Exercising with Pacemaker

Hello,

I am a 59 year old male with a 15+ year history of lone AFIB but no CAD. After 4 ablations, my AFIB was finally knocked out (if anyone wants info on who did my last procedure I would be happy to provide that) but developed sick sinus syndrome, hence a PM no defib was implanted on 10/31/12 at John Hopkins, so much for Trick or Treat. It is a two wire PM with wires in the right atrium and ventricle. I am currently on no meds. In Jan I started exercising for all the obvious reasons. I can get my heart rate into the 130/140s over 40+ minutes on the elliptical, but barely run a 1/4 mile without having to stop. And I still get winded walking up a flight of stairs. Being a former Marine and exercising most of my life, I know the difference between being out of shape and being winded for other reasons. I never get that "pumped" feeling I used to get when exerting myself and the Afib was kicking in. My goal is to run the Marine Corp Marathon in 2015. I plan to stick with exercising, but I am questioning if I will ever start to feel like I am making progress in my conditioning and should I go back to my cardiologist and have them tweak the PM again. They have tweaked it twice to allow my heart rate get up to the level it needed to. I was thinking that it need adjusting on low end so I don't get winded with minor exertion. I thought it might be a good idea to have them monitor me while doing a stress test to see how my heart is performing and then make adjustments accordingly. Of course I have no idea how much they can adjust PMs. Has anyone ever done something like that? Any and all feedback would be greatly appreciated. Thank you. Bill

7 Comments

exercising with pm

by BillRanken - 2014-04-10 02:04:35

Inga and Jerry. Wow! Thank you for all the great input. I have scheduled an appointment with my cardio, (chief of EP at Johns Hopkins) May 19th. I gotta believe he is on top of all that. I will email pior to the appointment and fill him on on why I will be there. On my last visit he mentioned that if need be he could get the rep in to tweak it. Very interesting in what type of exercise and or what part of the body is involved will activate it etc. Makes sense. Also the idea of shaking it to fool it was cool. Unfortunately I did not discuss my exercise plans prior to getting the PM. One, because it was done rather abruptly, as I was having pauses up to 11 seconds and secondly I have not exercised in years due to the afib. I do start out slow on the elliptical as well on the treadmill or track, which I tried out for the first time Sunday. I walk a 1/4 mile first and then try to jog as far as I can, but like I said can hardly make an 1/8 of a mile. Also, I was hoping to get in some bike riding with my kids, I guess I'll have figure out how to fool it to kick in. Don't get me wrong, having the afib gone is great, just now want to try and get back in the swing of exercising, something I have missed a long time. Again, thank you for all your input. I'll post any developments

Bill

p.s.

by Tracey_E - 2014-04-10 10:04:24

Your post showed up twice. I deleted the duplicate. (I'm one of the moderators)

adjustments

by Tracey_E - 2014-04-10 10:04:39

It can take a few tries to get it right! They like to make the changes in small increments, try it out, then tweak more if necessary. The average pm patient is not active, and those of us who are active all have different needs so there's no one-size-fits-all fix. A stress test while on the pm computer is an excellent way to get to the bottom line and see exactly what your heart is doing on exertion. Don't be shy about going back.

Rate response

by golden_snitch - 2014-04-10 11:04:15

Hi Bill!

Before you had the pacer put in, did you talk to cardio about what kind of exercise you'd like to be able to do? I'm just wondering, because with a sick sinus syndrome you'll probably need the pacemaker to adjust your heart rate to your level of activity (called "rate response"). Now, different pacemaker manufacturers use different sensors to measure activity and adjust the rate. And there are limitations to some sensors with regards to how well they manage to adjust the heart rate for different activities.

I read in your profile that you have a St. Jude pacemaker. St. Jude uses a so called "accelerometer" as a rate response sensor. This is a motion sensor; it does not react to increased breathing, but only to movement, typically upper body movement. An accelerometer reacts quickly when you start exercising and when you stop, but since it ignores the breathing rate it often does not keep up with lengthy endurance trainings. And because it needs upper body movement, it also usually doesn't react well to cycling or any other activities where your upper body doesn't move much.

There are different settings which can be tweaked to optimize the function of any rate response sensor, your accelerometer included. So, you might get better with a little more tweaking. And, like Tracey, I think that doing a stress test is a great idea. Just keep in mind that this stress test should be done using a treadmill and not a bicycle ergometre, because the accelerometer might not be responding to cycling.

If tweaking doesn't help at all, you can discuss replacing the pacemaker with a model that works with a different rate response sensor. There are only two alternatives out there: First, a "blended sensor" combining an accelerometer with a minute ventilation sensor, and secondly a "closed-loop stimulation" sensor which works by measuring cardiac contractility. But try the tweaking first, and probably even have a St. Jude tech come in to help with that, because the techs know their devices inside out, and usually better than any cardio. I just wanted to mention the other sensors to give you a perspective in case tweaking doesn't help.

Best wishes

Inga

Exercising with PM

by BillRanken - 2014-04-10 11:04:59

Thank you for your response and deleting the second post. I will contact my doctor and see what they can do. I will post my results. Thank you again. Bill

Agree

by gleesue - 2014-04-10 12:04:42

I agree with everything above, but want to add a couple things. I can get winded going up a flight of stairs and that is because it takes a bit before the PM knows your doing something. By the time I get to the top it kicks in and I am winded because by then I am done. Also, you need to warm up as you go. On the elliptical, because of the action you warm up and can go on and on. With running you just take off and go. Try starting out a little slower to get things warmed up and in tune. I play a lot of tennis and when I first start I can get winded because of the quick action. But once things get going all is fine. Another thing my EP said is to put your hand on the PM and shake it. That fouls it into thinking you are working harder and speeds things up quicker.

Because of all the exercise and other things I do it took about 4 adjustment to get things fine tuned.

Good luck, but be sure to keep it up and I hope you can do the marathon.

Jerry

Mission Accomplished 10/25/15!!!

by BillRanken - 2015-10-28 11:10:01

After 8 months of grueling, boring and tedious training. I completed the Marine Corps Marathon on Sunday. I wasn't the fastest that is for sure but I wasn't the slowest either. My goal was to complete it, which I did in 6:11:34. I am very pleased, considering it was only about 2 months ago that I still could not do 1 mile without having to stop and walk (there was alot of walking on Sundat). I did have my PM tweaked and it turned out that I did not heed to have the bottom wire (ventricle) pacing, so they turned that off. This was after I had them get me on a treadmill, all wired up, so they could really see what was going on when I exercised. Just wanted to share, thank everyone for their comments and encouragements and say, that if I can do it anyone can. Thanks again.

Bill

You know you're wired when...

You have a 25 year mortgage on your device.

Member Quotes

I am just thankful that I am alive and that even though I have this pacemaker it is not the end of the world.