate can spike unexpectedly. Avoid very high-intensity or competitive sports, unless specifically cleared.
Stay well-hydrated and avoid overheating, both of which can affect heart rate and rhythm.
Monitor for symptoms, such as palpitations or dizziness, and always have a plan in place if the ICD fires.
If you have an ICD, it’s important to know your trigger rate—the heart rate at which the device is programmed to deliver a shock. Your exercise heart rate should remain at least 10 beats per minute below that threshold to avoid inappropriate shocks. Tracking your heart rate closely during exercise is key for both safety and confidence.
Early Lifting With Pacemakers and ICDs
According to the American College of Sports Medicine (ACSM) and clinical consensus guidelines, upper body or upper extremity exercise should generally be avoided for the first 3 to 6 weeks following a pacemaker or ICD implantation. During this period, patients are typically advised to restrict movement of the arm on the side of the implant—particularly avoiding lifting the elbow above shoulder height or lifting more than 10–15 pounds—to allow the leads to stabilize in the heart tissue and minimize the risk of lead dislodgement. After this healing phase, gradual reintroduction of upper body movement and resistance training can begin, with careful monitoring of symptoms, surgical site healing, and patient confidence. Resumption of full upper extremity strength training should always be done under medical guidance and may be safely initiated 6–8 weeks post-implant in most cases, depending on individual recovery and physician clearance.
ICDs, Medications, and Heart Rate Monitoring
Many individuals with ICDs are prescribed beta-blockers and other heart rate lowering medications. These medications can significantly blunt your heart rate response to exercise, however, it is important to note that medication levels in your system can wear off throughout the day and a missed dose can significantly elevate your heart rate beyond expected levels.
For example, if you take your beta blocker dose in the morning and exercise later in the evening, your heart rate may rise more than usual, potentially approaching your ICD’s shock threshold. This highlights the importance of consistent heart rate monitoring during exercise and noting when you take medications and when you exercise. Adjusting your intensity or exercise timing may be necessary to stay in a safe heart rate zone.
Monitoring and Targeting the Right Heart Rate Zone
Whether you have a pacemaker or ICD, it is important to understand your heart rate
Here’s a general guideline:
For Pacemakers ensure an adequate heart rate increase during exercise. HR should be around or above 100 bpm and approaching max tracking rate during moderate to vigorous exercise
For ICDs prevent heart rate from approaching trigger rate. Exercising HR must remain at least 10 bpm below trigger rate
If your heart rate isn’t rising with activity—or is rising too high—you’ll need to adjust:
The type of exercise
The timing of exercise based on prescribed dose of medications
Your intensity
Or discuss reprogramming with your Exercise Physiologist and/or cardiologist
Building a Safe and Effective Exercise Routine
When exercising with a pacemaker or ICD, your routine should include three core components:
Aerobic Training
Walking, elliptical machines, cycling (with considerations mentioned above), or water aerobics.
Aim for 20–45 minutes, 3–5 days per week, at a moderate intensity (you should be able to talk but not sing).
Strength Training
Focus on major muscle groups with light-to-moderate resistance.
Avoid heavy lifting, especially above shoulder height early on post-implant.
2–3 sessions per week is ideal.
Flexibility and Balance
Include stretching and gentle mobility work.
Activities like yoga or Tai Chi can help improve posture and reduce fall risk.
Always warm up before and cool down after to prevent sudden heart rate fluctuations, and avoid any exercise that involves direct pressure or trauma over the device site.
Be aware of device placement—avoid contact sports or heavy chest exercises that may put pressure on the implant site. Initially, resistance bands and machines may offer more control and fewer safety issues than free weights.
Talk to Your Healthcare Provider
Before starting or modifying your exercise program, it’s important to consult with your cardiologist or device clinic. They can provide information about:
Your device’s sensor type and exercise response
Safe heart rate ranges
Any restrictions related to arm movement or lifting
Whether your pacemaker is programmed to respond adequately during the type of exercise you enjoy
They may also recommend a formal stress test to assess your fitness level and ensure that the device is responding appropriately during exercise.
Final Thoughts
Having a pacemaker or ICD doesn’t mean giving up on an active lifestyle—in fact, it’s an even stronger reason to stay mobile and fit. By understanding how your device works, what your heart rate targets should be, and how to recognize when your device isn’t responding as expected, you can exercise with confidence.
Work closely with your healthcare provider to ensure you know:
Whether your pacemaker is rate-responsive or continuously pacing.
Your pacemaker’s maximum track rate and resting rate.
Your ICD’s shock trigger rate, and the safe heart rate zone for exercise.
How medications like beta blockers may influence your heart rate
If you have a pacemaker or ICD it’s essential to consider the underlying diagnosis that led to the device’s implantation. Conditions such as heart block, sick sinus syndrome, atrial fibrillation, or heart failure all carry unique implications for exercise tolerance, symptom monitoring, and safety precautions. The type and severity of the cardiac condition will influence how intensely and how frequently a person can train, what heart rate ranges are appropriate, and what symptoms require attention. If you’re unsure how your diagnosis affects your ability to exercise safely, contact us at theonlineexerciseclinic.com. One of our qualified Exercise Physiologists can guide you through a personalized approach to activity that keeps your heart safe while helping you stay active and strong.
Exercise is medicine, and with the right knowledge and support, it’s a powerful tool—even with a pacemaker or defibrillator on board.
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.
