Cycling With A Pacemaker: A Cautionary Trail
It has been known for decades that one’s cardiovascular health can be improved through regular exercise. Many people with CVD (cardiovascular disease) embrace this through activities such as hiking, swimming, horseback riding, and even fencing. But what about bike riding/ cycling? Given that, statistically speaking, 42% of households worldwide own at least one bike, with the number varying regionally and country by country based on cultural expectations, how does this impact cardiovascular health, and is it safe for people with pacemakers to participate?
Hop on and let’s take a ride.
According to the Better Health Channel’s article, Cycling- Health Benefits, “cycling is a good way to control or reduce weight, as it raises your metabolic rate, builds muscle and burns body fat. If you’re trying to lose weight, cycling must be combined with a healthy eating plan. Cycling is a comfortable form of exercise and you can change the time and intensity – it can be built up slowly and varied to suit you” (Better Health Channel, 2013). It actually is a useful hobby for maintaining health in general and combating a variety of illnesses beyond CVD, including cancer, diabetes, bone injuries, arthritis, and mental health issues (Better Health Channel, 2013). While cycling is excellent for maintaining broader health and combating multiple illnesses, what about CVD?
The article continues saying this is because while “cardiovascular diseases include stroke, high blood pressure and heart attack,” (Better Health Channel, 2013) regular cycling can combat these risks because it “stimulates and improves your heart, lungs and circulation, reducing your risk of cardiovascular diseases” (Better Health Channel, 2013). Specifically, this is because cycling strengthens your heart muscles, lowers resting pulse, and reduces blood fat levels. Research also shows that people who cycle to work have two to three times less exposure to pollution than car commuters, so their lung function is improved. A Danish study conducted over 14 years with 30,000 people aged 20 to 93 years found that regular cycling protected people from heart disease” (Better Health Channel, 2013). Given all these health benefits for general and cardiovascular health, that means it's safe for pacemakers, right?
As is common with most sports, cycling is generally safe for individuals with a pacemaker, provided a few precautions are taken to receive the health benefits that consistent cycling offers.
The first is that once you receive the device, do not directly jump back onto the bike. There is a significant wait period. The article, FAQ’s: Pacemaker Implantation, advises how “you should avoid strenuous activities for around 4 to 6 weeks after having your pacemaker fitted. After this, you should be able to do most activities and sports” (NHS website, 2017). So, like all sports, one must be patient before one jumps back into the ring after a pacemaker implantation. However, even when you start cycling or jump back on the bike, do so with your doctor’s approval first. This is because the aforementioned 4-6 weeks is a guideline, and pacemakers and the recovery process need to be treated on an individual basis.
Once you’re back on the bike with your helmet on, ready to go, there are still a few aspects that need to be considered. The article Can Someone With A Heart Device Ride A Bicycle? by Medtronic states that, “depending on the type and placement of the heart device, riding a bike is unlikely to have any effects. However, intensity levels or body motions may need to be adjusted to prevent rough physical contact that could affect the device. Riding a bike, and exercise in general, following any device procedure should be discussed with a doctor” (Metronic, 2023). In summary, individuals should consider the device settings, the likelihood of physical damage, and potential bodily movements before riding the bike, and consult with a doctor to discuss these factors.
The pacemaker operates within a specific set of parameters that your electrophysiologist manages and can adjust to accommodate changes in health and lifestyle. Biking requires more stress on the heart and a higher level of cardiovascular activity, and one’s pacemaker must be set to address these needs. Before you go, be sure to discuss this with your doctor. Don’t forget to let them know afterwards to inform them whether the venture was successful. As often, the current setting can be adjusted to accommodate such physical activity while maintaining your comfort. was successful, as further adjustments may be required.
However, this is also why, if you are biking and suddenly feel faint or lightheaded, it is best to get off the bike, sit, and rest for a while. It may be the pacemaker causing the sensation, or maybe the heart itself. But don’t push yourself beyond your limits, as that could be dangerous. Should such an event occur, consult your doctor.
Another consideration when biking is the potential for an accident, which theoretically can damage or even dislodge the device itself. Excessive turbulence, rapid repeated impacts, and a sudden strike to the location, such as in a crash, are additional factors to consider. This is why, in my opinion, it is best to wear another layer of protection under your jersey or shirt. Like your helmet protecting your head, your chest also needs protection, thanks to the addition of a pacemaker.
Another consideration is the use of upper-body muscles when riding a bike. As your pacemaker is nestled within muscle, there is a potential for it to get jarred and rattled around as the rest of your body does. Not so severe in the way it could induce damage to the site, but your muscles may be extra sore as a result, especially with metal wires running through your veins. My advice is to start with flat, easy roads and then, if you wish, progress to bumpier trails. However, be aware that your muscles may become even more sore than before, so be prepared with Tylenol or Aspirin to alleviate any muscular discomfort.
Personally, I loved biking growing up, mostly because it was a family activity that we enjoyed together. My family consists of very healthy and athletic individuals, who often enjoy cycling and mountain biking. However, as time went on, I realized I was holding them back as no matter how hard I tried, I physically could not keep up with them. Plus, the blood thinners for the mechanical heart valves covered my shins in bruises and raised the risk too high for me should there be a collision. Additionally, to accommodate my short arm, I had to sit very straight and uncomfortably with the handlebars at a very high position. So, eventually, I fell off the bandwagon.
However, my father was very sweet and commissioned a bike handle that suited my short arm, and it was wonderful to finally be able to ride. Nevertheless, my other health issues, including feeling the jarring of my pacemaker when going over bumps and the ever-present likelihood of intense bruising, remained. Furthermore, as the years have gone by, I have become more sensitive to the musculature pain from the pacemaker. So, personally, I still don't ride a bike often.
However, I actively encourage all others to do so with or without a pacemaker. Because, for many, the benefits far outweigh the risks, and each person’s experience with CVD and pacemakers is unique.
So, don’t let your pacemaker stop you. Grab a bike, strap on a helmet, and take to the open road… but ideally after discussing it with your doctor.
Keep ticking my friends!
Do you ride a bike? Where do you go?
Reference List:
Better Health Channel (2013). Cycling - Health Benefits. [online] Vic.gov.au. Available at: https://www.betterhealth.vic.gov.au/health/HealthyLiving/cycling-health-benefits.
Metronic (2023). Can Someone With A Heart Device Ride A Bicycle? [online] Medtronic.com. Available at: https://www.medtronic.com/en-us/heart-device-answers/search-results/search-result.can-someone-with-a-heart-device-ride-a-bicycle.html [Accessed 31 Aug. 2025].
NHS website (2017). FAQs: Pacemaker Implementation. [online] nhs.uk. Available at: https://www.nhs.uk/tests-and-treatments/pacemaker-implantation/recovery/.
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