Exercise-based cardiac rehabilitation in heart transplant recipients

Abstract

We found moderate quality evidence suggesting that exercise-based cardiac rehabilitation improves exercise capacity, and that exercise has no impact on health-related quality of life in the short-term (median 12 weeks follow-up), in heart transplant recipients. Cardiac rehabilitation appears to be safe in this population, but long-term follow-up data are incomplete and further good quality and adequately-powered trials are needed to demonstrate the longer-term benefits of exercise on safety and impact on both clinical and patient-related outcomes, such as health-related quality of life, and healthcare costs.

The international prevalence and variability of nonadherence to the nonpharmacologic treatment regimen after heart transplantation: Findings from the cross‐sectional BRIGHT study

“…As insufficient activity is a major risk factor for several chronic diseases, including those that HTx recipients are at a higher risk of developing due to lifelong immunosuppressant intake, HTx recipients would benefit from interventions promoting physical activity. A meta‐analysis of 10 RCTs showed that cardiac rehabilitation programs could improve exercise capacity; however, most included studies focused on the immediate post‐transplant period and did not investigate the programs’ possible spin‐off effects, for example, higher physical activity levels in daily life. That is, physical activity is a poorly investigated domain in HTx.…”

Rehabilitating cardiac rehabilitation after heart transplantation

“…6 A recent Cochrane review of ETbased CR after HT assessed 10 randomized controlled trials of 300 participants, indicating that CR following HT significantly improved measures of CRF ( peak oxygen consumption or VO 2 ) , although there was no impact in this meta-analysis on health-related quality of life from the CR. 7 We 8-10 and others 11 have also reported numerous benefits of ET after HT, including improvements in pulmonary oxygen uptake kinetics, skeletal muscle function, and particularly aerobic capacity, including peak VO 2 , which likely explains much of the benefits noted with CRET following HT. Likely, the improvement in peak VO 2 is mostly from peak arterial-venous oxygen differences being higher after CRET due to improvements in peripheral mechanics, including improved microvascular and/or skeletal muscle function, as previously demonstrated in older patients with HF and preserved ejection fraction.…”

Multidisciplinary Inpatient Rehabilitation Following Heart and/or Lung Transplantation—Examining Cohort Characteristics and Clinical Outcomes

“…Cardiovascular fitness is targeted via walking (treadmill or regular), cycling, and the use of MOTOmed-assisted exercise equipment (RECK-Technik GmbH & Co. KG, Germany) for those with severe weakness or mobility impairments. Exercise intensity is monitored via the Borg Rating of Perceived Exertion scale, 19 with patients encouraged to achieve a target of "somewhat hard" activity (scores [12][13][14]. Balance training and targeted practice of activities of daily living are other key components of inpatient programs.…”

“…There is growing interest in the role of rehabilitation for patients following heart and/or lung transplantation, but the available literature remains limited. Most research to date has focused on outpatient rehabilitation models delivered after patients have been stabilized and discharged from hospital, with support for pulmonary rehabilitation and exercise‐based cardiac rehabilitation interventions . Little has been done investigating multidisciplinary inpatient rehabilitation in the acute phase following transplantation surgery.…”

“…Most research to date has focused on outpatient rehabilitation models delivered after patients have been stabilized and discharged from hospital, with support for pulmonary rehabilitation 4,12 and exercise-based cardiac rehabilitation interventions. 13,14 Little has been done investigating multidisciplinary inpatient rehabilitation in the acute phase following transplantation surgery. The earliest data come from Bowman and colleagues, who report functional improvements following rehabilitation among a cohort of 86 heart and/or lung transplant recipients between 2002 and 2009.…”