Abstract 9945: Early Ambulation After an Initial Implantable Cardioverter Defibrillator (ICD) is Safe and Efficacious
Introduction: Early ambulation after hospitalization accelerates return to physical functioning and reduces post-hospital complications. After an ICD, patients are discharged with activity restrictions to prevent lead dislodgement, but evidence-based recommendations for safe exercise are not in place.
Methods: Using a single group pre-post design, 225 patients after an initial ICD were prescribed a nurse-monitored home based walking program at hospital d/c and were followed for 3 months. The mild intensity (Borg rating=3) protocol was designed to increase walking from 10 min/day to 30 min/day. Activity progression was monitored by weekly nurse phone calls. Efficacy was measured in total steps/day (Cyma Step Watch™), self-reported exercise (exercise log), and self-efficacy for walking (SEW). ICD shocks and hospitalizations were verified with medical records. ANOVA was used to determine effects on outcomes from baseline to 3 months.
Results: Patients were (mean+SD) 64+12 years old, 90% Caucasian, 75% male, EF% 35.7+17.5, having received an ICD for primary (58%) or secondary prevention (42%), with a Charlson score =2.3+1.6. Safety: There were 15 (7.6%) individuals who received 22 ICD shocks, of which 11 were inappropriate for either atrial or supraventricular arrhythmias. There was 1 appropriate ICD shock related to physical activity (elliptical trainer), but none occurred during prescribed home walking. Hospitalization for any cause was 22.8%, with 10(5%) related to ICD shocks, none of which were exercise related. Efficacy: physical activity significantly increased in steps/day (6854+3502 to 7839+4064, p<0.001), exercise times/week (4.2+3.2 to 7.1+4.3, p<0.001), SEW (7.2+2.1 to 8.8+1.5, p<0.001). At 3 months 148/225 (66%) were walking 30 min/day on 4 days/week.
Conclusions: A mild intensity early ambulation program following initial ICD implant is safe and is related to increased physical activity and self-efficacy for exercise, without being related to ICD shocks or hospitalizations. The walking protocol offers clinicians an algorithm for incorporating ambulation into activity routines in early post-ICD recovery.
Author Disclosures: C.M. Dougherty: None. E.T. Lau: None. R.L. Burr: None. E.A. Thompson: None.
- © 2015 by American Heart Association, Inc.