Journal of Interventional Cardiac Electrophysiology

, Volume 55, Issue 3, pp 343–347 | Cite as

Effect of early pendulum exercise on shoulder function after cardiac rhythm management device implantation

  • Wanwarang Wongcharoen
  • Warisara Petvipusit
  • Narawudt Prasertwitayakij
  • Siriluck Gunaparn
  • Siriwan Meemajam
  • Cheeranun Pisespongsa
  • Arintaya PhrommintikulEmail author



Patients who are post-implantation of cardiac rhythm management devices (CRMDs) are commonly instructed to restrict ipsilateral arm movement to reduce risk of lead dislodgement. This immobilization practice increases risk of shoulder-related pain leading to limited shoulder function. We aimed to assess effect of pendulum exercise on shoulder function in patients after CRMD implantation.


This study was a prospective, randomized, open-blinded end point study conducted with 200 patients undergoing CRMD implantation. They were randomized into two groups, standard care (control) and pendulum exercise (experimental) groups. The shoulder function was assessed using QuickDASH-TH scores and measurement of the range of motion (ROM) of shoulder abduction and flexion before and 1 month after implantation.


Baseline characteristics did not differ between the two groups. The lower incidence of shoulder ROM reduction after CRMD implantation was demonstrated in the pendulum exercise group compared to the control group in both flexion (16.8% vs. 40.4%, P < 0.001) and abduction (9.9% vs. 32.3%, P < 0.001). A lower disability of shoulder function after implantation assessed by QuickDASH-TH scores was also noted in the exercise group compared to control (15.2 ± 16.4 vs. 23.4 ± 18.1, P = 0.001). Two patients in the control group and one in the exercise group had atrial lead dislodgement on the day following the procedure.


Early pendulum exercise with ipsilateral arm after CRMD implantation was safe and resulted in lower incidence of limited shoulder ROM and less disability of shoulder function compared to control group.

Trial registration

The study was registered in, and the identification number is TCTR20180612003.


Arm exercise Cardiac rhythm management devices Defibrillator Permanent pacemaker Shoulder pain 



We would like to thank all staff in the Northern Cardiac Center and Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, for their cooperation in the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


This work was supported by grants from the Thailand Research Fund (MRG RSA5780039 (W.W), MRG RSA5780040 (A.P.)), and the Faculty of Medicine Endowment Fund for Medical Research (082/2560), Chiang Mai University, Thailand.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Board of the Faculty of Medicine, Chiang Mai University (approval number 321/2559) and with 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the clinical study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Cardiology, Department of Internal Medicine, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
  2. 2.Faculty of Medicine, Maharaj Nakorn Chiang Mai HospitalChiang Mai UniversityChiang MaiThailand

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