A week-by-week guide to protecting your new device while keeping your shoulder healthy and strong.
For decades, patients were told to keep the arm on the side of the pacemaker almost completely still for six weeks. We now know that approach causes more problems than it prevents — most often a painful condition called frozen shoulder. The current evidence is clear: gentle, structured movement starting the day after surgery is safe, and it protects your long-term function.
This guide is built around what is currently considered safe practice. Your electrophysiologist may adjust it based on your specific case.
"The shoulder gets stiff from not moving, not from moving. Daily gentle exercise is what keeps it healthy."
Do each of these 3 times a day. They should not hurt. If something causes sharp pain at the device site, stop and call your team.
Open and close your fist 20 times. Spread your fingers wide, then make a fist. Squeeze a soft ball if you have one.
With your elbow tucked at your side, slowly rotate your wrist in circles — 10 in each direction.
Bend and straighten your elbow slowly, 10 times. Keep your upper arm against your body.
Lift both shoulders up toward your ears, hold 3 seconds, release. Repeat 10 times. Then roll your shoulders backward 10 times.
Lean forward, supporting yourself with your right hand on a chair or table. Let your left arm hang loose. Use your body — not your shoulder muscles — to swing the arm gently in small circles, then forward and back. Do 10 of each direction. This is the single most important exercise of the early phase.
Continue Phase 1 exercises. Add the following, once or twice a day.
Stand facing a wall, an arm's length away. Place your left fingertips on the wall and "walk" them up the wall as high as feels comfortable. Mark the spot. Try to go a little higher each day. Walk back down slowly.
Hold a broomstick or cane horizontally with both hands. Use your right arm to gently push the stick — and your left arm — up overhead. Stop when you feel a stretch, not pain. Hold 5 seconds, lower. Repeat 10 times.
Bring your left arm across your chest. Use your right hand on the elbow to gently increase the stretch. Hold 15 seconds. Repeat 3 times.
Place the back of your left hand against your lower back. Slowly slide it up your spine as far as is comfortable. Hold 5 seconds. Repeat 5 times.
By now your range of motion should be close to normal. Focus on rebuilding the muscle you lost.
Stand an arm's length from a wall, hands flat against it at chest height. Bend your elbows to bring your chest toward the wall, then push back. 10 repetitions, 2 sets.
You may begin using light weights (1–2 lb / 0.5–1 kg) for elbow curls, lateral raises (only to shoulder height), and rows. Stop if any movement is painful at the device site.
Driving, light gardening, cooking, and most household tasks are appropriate by week 4–6 unless your doctor has advised otherwise.
Once your electrophysiologist confirms the leads are stable at your follow-up device interrogation, you can return to full activity. This includes:
Heavier resistance training, swimming (with the incision fully healed), tennis and racquet sports, golf, and rowing. There are no permanent restrictions on what your left arm can do — the device and the leads are protected by a fibrous capsule that is fully formed by this point.