Training with a pacemaker

I am 65 year old a competitive masters rower, with 2nd degree AV block, had a pacemaker for 5 months. HR max is set at 170, the max I could get to prior to AV block. 

The HR max I can get to so far is 156, so it must be physiological not pacemaker limited. The odd thing is that when I do  aerobic limit training 40 mins at HR <145 3 times a week, I am not seeing any improvement in performance over 1 month. Prior to pacemaker I would see clear incremental improvements in power at a given heart rate. 

Any of the cyclists or long distance runner seen a change in the way training affects performance after pacemaker ? 




Training response

by ar_vin - 2019-01-24 01:38:58

I was diagnosed with sick sinus syndrome in May 2017 and around the same time experienced what you describe - lack of response to training. I had a pacemaker implanted in September 2018 and only in late November 2018 started to get back to my training. However, I don't yet see a significant improvement in my fitness level. Some days are clearly better than others but not the gradual increase in fitness in response to training load.

I'm looking at having my (Medtronic) two-lead pacemaker tweaked by the PM tech to be more sensitive to rate response.

What HR monitor do you use? I have a Scosche Rhythm24.




Max heart-rate

by IAN MC - 2019-01-24 06:29:50

No matter how hard you exercise your HR won't go above 156 bpm. What is causing this ?  Among the many possibilities,  two  that spring to mind are  :-

I )   as you say , it is physiological and your heart simply won't beat any faster 

ii) OR    It is physiological so you have Rate Response switched on and the maximum sensor rate is set at around 156. If that is the case your PM would only generate extra heartbeats up to that level. ( it sounds suspiciously to me that a settings guru may have imposed the 220 minus your age formula on your RR settings but I may be wrong )

It is possible that a settings change to your PM could help.

When you say your PM max is set at 170 I assume that you are referring to the max tracking rate i.e. the safety level above which your PM ceases to match your ventricular rate to that of the upper chamber.

I hope you get it resolved


Follow up

by mikeyrowing - 2019-01-24 14:48:29

Ian, Good thought - I started at the 220-age and a month ago I got it changed to stop  sequencing at 170, mode switche at 180. So I think its physiological.

ar_vin - Sounds very similar to my situation. I use a Wahoo TICKER-X because its clever enough to store data on the belt and then down load rather than be tethered to a phone the whole time. 

Thanks for your thoughts, I will go back to the PM tech and reask questions about settings. 

Lets keep in touch as to progress. Mike 


Medtronic PM for Athletes

by KonaLawrence - 2019-01-25 02:19:09

Aloha Mikey,

I'm a 70 year old competitive paddler.  I paddle 6-man Outrigger canoes in Hawaii.  After you get a PM, there is usually a 30 day checkup, then at 6 months, then annually after that.  I had 8 appointments in the first 9 months.  They told me they wanted it work right for my life and I took them at their word.  Since I had read that Athletes have a difficult time getting it set just right, I asked for and received a monthly appointment until it worked the way I needed it to work.  I used a Polar chest strap before the PM. then a Polar OH1 arm-band for months, now a Polar M430 Runners Waterproof Watch.  All that means is that I had Heart Rate charts for my workouts to take in to show the Medtronics technician and PM Specialist.  I said "here I'm at max Cardio and my rate isn't steady, or it's only 105 - too low, or whatever.  

Use the search function on this site for "athletes" and "pacemaker settings" and you will get lots of posts with good information.  The PM is a complex computer running some very complicated programs (apps).  As with any program (app) there are many parameters that can be changed. 

I had many problems getting my PM set the best for me and my sport.  I downloaded the Medtronics Manual for my PM.  It's complicated. but it helped a lot.  There are many settings changes that can be made, Rate Response mode, High Rate, Daily Living Rate, Sensitivity, Acceleration, etc.  For me, the culprit was the Rate Response Optimization routine.  It is there to help the Golfing crowd get their heart rate higher, but not too high.  For an athlete, it also constrains too much high rate.  This means the more you work out, the more it pulls you back from the high rate.  I finally had Optimization turned off.

Another issue is the Medtronics hardware.  The Medtronics PM hardware increases your Heart Rate based on upper body movement.  There's a "motion detector" inside the PM.  This is great for Runners.  The jarring motion of each stride causes the PM to speed up.    It isn't very good for Bicyclists because their upper body mostly doesn't move.  Rowing and Paddling fall somewhere in the middle.  

Lastly, there's medication.  I also have Afib so I take a Beta Blocker and an Antiarrhythmic.  Both of them restrict high heart rate.  I usually skip them on race days.  On practice days I have to be content with a lower rate.  

Good Luck   


by mikeyrowing - 2019-01-25 10:58:07

great invites to the techs, thx

Training response

by phadzip - 2019-01-25 22:47:41

I, too, am having difficulty getting back into shape. I was a 3:10 marathoner and sometimes placed in the top 5-10% in my age group in Boston, but that was before my heart wiring went all wonky. Now, approaching 64 and two years after cardiac ablation and 8 months after pacemaker implant, I am adding mileage - and slowly responding. But very slowly. I have a follow-up next month where I hope they can do some tweaking - my HR does go over 180 sometimes, but I don't really feel it.

Anyway, the getting less young and carrying more weight than I should be if I want to return to endurance events, doesn't help. I do feel like my old self, though, for short bits from time to time. It's the endurance that's tought to get back.

So hopefully, for me - and maybe for you - it's a matter of keep at it.

Training with a pacemaker

by mikeyrowing - 2019-01-30 15:53:22

News from here, they activated the rate response function. with max set at my pre PM number.  Bingo .... in a 2 minute piece at full tilt I could get my HR to my previous max (165) when I was stuck at 153 previously. 

The standard race for rowers is a 4 minute sprint, with long distance (20 min) in the fall. So far so good. 

It appears to me  that with the pacemaker, some of the natural signals that cause HR to rise do not function the same as when I had the original equipment.. 


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It may be the first time we've felt a normal heart rhythm in a long time, so of course it seems too fast and too strong.