Research finds early exertion plateau in patients with new implanted cardiac devices

Research finds early exertion plateau in patients with new implanted cardiac devices

Research at East Carolina University is shedding light on how patients with cardiac implantable electronic devices (CIEDs) recover physically in the months following surgery, and specifically, tracks a surprising early plateau in activity levels.

The findings were published this year in the Journal of Cardiopulmonary Rehabilitation and Prevention.

The study analyzed data from 294 patients and found that while activity increases steadily after implant surgery initially, it levels off after about two months and remains unchanged for the next four.

Clinical health psychology doctoral candidate Elizabeth Jordan, the study's first author, says the project began as a deep curiosity about how patients in different places and with different resources and backgrounds regain mobility after receiving a life-saving device.

"I became involved with this study as my master's thesis, when I developed an interest in physical activity patterns in CIED patients, particularly the period immediately following implantation," Jordan said. "These devices contain accelerometers, which give us a wealth of objective activity data. That opened the door for me to really explore my research interests."

Working alongside Dr. Samuel Sears, a psychologist known nationally and internationally for his work with cardiac device patients, Jordan helped design a study that captured 180 days of physical activity for each patient. The findings revealed that patients showed the most dramatic increase in movement between the first and second month post-implantation. After that, a profound and unsatisfactory plateau set in for a statistically significant number of the patients studied.

According to Sears, this plateau highlights a critical moment in recovery.

"Clinically, we've always known patients have to restrict movement in the first several weeks to protect the implanted leads," Sears said. "What this study shows is that the habits formed during that period might persist long after restrictions are lifted. The two-month point may be a key moment for re-engaging patients and helping them rebuild an active lifestyle."

ECU's Research Sample - From the East, For the East

The research sample reflected the demographics of the university's largely rural region. Two thirds of patients studied live in rural communities, and 52% identify as Black, two demographic populations often underrepresented in cardiac device research.

Jordan said that seeing those numbers was one of the most striking parts of her work.

"Understanding physical activity in these groups is critically important because they face higher burdens of chronic illness and more limited access to specialty care," she said.

Maeve Sargeant, another doctoral student who supported the analyses for the research, said what deserves special attention is the real-world data.

"Device-based activity data gives us a good look into how patients are really functioning in their daily lives," Sargeant said. "Analyzing these patterns alongside the realities of work, caregiving and other responsibilities helps contextualize what recovery actually looks like for these patients."

Different Hometowns, Different Outcomes

One remaining methodological challenge is that while CIED technology offers rich data into patient movement, it does not distinguish the intensity or type of activity.

Still, the findings point to a therapeutic direction for clinical psychologists, Sears said.

"These devices are with patients 24/7," he said. "With a study like this, we have the research backing we need to leverage new data collected to better tailor rehab programs, and do so with limited patient facetime. We can identify struggling patients and improve long-term outcomes."

Jordan hopes to build on this work as she continues her doctoral training.

"If I could continue with this line of research, I'd like to examine differences in activity outcomes across geographical areas," she said. "Comparing long-term engagement and health outcomes between clinics across the United States could tell us so much about how environment and location shapes recovery."

Jordan, who earned her undergraduate degrees in psychology and human development and family studies from the University of North Carolina at Chapel Hill, plans to graduate with her doctorate in 2028. Her long-term goal is to stay close to the populations highlighted in the study.

"In the future, I hope to continue providing psychological care to patients with chronic illness or those facing health disparities," she said. "This research has only strengthened that commitment."

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