Exercise and Physical Activity
Patient Perspective Paper 3
These notes are a patient’s view on physical exercise for those with an ICD. They follow an interesting discussion
that we had with Hannah Hindmarsh of the JR Cardiac Rehabilitation Service a few months ago. I have on file her helpful
leaflet on “Getting Started”, the booklet published by the Arrhythmia Alliance, and some information on a “Health Walks”
scheme in Oxfordshire. I bring my stock of information to every meeting of the Group.
I must emphasise once again that notes such as these are very much my personal interpretation and I apologise
but take no responsibility for any inaccuracy. If you are worried in any way concerning your own position, please consult
your own doctor or consultant.
Introduction. ICDs are given to people who are at increased risk of heart rhythm disturbances. Your physical
activity is influenced by the diagnosis of your heart condition, not the fact that you have an ICD. Therefore it is
important to state that you are only referred to an official hospital based cardiac rehabilitation course, if it is
considered that your heart condition makes this necessary. Not all ICD patients are therefore referred – this causes
misunderstanding. It is also important to state at the outset that exercise is not a substitute for medication.
It may reduce the necessity of some drugs and is a complement to others.
Physical Activity & Exercise. Physical activity is any bodily movement produced by the muscles that
utilises energy expenditure. Exercise is planned and structured and contains repetitive body movements. If you
are then physically fit, you have a set of skills which enables you to participate in a particular physical activity.
It is therefore important that on leaving hospital, a heart patient keeps up a reasonable level of physical activity
and engages in exercise suitable for their condition. Expert advice (see below) is obviously helpful. It is also helpful
to have an aim to reach a state of physical fitness for a particular activity. In the early stages this might be to do
a walk of a certain distance every day. Later it might involve reaching a state to participate in a desired sport such
as a round of golf, a session of surfing or a game of tennis,
Importance of regular exercise. It reduces risk of another heart attack (by about 25-30%). It reduces angina
(i.e., its threshold). Improves collateral circulation. It helps to the control of high blood pressure. Reduces blood
cholesterol. Helps the loss of weight. Reduces stress. Improves the control of a diabetic condition. Helps to manage
osteoarthritis. Helps the maintenance of independence. Improves sleep patterns. Improves feelings and self-confidence.
Effect on the body. Exercise increases oxygen demands and it therefore increases the efficiency of the heart and
other muscles. It therefore reduces the demands on the heart in everyday living. It also increases coronary flow so
reducing the risk of strokes.
Activity guidelines. Aim for a minimum of 30 minutes 5 days per week. Any activity should be of moderate
intensity, enough to enable you to just hold a conversation whilst doing it. Your maximum heart rate should be 60-70%
of a figure equal to 220 minus your age. Aerobic activity which uses large muscle groups is the best (e.g. walking,
cycling, and swimming.) Recreational activities (e.g. swimming) should never be done alone. In the case of swimming
tell the lifeguard about your condition before going in the water however it is very good for strengthening the upper body.
Avoid heavy lifting (e.g. weights) and contact sports are a definite no-no. Avoid snorkelling or scuba diving. It is
important to warm up before any sustained exercise and to cool down afterwards.
ICD considerations. Know your ICD settings for the threshold figure before therapy is delivered by a shock
from the machine. Some medication such as a beta-blocker will affect the intensity of exercise available to you.
If you are in a gym, take advice. Ask whether a Phase 4 Cardiac Rehab Instructor is available to advise you.
Carry your ICD card and GTN spray with you at all times. For the first few weeks after your operation avoid any
physical activity raising your arms above the horizontal. Some ICDs are triggered specifically by swimming.
Reasons for stopping exercise. Immediately stop or slow down if you have pains in your chest, neck or
jaw (use your GTN spray), have excessive shortness of breath, experience nausea or dizziness or just feel generally unwell.
Further advice. The websites – www.incirculation.net, www.heartrhythmcharity.org.uk, www.arrhythmiaalliance.org.uk,
www.heart2hearts.co.uk, might be helpful. The Arrhythmia Alliance publishes a booklet entitled “Physical activity and
exercise advice for patients with an ICF” – I have copies of this. The British Heart Foundation has a booklet entitled
“Heart Attack and Rehabilitation”.
GCS/10.12.07
Geoff Shaw