The chronotropic response is the most important means by which cardiac output is increased and oxygen delivery is maintained in response to increased oxygen consumption during exercise or stress. When the chronotropic response is suboptimal or absent, exercise intolerance results. This condition is called chronotropic incompetence, and can be treated effectively with a sensor driven rate-responsive pacemaker. The effectiveness of this therapy assumes that the pacemaker is programmed appropriately. This article focuses on the programming of sensor driven pacemakers and provides additional suggestions for follow-up testing to ensure maximum benefit from these devices.