Exercise Interventions in Patients with Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy: A SYSTEMATIC REVIEW and META-ANALYSIS

Daniel A. Steinhaus, Steven A. Lubitz, Peter A. Noseworthy, Daniel B. Kramer

Research output: Contribution to journalReview article


Purpose: Physical activity improves outcomes across a broad spectrum of cardiovascular disease. The safety and effectiveness of exercise-based interventions in patients with implantable cardioverter-defibrillators (ICDs) including cardiac resynchronization therapy defibrillators (CRT-Ds) remain poorly understood. Methods: We identified clinical studies using the following search terms: "implantable cardioverter-defibrillators"; "ICD"; "cardiac resynchronization therapy"; "CRT"; and any one of the following: "activity"; "exercise"; "training"; or "rehabilitation"; from January 1, 2000 to October 1, 2015. Eligible studies were evaluated for design and clinical endpoints. Results: A total of 16 studies were included: 8 randomized controlled trials, 5 single-arm trials, 2 observational cohort trials, and 1 randomized crossover trial. A total of 2547 patients were included (intervention groups = 1215 patients, control groups = 1332 patients). Exercise interventions varied widely in character, duration (median 84 d, range: 23-168 d), and follow-up time (median 109 d, range: 23 d to 48 mo). Exercise performance measures were the most common primary endpoints (87.5%), with most studies (81%) demonstrating significant improvement. Implantable cardioverter-defibrillator shocks were uncommon during active exercise intervention, with 6 shocks in 635 patients (0.9%). Implantable cardioverter-defibrillator shocks in follow-up were less common in patients receiving any exercise intervention (15.6% vs 23%, OR = 0.68; 95% CI, 0.48-0.80, P <.001). o2 peak improved significantly in patients receiving exercise intervention (1.98 vs 0.36 mL/kg/min, P <.001). Conclusion: In conclusion, exercise interventions in patients with ICDs and CRT-Ds appear safe and effective. Lack of consensus on design and endpoints remains a barrier to broader application to this important patient population.

Original languageEnglish (US)
Pages (from-to)308-317
Number of pages10
JournalJournal of Cardiopulmonary Rehabilitation and Prevention
Issue number5
StatePublished - Sep 1 2019



  • exercise
  • implantable cardioverter defibrillator
  • meta-analysis
  • review

ASJC Scopus subject areas

  • Rehabilitation
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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