Heart failure (HF) significantly reduces physical capacity and harms the overall functioning. In the end-stage cases of HF, the only options are surgical procedures including left ventricular assist devices (LVAD) implantation and heart transplant. Due to the insufficient number of available organs for transplantation, LVAD are used more and more frequently. Rehabilitation of patients with LVAD is a crucial element of therapy because of long-term immobilization of patients awaiting transplant or heart muscle regeneration. Purpose The aim of the study was to evaluate the impact of early hospital rehabilitation on exercise tolerance, muscles strength and complex coordination in LVAD patients. Methods The total of 20 LVAD patients were recruited to the study (all male, aged 19–66 years). All patients underwent standard cardiac rehabilitation in the postoperative and medical treatment wards. After the end of hospitalization, patients were admitted to the rehabilitation department for 4–5 weeks. During that period they performed endurance training, conditioning exercises with elements of resistance and coordination exercises. All patients were tested before and after the rehabilitation program using ergospirometry (CPX), 6-MWT, upper and lower limbs muscle strength (30 Second Chair Stand) and complex coordination (Up&Go test). Results A significant increase in the values of most of studied parameters was observed after exercise training in comparison to the results before rehabilitation process (VO2 peak) [ml/kg/min]: 11.1±2.2 vs. 12.5±2.7, p<0.001; Watt: 42.6±12.4 vs. 54.1±13.1, p<0.0001; 6- MWT [m]: 300.1±102.2 vs. 404.8±105.9, p<0.0001; 30 Seconds Chair Stand [number of stands] 8.4±3.3 vs. 11.6±4.8, p<0.0001; Up&Go [sec] 9.0±1.7 vs. 7.1±1.5, p<0.0001; left hand grip strength [kg]: 31.5±8.4 vs. 34.8±8.1, ns; right hand grip strength [kg]: 33.6±11,2 vs. 36.0±9.0, ns. No adverse effects were observed during rehabilitation process. Conclusions Hospital-based rehabilitation is safe and effective in LVAD patients. Rehabilitation after LVAD implantation brings significant benefits in terms of exercise capacity and tolerance, muscle strength and complex coordination in this group of patients. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): NATIONAL RESEARCH AND DEVELOPMENT CENTER
Background Rehabilitation after LVAD implantation is increasingly used. We developed the novel method of comprehensive rehabilitation starting directly after LVAD implantation. Study group 21 recent LVAD (15 Heart Mate III, 6 HeartWare) recipients (56.2±11.7 yrs, 100% men) were included to 5-week rehabilitation program, which included supervised endurance training on cycloergometer (5 times per week), resistance training, general fitness exercises with elements of equivalent and coordination exercises (every day). 6-minute walking test (6MWT), cardiopulmonary exercise test (CPET) and prognostic biomarkers: NT-proBNP, Galectin-3 and ST2 were investigated at the beginning and at the end of rehabilitation program. Results See Table 1. At the end of rehabilitation program, significant increase in 6MWT distance, maximum workload, peak VO2 and upward shift of anaerobic threshold in CPET were observed in all patients. Significant reductions of NTproBNP, ST2 and galectin-3 levels were observed. There were no major adverse events during rehabilitaton. Conclusions Comprehensive novel rehabilitation in LVAD recipients is safe and results in significant improvement of 6-minutes walking test distance and cardiopulmonary exercise test results. Moreover, this novel rehabilitation program reduces levels of prognostic biomarkers of heart failure: NT-proBNP, Galectin-3 and ST2. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Center for Research and Development - STRATEGMED II project
Background Patients with cardiovascular diseases also suffer from problems related to the sexual sphere, among others: reduction or loss of libido, avoiding sexual activity, impotence. They may result from depressive disorders and the fear of the appearance of health and life-threatening symptoms during sexual intercourse (dyspnea, angina, myocardial infarction, arrhythmias, sudden death). The aim of the study was to evaluate sexual and physical activity in patients after implantation of left ventricular assist device (LVAD). Methodology The study included 50 men aged 18–66, average 55 years, after LVAD implantation. Finally 20 patients did not complete the program and were excluded from the analysis. The subjects were assessed by a sexologist in terms of the quality of sexual life and erectile dysfunction. Sexological