Cardiopulmonary exercise testing for evaluation of a randomized exercise training intervention following aortic valve replacement

Abstract

Summary Aortic valve surgery is the definitive treatment for aortic stenosis ( AS ). No specific recommendation is available on how exercise training should be conducted and evaluated after aortic valve replacement ( AVR ). This study aimed to examine the effect of aerobic exercise training on exercise capacity following AVR . In addition to our primary outcome variable, peak oxygen uptake (peak VO 2 ), the effect on submaximal cardiopulmonary variables including oxygen uptake kinetics (tau), oxygen uptake efficiency slope ( OUES ) and ventilatory efficiency ( VE / VCO 2 slope) was evaluated. Following AVR due to AS , 12 patients were randomized to either a group receiving 12 weeks of supervised aerobic exercise training ( EX ) or a control group ( CON ). Exercise capacity was assessed by a maximal cardiopulmonary exercise test ( CPET ). There was a significant increase in peak load (+28%, P = 0·031) and in peak VO 2 (+23%, P = 0·031) in EX , corresponding to an increase in achieved percentage of predicted peak VO 2 from 88 to 104% ( P = 0·031). For submaximal variables, there were only non‐statistically significant trends in improvement between CPET s in EX . In CON , there were no significant differences in any maximal or submaximal variable between CPET s. We conclude that 12 weeks of supervised aerobic exercise training induces significant adaptations in cardiopulmonary function following AVR , especially in regard to maximal variables including peak VO 2 . In addition, we provide novel data on the effect on several submaximal variables following exercise training in this group of patients.

Cardiorespiratory Performance in Kidney and Liver Transplant Recipients: The Dilemma to Combine Lifestyle and Fitness

“…Furthermore, the maximal oxygen uptake (VO2 max) demonstrated a parallel negative correlation trend with fat mass (R-0.42692), with a linear correlation coefficient of R = −0.42692. These correlations align with findings from the existing literature, indicating that VO2 max is associated with better body composition while being negatively related to the adipose component [6,21,22]. This represents a novel aspect not previously reported in studies, especially within the transplant population.…”

“…Lifestyle reconditioning is important to reduce cardiovascular risk factors in many metabolic chronic diseases, including post-transplantation. Changes, especially in cardiorespiratory function and metabolic profile, have been largely observed in the presence of comorbidities, like coronary artery disease, hypertension, and diabetes, and also posttransplantation [1][2][3][4][5][6][7][8][9][10][21][22][23]; however, other specific determinants, such as the body composition parameters, have not been yet investigated. Prolonged sedentarism and potential cardiotoxicity due to the long-term immunosuppression therapy increase the eventual impairment of the system-diastolic function, reducing the cardiorespiratory performance and the possibility of following constant training.…”

Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses

“…With respect to the efficacy and safety of exercise-based CR, a randomized pilot trial has shown that an 8-week moderate combined endurance and strength training was safe, with no adverse effects on valve prosthesis, kidney, or neurohumoral function ( 58 ), and was able to improve long-term oxygen consumption at anaerobic threshold (VO 2 AT). However, peak VO 2 , muscle strength, or quality of life was unchanged ( 59 ), which contradicts findings from several other studies demonstrating that post-operative exercise was able to improve peak VO 2 ( 60 – 62 ), though a longer follow-up period may be required to fully confirm the effects of exercise training on muscle strength and other quality of life indicators. Nevertheless, despite the risk of post-exercise complications, such as arrhythmias, musculoskeletal injuries, or chest pain, patients after TAVR can undergo CR safely and successfully if monitored and guided by rehabilitation physicians ( 61 ).…”

The impact of additional resistance and balance training in exercise-based cardiac rehabilitation in older patients after valve surgery or intervention: randomized control trial

“…Our results are comparable to those of other phase-II CR studies reporting improvements in 6MWD [12,[24][25][26][27][28][29][30] after 3-4 week CR. Other studies show that improvements in VO 2 peak are to be expected in outpatient programs with longer duration [29,[31][32][33][34]. The improvements in physical performance did not reveal significant differences between groups.…”