Article-8

EXERCISE PRESCRIPTION AFTER PERMANENT PACEMAKER IMPLANTATION

Dr. Pratima Parmar (MPT cardiopulmonary)
Olympus hospital, Rajkot

Why it's done :

A pacemaker is a small device that's placed (implanted) in the chest to control the heartbeat. It's used to prevent the heart from beating too slowly. A pacemaker is implanted to help control your heartbeat. Doctor may recommend a temporary pacemaker when you have a slow heartbeat (bradycardia) after a heart attack, surgery or medication overdose but your heartbeat is otherwise expected to recover. A pacemaker may be implanted permanently to correct a chronic slow or irregular heartbeat or to help treat heart failure.

After the procedure :

You'll likely stay in the hospital for a day after having a pacemaker implanted. Your pacemaker will be programmed to fit your heart rhythm needs. Doctor recommends that you avoid vigorous exercise or heavy lifting for about a month. Avoid putting pressure on the area where the pacemaker was implanted. If you have pain in that area, taking medicines available, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).

Why Regular Physical Activity :

  1. Increases your energy
  2. Improves your mood and sleep
  3. Helps keep your mind sharp as you get older and reduce your risk of dementia and Alzheimer’s
  4. Lowers your risk of heart disease, stroke, high blood pressure, Type 2 diabetes, several kinds of cancer and weight gain
  5. Helps you move better and slow the effects of aging

Results :

A pacemaker helps keep your heart beating safely at rest and during exercise. Many people get a pacemaker because they’re too short of breath or weak to do activities like housework (or simply walking) because of problems with their heart rhythm. Gradually increasing your level of physical activity can help you return to activities that are important to you. Moderate-to-vigorous exercise, such as aerobic activity and strength training, are safe for people with a pacemaker. Having a pacemaker should improve symptoms caused by a slow heartbeat such as fatigue, lightheadedness and fainting. Because most of today's pacemakers automatically adjust the heart rate to match the level of physical activity, they may be able to allow you to resume a more active lifestyle.

Physicaltherapy after PPI :

Communicate with Doctor :

Physical activity is normal with pacemaker implantation patients, after proper guidelines of cardiologist and cardiac physiotherapist, start accordingly

Start Gentle Motion :

Use of upper body in gentle range of motion activites (such a shoulder rolls) for first 24 hours after PPI.

Start simple Exercise :

Light to moderate activities such as walking can be started within 2 to 3 days after PPI. Its easy to wall around the corridor area.

Aerobics Exercises :

After 21 to 45 days after PPI according to physiotherapist you can start aerobic exercises for upper and lower limbs, treadmill, cycling and brisk walking 4-5 days a week.

Before Initiation of Exercise Program :

  1. To help with healing after pacemaker implantation, avoid moderate-to-vigorous activities using your upper body (such as swimming, bowling, golf and weights) for 4 to 12 weeks. Ask your doctor when it’s OK for you to return to these types of activities.
  2. Gradually increase your pace or speed over several days to weeks. Once you have recovered from your pacemaker procedure, you can begin to return to your preferred physical activities.
  3. If you play contact sports, such as hockey or football, ask your health care provider whether it is OK to return to these sports.
  4. Watch for symptoms that the pacemaker might not be working right, particularly in the first 3 months. These include unusual shortness of breath, tiredness, or weakness. If these occur, stop exercise and contact your health care provider.

Aerobic Exercises :

Aerobic activity increases your heart rate and breathing. Build up to doing at least 150 minutes/week of moderate-intensity activity (such as a brisk walk, light cycling or water exercise). You’ll improve your stamina and heart health. When starting a new (or returning to a previous) program, begin with light to medium effort. If you monitor your heart rate during exercise, ask your health care provider what heart rate limits are appropriate for you. Gradually increase your pace and time spent being active. Start low and go slow! Warm up and cool down before and after exercise.

Strength Training :

Strength training can help your muscles work better and increases your strength for daily and recreational activities. Slowly increase how much you lift and how often. Avoid straining or holding your breath when lifting. This increases your blood pressure.

What ?

  • Aerobic exercise : Any rhythmic, continuous activity.
  • Strength training : Hand weights, resistance bands, weight machines, or your own body.

How often ?

  • Aerobic exercises : 3-5 days a week

How hard ?

  • Fairly light to somewhat hard

How much ?

  • Aerobic exercises : Start w/5-10 mins. Gradually build up to 20-60 minutes
  • Strength training : 10-15 repetitions (for each major muscle group). Perform 1-3 times.

Other types of Physical Activity :

  1. Flexibility Stretch your muscles 2-3 days/week (or every day) to the point of feeling tightness. Hold for 10-30 seconds (30-60 seconds for older adults). For example, stretch your calves or the back of your thighs.
  2. Yoga, Tai Chi and Pilates All help balance, flexibility and strength, and are relaxing too.
  3. Take More Steps Use a smart phone or activity tracker. Count your steps each day for the first few weeks. Slowly build to 2,000 more daily steps than you’re doing now. Good job! Then aim for 7,000-9,000 steps/day.
  4. Just for Fun Find ways of being active that are just plain fun. Try pickleball or ping pong. Dance. Tend your garden. Play outdoors with your kids or grandkids. Find what makes you smile and do it often.