Exercise Guidelines and Special Considerations for Cardiac Patients Following an Implantation of a Cardioverter Defibrillator (ICD)

It has been demonstrated that ICD improves survival in heart failure patients. It is also known that exercise can provoke arrhythmias, which can lead to fired shocks from the device. However, the American College of Cardiology (ACC) and the American Heart Association (AHA) highly recommend physical activity to these patients, due to the established advantages of exercise on their functional capacity. Even though patients with ICD usually have lower VO₂ peak levels (before training) and high prevalence of anxiety, studies show significant improvements in peak VO₂ after training. However, diagnostic exercise testing should be performed prior to recommending exercise training, in order to detect patients with high risk for arrhythmias.

In general, exercise training can begin six weeks following the implantation of the ICD. It is recommended to perform aerobic activities according to the standard guidelines, gradually reaching five days a week, 30 minutes at moderate intensity (40-80% heart rate reserve). It is important to monitor these patients in order to detect arrhythmias and to maintain target heart rate below 10bpm of programmed shock of the ICD. Resistance training can be engaged after six weeks of transplant or after four weeks in a CR program. Activities involving raising the arms above the shoulders or reaching behind the back using resistance are generally prohibited, in order to prevent dislodgment of the electrodes. There are several exercises that can be performed immediately following the procedure for maintaining normal range of motion, facilitating the healing process and relieving the pain of the upper body.