What lifestyle modifications should I advise patients with pacemakers or ICDs to ensure optimal device function and patient safety?

Advise patients with pacemakers or implantable cardioverter-defibrillators (ICDs) to engage in regular, moderate physical activity tailored to their individual capacity, as exercise is generally safe and beneficial for improving cardiovascular health and device function, but should be introduced gradually and under professional guidance to avoid triggering inappropriate device shocks or complications. Patients should be counselled to avoid strong electromagnetic interference sources such as MRI scanners (unless device-compatible), high-voltage transformers, and certain industrial equipment, as these can disrupt device function. They should also be informed about the importance of regular device checks and follow-up appointments to monitor device performance and battery status. Lifestyle advice should include smoking cessation, moderation of alcohol intake, and adherence to a heart-healthy diet, such as a Mediterranean-style diet, to optimise overall cardiovascular health. Stress management and psychological support may also be beneficial as part of comprehensive care. Patients should be reassured that sexual activity is generally safe after recovery and that they can resume normal activities gradually as tolerated. Additionally, patients should be educated on recognising symptoms that warrant urgent medical review, such as palpitations, dizziness, or device alarms. Finally, patients should be informed about the possibility of device deactivation in specific clinical circumstances and the importance of shared decision-making regarding their device management ¹ (Pandey et al., 2017; Steinhaus et al., 2019; Wan et al., 2024).