Is it safe to lift with an implantable cardioverter-defibrillator (ICD) vest?

Safety of Weightlifting with a Wearable Cardioverter-Defibrillator (Life Vest)

Weightlifting and resistance exercise with a wearable cardioverter-defibrillator (WCD/Life Vest) carries significant risk of inappropriate shocks and should be avoided during the period of WCD use. 1, 2

Primary Safety Concerns

Risk of Inappropriate Shocks During Physical Activity

• Motion artifacts from physical exertion are the second most common cause of inappropriate shocks, accounting for 32.7% of all inappropriate shock events with WCDs. 2

• Activities involving repetitive motion or vibration—including riding motorcycles, lawnmowers, or tractors—have triggered inappropriate shocks, and weightlifting involves similar repetitive upper body movements that can disrupt electrode contact and create motion artifacts. 2

• Inappropriate shocks can be arrhythmogenic, with 19 patients in one series developing sustained ventricular tachycardia or ventricular fibrillation directly induced by the inappropriate shock itself. 2

Exercise-Induced Tachycardia Risk

• Sinus tachycardia from intense exercise can trigger inappropriate shocks, as tachycardias (including supraventricular tachycardia) account for 48.9% of all inappropriate shock events. 2

• Weightlifting typically elevates heart rate significantly, particularly during compound movements or high-intensity sets, increasing the risk that the WCD will misinterpret exercise-induced sinus tachycardia as ventricular tachycardia. 3, 2

Physical Consequences of Inappropriate Shocks

• Thirty patients who received inappropriate shocks fell and suffered physical injuries, creating particular danger during weightlifting when patients may be holding heavy weights or using equipment. 2

• Conscious patients failed to use response buttons to abort shocks in 47.9% of cases or used them improperly in 20.2% of cases, meaning most patients cannot reliably prevent inappropriate shocks even when awake. 2

Guideline-Based Activity Recommendations

General Physical Activity Guidance

• Patients with cardioverter-defibrillators may participate in a wide variety of noncompetitive and noncontact physical activities, but intense exercise should not be advocated explicitly. 3

• The presence of a defibrillator does not provide license for unrestricted physical activity; rather, activity recommendations should be made in concert with the responsible electrophysiologist. 3

Specific Restrictions for WCD Users

• Activities involving burst exertion or intense competitive activity should be excluded, as these can trigger both inappropriate shocks from motion artifacts and exercise-induced tachycardia. 3, 2

• The device must maintain proper electrode pad contact with the skin to ensure effective shock delivery if needed, and vigorous upper body movement during weightlifting can disrupt this contact. 4

Clinical Algorithm for Activity Decisions

During the WCD wear period (typically 40-90 days), patients should:

1. Avoid all weightlifting and resistance training that involves significant upper body movement, Valsalva maneuvers, or exercises that elevate heart rate above 120-130 bpm. 3, 2

2. Limit physical activity to low-intensity walking, light household activities, and gentle stretching that does not cause significant electrode movement or heart rate elevation. 3, 1

3. Ensure the device is worn 23 hours per day minimum, removing it only for bathing, as compliance is critical for protection during this high-risk period. 1, 5

4. Undergo reassessment at 40-90 days for potential permanent ICD implantation, after which activity restrictions can be liberalized based on device type and underlying cardiac condition. 3, 5

Critical Pitfalls to Avoid

• Do not assume the WCD provides protection that allows unrestricted activity—the device is designed for temporary protection during a high-risk period, not to enable intense physical exertion. 3, 1

• Do not rely on response buttons to prevent inappropriate shocks during exercise—the majority of patients cannot successfully abort shocks even when conscious and alert. 2

• Avoid activities that could cause falls or injuries if an inappropriate shock occurs, as 17.3% of patients discontinued WCD use after experiencing inappropriate shocks, leaving them unprotected. 2

• Remove transdermal medication patches from areas where defibrillator pads are placed to prevent electrical arcing during any potential shock delivery. 4