Exercise and Sports Participation in Patients with Cardiac Implantable Electronic Devices

The term cardiac implantable electronic devices (CIEDs) encompasses pacemakers (PMs), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, which are well-established treatments for cardiac arrhythmias and heart failure with reduced ejection fraction. Advances in CIED therapy have led to an increasing number of patients with cardiovascular disease (CVD) receiving such devices. In general, low levels of physical activity are associated with a higher risk of cardiac and all-cause mortality in patients with CIED. These patients are considered eligible for exercise programs not only to improve prognosis related to their underlying heart disease but also to facilitate psychological adaptation to living with the device, to enhance evaluation of device performance and, particularly in ICD recipients, to reduce the risk of inappropriate shocks. Studies have shown that exercise training improves physical performance in CIED patients without increasing the risk of adverse events. A comprehensive clinical evaluation, a personalized exercise plan, appropriate device programming, and regular follow-up are essential to ensure that patients can safely engage in effective physical activity tailored to their specific needs. Participation in sports is another consideration for many CIED patients. Recent guidelines recommend encouraging individuals with CIEDs to engage in sports activities, unless contraindicated by their underlying heart conditions. It is generally accepted that low- to moderate-intensity leisure-time sports activities are safe and clinically beneficial for most individuals with a CIED. However, individualized recommendations may vary significantly depending on the patient's cardiovascular health, the impact of physical activity on their underlying disease, and the type of implanted device.