counselling and education (positions during intercourse, safety recommendations) and physical activity (training forms, frequency and duration of training) were conducted, 13 patients were qualified for pharmacological treatment of erectile dysfunction. The level of physical activity (according to International Physical Activity Questionnaire, IPAQ) and sexual satisfaction (questionnaire) as well as quality of sexual life (Mell-Krat Scale) were assessed before LVAD implantation and after 6 months. Additionally, exercise tolerance was evaluated with 6 minute walk test (6-MWT). The tests were repeated after 6 months. Results After the implementation of sexual and physical activity education, a significant improvement was observed in the results of the parameters tested: 6-MWT [m]: 355.5 (131.1) vs. 465.5 (93.8), p<0.001, IPAQ [met / min / week]: 1.411.5 (513.4, 2.465.2) vs. 3.870.0 (983.0, 5.274.0), p<0.002, sexual satisfaction: 26.5 (24.2, 28.0) vs. 28.5 (27.2, 29.0), p<0.01. The quality of sex life in the whole group significantly decreased after LVAD implantation compared to the period before onset of the disease, Mell-Krat Scale score: 50.0 (46.0, 51.8) vs. 26.0 (9.2, 48.5), p<0.001. In patients who received pharmacological treatment, the quality of sexual life assessed by the Mell-Krat Scale improved significantly: before treatment 10.0 (8.0, 13.0) vs. 34.0 (6.0, 37.0) after treatment, p<0.006, but did not return to pre-onset levels. A significant positive correlation was observed between the assessment of sexual satisfaction and the results of 6-MWT and IPAQ score. Conclusions Sexual health education significantly improves sexual satisfaction in patients following LVAD implantation. Increasing exercise tolerance and the level of daily activity has a positive effect on the subjective assessment of sexual satisfaction. However, the quality of sexual life significantly decreases after LVAD implantation and even after pharmacological treatment it does not return to the level from before the onset of the disease. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): STRATEGMED II - RH-ROT - NATIONAL RESEARCH AND DEVELOPMENT CENTER
Background In extreme cases of heart failure, the only method of treatment is heart transplantation. Due to the insufficient number of organs for transplantation, left ventricular assist devices (LVAD) are increasingly being used. Rehabilitation of patients with LVAD is a very important element of complex therapy due to the long-term immobilization of these patients awaiting transplant or regeneration of the heart. The aim of the study was to assess the impact of early hospital rehabilitation on exercise tolerance, muscle strength and complex coordination in patients after LVAD implantation. Material and methods The study included 37 patients (35 men), aged 19–66 years, mean 58.7 years, after LVAD implantation. All of them underwent standard rehabilitation in the postoperative and rehabilitation department. The patients have started and continued trainings in a rehabilitation department for 4–5 weeks: endurance trainings, general fitness exercises with elements of balance and coordination exercises, elements of resistance exercises. Before the start of rehabilitation and after its completion, all patients underwent: cardiopulmonary exercise testing (CPET), a six-minute walk tests (6-MWT), the tests of strength of the right and left hand grip, strenght of muscles of the lower limbs and complex coordination (up and go test). There were no adverse events that would justify changing the mode or discontinuing rehabilitation. Results A significant increase in the value of most of the parameters studied was observed after the completion of hospital rehabilitation: VO2peak [ml/kg/min], baseline: 10.60 (9.60, 12.90) vs. 12.85 (11.60, 15.73), p<0.001; 6-MWT [m]: 322.81 (113.62) vs. 416.12 (106.37), p<0.001; 30 second chair stand: no of stands: 9.12 (3.60) vs. 11.18 (4.50), p<0.001; up & go [sec] 9.18 (8.07, 10.50) vs. 7.58 (6.69, 9.04), p<0.001; left hand grip strengh [kg]: 30.04 (8.38) vs. 31.91 (8.10), p<0.011; right hand grip strengh [kg]: 31.52 (9.88) vs 33.20 (8.72), ns. Conclusions Early hospital rehabilitation in patients after implantation of left ventricular assist devices has significant benefits in terms of exercise tolerance, muscular strength and complex coordination. Complex rehabilitation is safe and effective in this group of patients. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): STRATEGMED II - RH-ROT - NATIONAL RESEARCH AND DEVELOPMENT CENTER
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