Ask the Teacher is an advice column that connects Yoga Journal members directly with our team of expert yoga teachers. Every other week, we’ll answer a question from our readers. Submit your questions here, or drop us a line at email@example.com .
Are there any special precautions you need to take if you have a pacemaker?
—Deborah in Clearwater, Fla.
For this question, we turned to our contributor Carol Krucoff for guidance. A yoga therapist and co-director of the Integrative Yoga for Seniors teacher training at Duke University’s Integrative Medicine Center, she’s nationally known for her work with seniors, so we figured she may have dealt with a pacemaker or two.
As it turns out, the subject is literally close to her heart (pun intended): A while back, Krucoff wrote a piece for YJ about her experience with open heart surgery to correct a malformed valve. Her husband, Mitchell Krucoff, MD, is a cardiologist and a member of the faculty for her teacher training. Carol Krucoff was a wealth of knowledge about yoga and heart conditions.
“An important consideration is not just having the pacemaker itself, but why you have the pacemaker,” Krucoff says.
“The pacemaker is a device that is implanted in your body to help your heart beat correctly,” she explains. It’s adjusted for your particular needs and it only works when it’s needed. If your heart beats too slowly (brachycardia), the pacemaker kicks in to make sure your heart rate doesn’t go too low. It can help people who have types of dysrhythmia (irregular heartbeat) or who are experiencing heart failure. Your doctor can best explain what physical activity you should or shouldn’t do, depending on your condition.
That said, Krucoff says a pacemaker itself is very small and will likely not interfere with many yoga poses and practices.
Right after the pacemaker is implanted and until you’re cleared for exercise, your doctor may advise you to avoid strenuous activity and to not lift your left arm above shoulder height. That eliminates complex, energetic poses and/or those that require raised arms. “Once the device is really secure in the body—after a period of six weeks or two months or so—it really usually doesn’t get in the way of your practice,” she says.
She says some people may feel or even see a little bump under their skin where the placemaker is implanted. That may make poses that require you to lie on your belly uncomfortable.
Balance poses may also be challenging for people who tend to have a low heart rate or who take heart medications that cause dizziness. “It’s important to practice near a support—a wall, a chair, or something stable in case it’s needed for stability,” she says.
Depending on the heart condition, inversions may be unwise, she says. Someone with heart failure may tend to get edema or swelling in their legs and ankles because the heart isn’t pumping blood and fluids efficiently. “When you do an inversion—even a seemingly gentle inversion like Legs Up the Wall—that may cause a column of fluid to run down the legs and overwhelm an already compromised heart,” she says.
That doesn’t mean you can’t practice yoga. Instead of putting your legs at a 90-degree angle in Legs Up the Wall, for you may rest them on a chair or on a pillow. Or try Lazy Boy Pose, a modification Krucoff developed with her Relax into Yoga for Seniors co-author and teaching partner Kimberly Carson as part of their Integrative Yoga for Seniors Professional Training.
In this “recliner chair” variation, rather than lie flat on the floor, elevate the upper body into a reclined position with a bolster on a block. Then raise the legs with another bolster or pillow. “Now the head is above the heart and any excess fluid that comes down the legs is going to the pelvic area, and not overwhelm the heart,” she explains.
While yoga is often touted as gentle and completely benign, even seemingly harmless practices could be risky for people with cardiovascular disorders, depending on your heart condition.
Krucoff advises against strong pranayama practices, for example. “There is such a connection between the respiratory system and the cardiovascular system that when we do extreme breathing practices—say a Kapalabhati or Bhastrika—that may put too much pressure on the intrathoracic chamber,” she says. “That just may be too much stress on the heart.”
Even holding your breath may be problematic if you have high blood pressure or a heart condition. Instead, practice pranayama techniques that keep the breath flowing and comfortable, she says. A gentle suspension of the breath after exhalation may be fine, she says. Avoid breath retention after inhalation.
“It’s always an important question, whether you’re a teacher or a practitioner, to ask yourself, Why am I doing this?” she says. You can almost always find a way to achieve the intention of a pose and reduce the risks by practicing a modification, using props, or trying a gentler variation.
Got a question about alignment in a certain yoga pose? Want to better understand an aspect of yoga philosophy? Need advice on how to approach a challenging situation in your class? Submit your questions here or email us at firstname.lastname@example.org, and we may answer it in an upcoming column.