Effect of a 12-Week Structured Exercise Program on Aerobic Capacity and Flexibility in Cardiac Physiologic Pacing Pacemaker Patients

Background: Cardiac conduction disorders causing bradyarrhythmias often require permanent pacing. Although physiologic pacing better preserves ventricular activation than conventional right ventricular pacing, many patients continue to experience reduced exercise capacity, flexibility, and functional independence after implantation. Despite the recognized benefits of cardiac rehabilitation, evidence regarding structured exercise programs in patients with cardiac physiologic pacing remains limited. Objective: To evaluate the effects of a 12-week structured aerobic and flexibility exercise program on functional exercise capacity (Six-Minute Walk Test (6MWT)) and upper- and lower-limb flexibility in clinically stable adults with cardiac physiologic pacing, including Left Bundle Branch Area Pacing (LBBAP) and His Bundle Pacing (HBP). Methods: A quasi-experimental single-group pre-post study was conducted at Krishna College of Physiotherapy. Sixty-one clinically stable adults (52-74 years), at least three months after pacemaker implantation, were recruited by convenience sampling. Participants completed a 12-week exercise program comprising 40-50-minute sessions, 3-4 times weekly, integrating aerobic and flexibility training. Functional exercise capacity was assessed using the 6MWT, upper-limb flexibility using the Back Scratch Test, and lower-limb flexibility using the Sit-and-Reach Test. Data were analyzed using paired t-tests in IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York), with p < 0.05 considered statistically significant. Results: Participants had a mean age of 59.72 ± 4.54 years; 52 (85.2%) were male, and 9 (14.8%) were female. After 12 weeks, significant improvements were observed in all primary outcomes. The mean 6MWT distance increased from 336.93 ± 18.90 m to 344.00 ± 26.59 m (t = 2.674, p = 0.0096). Upper-limb flexibility improved from −20.22 ± 4.80 cm to −19.09 ± 5.14 cm (t = 3.373, p = 0.0013), while lower-limb flexibility improved from −21.37 ± 4.67 cm to −18.32 ± 9.30 cm (t = 2.966, p = 0.0043). No major adverse events, device malfunctions, or lead-related complications occurred during the intervention. Conclusion: A 12-week structured aerobic and flexibility program was feasible and associated with significant improvements in functional exercise capacity and flexibility in patients with cardiac physiologic pacing. No major adverse events occurred during the intervention. These findings provide preliminary evidence supporting structured exercise rehabilitation in this population; however, larger randomized controlled trials with longer follow-up are required to confirm these findings before routine clinical implementation can be recommended.