Although the primary indication for implantation of a pacemaker or an implantable defibrillator (ICD) may not be the intention to continue playing sports, their practice is not incompatible.
It has been demonstrated that sport has wide-ranging psychosocial benefits that favor quality of life in general and, in particular, that of individuals with cardiovascular disease. One of the main benefits of cardiac rehabilitation is the reduction of symptoms of anxiety and depression. In addition, there is sufficient evidence to show that moderate physical activity can be beneficial for wearers of these intracardiac devices. Although not all sports would be recommended, a general and absolute prohibition cannot and should not be established. It is key to adapt each situation, following some general principles.
General physical activity
Generally, people with pacemakers are not restricted in sports, except in sports where there is a risk of collision. Some athletes are “pacemaker-dependent”, which would constitute a formal contraindication. Except in this case, all other pacemaker wearers should be aware of the risks and, if they assume them, it is advisable to wear protective equipment designed to cushion possible shocks.
On the other hand, in patients with ICDs, safety is not so clear, according to recommendations made by the American Heart Association and American College of Cardiology in 2005. These recommendations warned of a possible increased risk of arrhythmias associated with vigorous physical activity, with restrictions on its performance.
All patients with pacemakers or defibrillators must always carry the European card that identifies them. At the hospital, in addition to this card, they are given a guide with the peculiarities of their device, recommendations and precautions. This is a document that they should read and be familiar with.
Patients with an ICD must wait six weeks after implantation or after receiving a shock before resuming physical activity.
Recommendations for pacemaker or implantable defibrillator patients
- Contact sports should be avoided because of the risk of fracture or dislocation of the device.
- Extreme movements of the homolateral arm should be avoided, as they may increase the risk of fracture and dislocation of the device.
- Sports in which dyspnea or syncope may expose patients to additional risks, such as drowning, falls from height, etc., should be avoided.
- Sports that could be exposed to electromagnetic fields should be avoided.
- Physical exercise in young patients can induce sinus tachycardia that sometimes exceeds the defibrillation threshold and causes inappropriate shocks that produce pain and psychological problems such as anxiety and lack of rest. This can even lead to aversion to the defibrillator. Therefore, it is very important to adjust the device settings and to perform sports at an intensity level below the defibrillation threshold heart rate.
- Antitachycardia/antibradycardia therapy programming should be considered because there are structural or arrhythmogenic conditions that may increase the risk of atrial arrhythmias.