Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. X:X | DOI: 10.5507/bp.2026.024

Effects of early shoulder exercise on functional recovery after cardiac implantable electronic device implantation: A 3-year randomized cohort follow-up

Muharrem Said Cosgun¹, Cansu Cosgun²

¹ Department of Cardiology, Mengucek Gazi Education and Research Hospital, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey

² Department of Physical Therapy and Rehabilitation, Mengucek Gazi Education and Research Hospital, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey

Background: Shoulder dysfunction after cardiac implantable electronic device (CIED) implantation may impair upper-extremity function and quality of life (QoL). Although a prior randomized trial demonstrated short-term benefits of early postoperative exercises, long-term outcomes remain unclear.

Aim: To evaluate the 3-year efficacy and safety of an early postoperative shoulder exercise protocol after CIED implantation.

Methods: Of 92 patients randomized in the original trial, 82 completed the 3-year follow-up. Participants had completed a 6-week intervention consisting of pendulum exercises (PE), stretching & strengthening exercises (SSE) or standard care, without further structured exercise. Outcomes included Visual Analog Scale (VAS) pain scores, grip strength, shoulder flexion and abduction range of motion (ROM), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and the Physical and Mental Component Summary scores (PCS and MCS) of the 36-Item Short-Form Survey (SF-36). Lead-related complications were also assessed.

Results: VAS and SF-36 MCS scores were comparable across groups. However, compared with standard care, both exercise groups maintained superior outcomes at 3 years for grip strength (PE: +9.0 kgf; SSE: +9.0 kgf), shoulder flexion ROM (PE: +10.0°; SSE: +11.0°), shoulder abduction ROM (PE: +7.0°; SSE: +7.0°), QuickDASH (PE: -5.0 points; SSE: -6.0 points), and SF-36 PCS (PE: +9.0 points; SSE: +10.0 points) (all P < 0.05). No lead-related complications occurred during follow-up.

Conclusion: Early postoperative shoulder exercise after CIED implantation provides sustained improvements in shoulder function and physical QoL without compromising lead safety.

Trial registration. ClinicalTrials.gov, NCT07496554. https://clinicaltrials.gov/study/NCT07496554

Keywords: cardiac implantable electronic device, shoulder dysfunction, exercise therapy, rehabilitation, quality of life, lead safety

Received: March 30, 2026; Revised: June 29, 2026; Accepted: July 28, 2026; Prepublished online: August 18, 2026