Efficacy and Safety of a Combined Aerobic, Strength and Flexibility Exercise Training Program in Patients with Implantable Cardiac Devices

The “FIDE Project” (Fitness Implantable DEvice) was organized by the Instituteof Sports Medicine and Science and the World Society of Arrhythmias with the aim of demonstratingthe usefulness of exercise training in improving functional capacity in patients with implantablecardiac devices. Materials and Methods: Thirty sedentary patients were selected for the project(25 males and 5 females), with a mean age of 73 ± 5 years (range 44–94 years). Twenty-five wereimplanted with a Pacemaker (PM) and five with an Implantable Cardioverter Defibrillator (ICD).Atrial fibrillation/atrial flutter was present in ten (34%) patients, post-ischemic dilated cardiomy-opathy in five (17.2%), sick sinus syndrome in six (20,7%), complete atrium-ventricular block insix (20.7%), hypertrophic cardiomyopathy in one (3.4%) and recurrent syncope in one (3.4%). Thebaseline assessment comprised cardiovascular examination, resting and stress ECG, cardiopulmonaryexercise testing (V ·O2peak), strength assessment of different muscle groups, and a flexibility test.The same measurements were repeated after 15–20 consecutive training sessions, over a 2-monthperiod. The exercise prescription was set to 70–80% of HRR (Heart rate reserve) and to 50–70%of 1RM (1-repetition maximum, muscular force). The training protocol consisted of two trainingsessions per week performed in our institute, 90 min for each (warm-up, aerobic phase, strengthphase and stretching) and one or more at home autonomously. Results: The cardiopulmonary testingafter the training period documents a significant improvement in V ·O2peak (15 ± 4 mL/kg/min vs.17 ± 4; p = 0.001) and in work load (87 ± 30 watts vs. 108 ± 37; p = 0.001). Additionally, strengthcapacity significantly increased after the cardiac rehabilitation program, (quadriceps: 21 ± 18 kg vs.29 ± 16 kg, p = 0.00003). Flexibility tests show a positive trend, but without statistical significance(sit-and-reach test: −19 ± 11 cm vs. −15 ± 11.7 cm; back-scratch test: −19 ± 11.6 cm vs. −15 ± 10 cm;lateral flexibility right −44 ± 1.4 cm vs. −43 ± 9.5 cm; left −43 ± 5 vs. −45 ± 8.7 cm). Conclusion:A brief period of combined aerobic, strength and flexibility exercise training (FIDE project) proved tobe effective and safe in improving functional capacity in patients with cardiac implantable devices.