Exercising after pacemaker

I've had my pacemaker for over a year now, and unfortunatly I haven't felt any significant improvment.. Aside from my heart beating up to 160bpm, my max pre-pacemaker was about 90bpm on the stress test. Anyways, I have been struggling to pushing myself and get exercise  with my pacemaker. I have anxiety and fear that has been holding me back from  just see how far I can go. This is partly due to the fact that, in previous attempts at working out (brisk walk/jogging) I would get my heart rate up, but would eventually get scared after seeing such high bpm and stop. And I would get an episode of tackycardia hours following the workout. Has anyone else had a similar experience or faced any anxiety when exercising? 


4 Comments

Exercising after pacemaker

by Gemita - 2023-10-27 06:31:08

Vtl:  from your post, I see two problems.  One clearly being with your continuing anxiety and the other possibly being with your settings, in particular a setting like Rate Response or other related setting that may need adjusting.   You clearly state “I have anxiety and fear that has been holding me back from just seeing how far I can go. This is partly due to the fact that, in previous attempts at working out (brisk walk/jogging) I would get my heart rate up, but would eventually get scared after seeing such high bpm and stop”.  

What I am picking up is not your inability to exercise with your pacemaker, but your fear of pushing yourself too much when you reach or see a higher heart rate displayed on your monitor.  One way of helping is perhaps not to check your heart rate each time you exercise and to just live your life and enjoy your exercise, without restriction.  Your body would certainly tell you if you got into trouble since you might pass out, get breathless, experience chest pain or other symptoms and I don’t think you are getting symptoms like these are you?  

So I am picking up more in the way of anxious thoughts (which are real and need addressing too) rather than actual symptoms, as I have described, when you reach higher heart rates.  I also see that you are experiencing tachycardia episodes hours “after” any workout.   This may or may not be related to your workout.  Some of us get tachycardia episodes during workouts, others may notice higher than normal heart rates when at rest, particularly after strenuous exercise.  Tachycardia hours after exercise may not be related to strenuous exercise at all since you might be getting some abnormal heart rhythms.

I have arrhythmias which seemed worse for the first few months following my implant as my heart was settling down and getting used to being paced.  However I see you have had your pacemaker for over a year now, so healing should no longer be an issue.  I would ask your doctors if you could have some extra monitoring to try to pick up what is happening and to establish the frequency, duration, significance of any new heart rhythm disturbance so that they can advise how best to treat it, if indeed treatment is required?  I would also ask for help with your continuing anxiety.  Many of us need emotional support long after our pacemaker implant until we slowly build confidence and come to terms with our heart condition and pacemaker.  Talking therapy like Cognitive Behavioural Therapy is very helpful for this, rather than suppressing our fears with medication.  Also a low dose beta blocker is sometimes used for the treatment of both anxiety and intermittent high heart rates.  A low dose beta blocker may help calm both conditions, so please speak to your doctors. 

I used to be anxious about my rhythm disturbances and this seemed to make them more active.  Now that I have a diagnosis and am on appropriate treatment, I no longer fear them.  I hope with understanding and with time, you can be helped too.  

Reassurance

by piglet22 - 2023-10-27 07:17:16

I would echo Gemita's advice and speak to someone about your anxieties. That someone needs to be your cardiology specialist,

You say you have complete heart block (CHB) which is a common reason for having a pacemaker (PM) fitted.

CHB comes in many types ranging from symptomless, type 1, through to full blown type 3 that comes with debilitating symptoms like permanent bradycardia that will make you feel very ill.

It's also common for CHB to progress through the various stages.

From my own experience, you would not be getting up to 90 BPM with one of the higher grades of CHB. Even flat out on an exercise bike, I would be lucky to achieve 40 BPM which was type 2 Mobitz and has now progressed to type 3.

Once diagnosed and PM fitted - 18 years ago - I was able to fully exercise and was doing some pretty grueling bike rides. I never worried about heart rates going high and the only thing I checked was that the IPG rate (Implanted Pulse Generator rate, a minimum rate set on the PM of say 60 or 70 BPM which the PM maintains. It doesn't but that's another story).

