@fireguy8891 Hi welcome to Mayo Connect. I too back at the start of my journey had a low ef due to an enlarged Heart after a virus cause me to build up fluids in the sac around the heart. This caused the heart to work harder and enlarged. This is yhe one muscle we don't want larger. After they recommended a pacemaker in my case i left the Hospital with an ef of 5% . My case was definitely worse than yours but i wanted to write because at the time i worked a real physical job as an electronic technician for the dept of energy which required me to go to mountain tops and climb towers up to 300 ft. Well after a recovery period of 6 weeks after the pacemaker procedure i was back at work light duty for 6 months and then i was back working as normal. They did give me some time to build up to climbing towers again but within a couple of years i was climbing again. My EF came up also and after the first year it was about what yours is now and by 2 years i was about 45-50. I also worked out at a moderate pace first thru cardio rehab then on my own. I loved to hike so i was back hiking moderate trails rather quickly up to 6-7 miles within a couple of years. I will warn you tho i think what i didn't take seriously enough was i still smoked and enjoyed a few beers on the weekends. I did quit smoking finally after i got shocked my first time but i think i did more damage which ended up needing a Heart transplant 2 years ago. But o remember talking to my EP Cardiologist back then and he assured me the sky is the limit. He actually knew of some with heart issues and pacemakers that compete in triathlons. So he always told me to listen to your body and adjust as needed. And i recommend Cardio rehab will help you adjust your workout based on how your heart reacts. I'm hear if you have any questions.