Leisure-Time Activities of Patients with ICDs: Findings of a Survey with Respect to Sports Activity, High Altitude Stays, and Driving Patterns

Clinical Implications for Exercise at Altitude Among Individuals With Cardiovascular Disease: A Scientific Statement From the American Heart Association

An increasing number of individuals travel to mountainous environments for work and pleasure. However, oxygen availability declines at altitude, and hypoxic environments place unique stressors on the cardiovascular system. These stressors may be exacerbated by exercise at altitude, because exercise increases oxygen demand in an environment that is already relatively oxygen deplete compared with sea‐level conditions. Furthermore, the prevalence of cardiovascular disease, as well as diseases such as hypertension, heart failure, and lung disease, is high among individuals living in the United States. As such, patients who are at risk of or who have established cardiovascular disease may be at an increased risk of adverse events when sojourning to these mountainous locations. However, these risks may be minimized by appropriate pretravel assessments and planning through shared decision‐making between patients and their managing clinicians. This American Heart Association scientific statement provides a concise, yet comprehensive overview of the physiologic responses to exercise in hypoxic locations, as well as important considerations for minimizing the risk of adverse cardiovascular events during mountainous excursions.

Impact of the implantable cardioverter defibrillator on confidence to undertake physical activity in inherited heart disease: A cross-sectional study

BACKGROUND

Physical activity is associated with improved quality of life. Patients with an implantable cardioverter defibrillator (ICD) face unique clinical and psychological challenges. Factors such as fear of ICD shock may negatively impact on physical activity, while a sense of protection gained from the ICD may instil confidence to be active.

AIM

We aimed to examine the impact of an ICD on physical activity levels and factors associated with amount of activity.

METHODS

Two cross-sectional studies were conducted. Accelerometer data (seven-day) was collected in March-November 2015 for 63 consecutively recruited hypertrophic cardiomyopathy patients, with or without an ICD, aged ⩾18 years. A survey study was conducted in July-August 2016 of 155 individuals aged ⩾18 years with an inherited heart disease and an ICD in situ.

RESULTS

Based on the International Physical Activity Questionnaire, mean leisure time physical activity was 239 ± 300 min/week with 51% meeting physical activity guidelines. Accelerometry showed that mean moderate-vigorous physical activity was the same for patients with and without an ICD (254 ± 139 min/week versus 300 ± 150 min/week, p=0.23). Nearly half of survey participants ( n=73) said their device made them more confident to exercise. Being anxious about ICD shocks was the only factor associated with not meeting physical activity guidelines.

CONCLUSIONS

Patients with inherited heart disease adjust differently to their ICD device, and for many it has no impact on physical activity. Discussion regarding the appropriate level of physical activity and potential barriers will ensure best possible outcomes in this unique patient group.

Sports participation in patients with implantable cardioverter-defibrillators

The safety of sports participation for patients with implantable cardioverter-defibrillators (ICDs) is not yet defined, and current recommendations in both Europe and the US restrict these patients from competative sports more vigorous than golf or bowling. Postulated risks include increased frequency of arrhythmias, inability of the ICD to terminate ventricular arrhythmias during the metabolic changes accompanying extreme exercise, injury to the patient, or damage to the ICD system. However, survey data suggest that many ICD patients do participate in sports, and risks may be fewer than postulated. Ongoing research will better delineate the risks of sports for patients with ICDs.