However, my high rate is not yours and I rarely went over 100 BPM. If I was getting 140 BPM plus, I would be wondering what was going on.

A complicating factor is that I was already on medication for hypertension including the beta blockers (BB) that Gemita mentioned and those slow you down.

With the PM in place, you should be able to take a beta blocker without ill effect.

Many people on this forum will be taking something like Bisoprolol fumarate which is a potent BB at quite low doses, I wouldn't worry if one were prescribed. Allegedly, some sports persons in high concentration, low physical demand sports like snooker or darts, regularly take BBs to aid their concentration.

The main thing to do is sort your anxieties out by talking to a pacing specialist, soon, as anxiety and related stress is going to do you no good at all.

You have years ahead of you and you need to get down to enjoying them. You also have a heart condition that needs looking after, but you are in good company. Pacing problems are very common and generally very fixable.

Good luck

Bpm

by akaDM - 2023-10-27 09:49:21

I have CHB (IE type 3).

My pm is set to 156bpm max; I doubt they'd put it higher given my age. My Fitbit occasionally says I go over that when exercising hard (but that's most likely a mismeasurement). I don't worry at all about getting into the 150s. If I get a bit tired or breathless partway up a hill, I rest a few minutes and go again. I know my fitness won't improve without pushing myself and I can go at lower levels (say BPM below 135) indefinitely, but also without improvement. My resting heart rate has always been reasonably low, but heart rate with exercise has always gone high at times. So this feels normal for me. And they say that there's nothing (else) wrong with my heart, so I see no reason to worry.

I'd suggest talking to your docs about your specific observations and worries. Your anxiety is unlikely to go until you're confident that they are on top of it, and also have your settings right. They need to respond to what you have posted here. Maybe more stress testing will help.

Personally I would have expected to reach higher BPM with pacemaker than before, given that some of your heart's signals were being blocked before.

exercising after a pacemaker

by Selwyn - 2023-10-27 19:27:40

A pacemaker is set to provide a maximum heart rate based on the experience of the pacemaker electrophysioloigists , the fitness of the patient, as well as the psychology of the patient.

There are no firm boundaries when negotiating maximum heart rate. The ususal 220-AGE is inaccurate ( see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523886/). 

I have to say, what do you want? And more to the point, why? If you have complete heart block you are 100% pacemaker dependent. 

At your age, without coronary artery disease, you can reach your maximal heart rate ( what ever that is?) with a certain degree of safety.  

Personally, I have no interest in reaching any limit to my cardiovascular output. Why should I want to put myselft at risk? The purpose of exercise is to keep fit.

So many peope forget that. So many peope have died during exercise by pushing the boundaries ( You have only see the history of the first marathon- https://marathonhandbook.com/marathon-history/   characterised by death). I would suggest  to you as a fit 21 year old - keep yourself fit. Do reasonable exercise regularly. There is no merit in pushing the boundaries, indeed such exercise is characterised by a mortality. 

(https://nypost.com/2017/10/17/you-can-exercise-yourself-to-death-says-new-study/)

The 2018 physical activity guidelines for Americans, consistent with the 2008 guidelines, recommends that adults should engage in at least 150 minutes of moderate intensity aerobic physical activity or at least 75 minutes of vigorous intensity aerobic physical activity each week, or an equivalent combination of both. Furthermore, adults should engage in muscle strengthening activities of moderate or greater intensity on two days or more each week. 

With regard to pacemakers the rate response ( ie. the ability of the PM to raise your HR with exercise) has settings for onset speed of response and OFF SET. You may need to look at the latter if your heart rate is staying high for too long after exercise. 

You will find, if you talk to people of age, that they take life in moderation.  At the end of the day it may be better to be a tortoise than a hare! Who lives the longest?

Maybe, it is time for a re-think?

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