In brief: Because cardiac pacemaker patients are a heterogeneous group, a graded exercise test using 1-met increments for robust patients and 1/2-met increments for frail patients should be performed before recommending an exercise program. Most patients are comfortable with a peak work load of 60% to 80% of their maximum capacity, and the physician can recommend an appropriate activity ranging from strolling at 1 mph (1/2 to 2 mets) to singles tennis (5 to 6 mets) based on the exercise test results. For most patients, a self-administered or supervised exercise program can be set up that will increase their capacity for sports or activities of daily living.