Heart Rate and V˙O2 Concordance in Continuous-Flow Left Ventricular Assist Devices

Kerrigan, Dennis J.; Williams, C.; Brawner, Clinton A.; Ehrman, Jonathan K.; Saval, Matthew A.; Peterson, Edward L.; Lanfear, David E.; Tita, Cristina; Velez, Mauricio; Selektor, Yelena; Keteyian, Steven J.

doi:10.1249/mss.0000000000000776

Cited by 12 publications

(4 citation statements)

References 15 publications

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“…12 If that is the case, in this study prolonged head-down-tilt, alone or in combination to repeated Valsalva maneuvers during resistance training causing marked increase of the systolic blood pressure and concomitant ICP elevation to stabilize the cerebrovascular transmural pressure, 8, 20, 32 may have raised the ICP more than IOP. This may have impaired the regular axoplasmic flow and caused retinal nerve fibers swelling, 9 which was captured by Spectralis OCT post bed rest.…”

Section: Discussionmentioning

confidence: 72%

Ophthalmological Evaluation of Integrated Resistance and Aerobic Training During 70-Day Bed Rest

Taibbi

Cromwell

Zanello

et al. 2017

Aerospace Medicine and Human Performance

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INTRODUCTION We evaluated ophthalmic changes in healthy individuals who underwent integrated resistance and aerobic training (iRAT) during 70-day 6° head-down-tilt (HDT) bed rest (BR). METHODS Participants were selected using NASA standard screening procedures. Standardized NASA BR conditions were implemented. Subjects were randomly assigned to the iRAT protocol or no exercise during HDTBR. Weekly ophthalmic examinations were performed in the sitting (pre/post-BR only) and HDT (BR only) positions. Mixed-effects linear models compared pre and post-HDTBR intraocular pressure (IOP), Spectralis OCT circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and peripapillary retinal thickness observations between groups. RESULTS Six controls and nine exercisers completed the study. There was an overall effect of BR on our outcomes. Except Goldmann IOP (mean pre/post difference in controls and exercisers: −0.47mmHg versus +1.14mmHg), the magnitude of changes from baseline was not significantly different between groups. There was a +1.38mmHg and a +1.63mmHg iCare IOP increase during BR in controls and exercisers, respectively. Spectralis OCT detected a +1.33μm average cpRNFLT increase in both groups, a +9.77μm and a +6.65μm peripapillary retinal thickening post-BR in controls and exercisers, respectively. Modified Amsler grid, red dot test, confrontational visual field, color vision, and stereoscopic fundus photography were unremarkable. CONCLUSIONS Seventy-day HDTBR induced peripapillary retinal thickening and cpRNFL thickening without visible signs of optic disc edema. The magnitude of such changes was not different between controls and exercisers. A slight IOP increase during BR subsided post-BR. Further study should evaluate whether different physical exercise paradigms may prevent/mitigate the risk of space-related visual impairment.

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Section: Discussionmentioning

confidence: 72%

Ophthalmological Evaluation of Integrated Resistance and Aerobic Training During 70-Day Bed Rest

Taibbi

Cromwell

Zanello

et al. 2017

Aerospace Medicine and Human Performance

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“…Despite the presence of a foreign device augmenting cardiac output, the relationship between HR and V ˙ o 2 remains intact. 83 An exception to this would be in patients who display chronotropic incompetence or are paced with inadequate HR responsiveness. 83 For these patients prescribing exercise at a RPE level of 11-14 on the Borg 6-20 scale would be appropriate.…”

Section: Exercise Prescription and Trainingmentioning

confidence: 99%

“…83 An exception to this would be in patients who display chronotropic incompetence or are paced with inadequate HR responsiveness. 83 For these patients prescribing exercise at a RPE level of 11-14 on the Borg 6-20 scale would be appropriate. For patients on LVAD support who do have an intact HR response, a target HR range set at 40-80% HR reserve can be used.…”

Section: Exercise Prescription and Trainingmentioning

confidence: 99%

Rethinking Rehabilitation

Overstreet

Kirkman

Qualters

et al. 2021

Journal of Cardiopulmonary Rehabilitation and Prevention

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Rethinking Cardiac Rehabilitation 389C ardiac rehabilitation (CR) is a class 1 guideline-based therapy that provides comprehensive secondary prevention strategies. Best practices for CR include exercise training, outcome assessments, risk factor management, and nutritional/behavioral education to individuals who qualify. Research indicates that CR participation provides many health benefits including reduced risk for morbidity and mortality, increased cardiorespiratory fitness (CRF), enhanced quality of life, and improved mood and symptoms. 1,2 Furthermore, CR is cost-effective by reducing the rate of recurrent myocardial infarctions (MIs) and hospital readmissions. 3 Several meta-analyses have demonstrated the benefits of CR programs, specifically examining the individual components of these programs and their impact on patient well-being. 4,5 Despite the large number of different cardiovascular diseases (CVD), only seven diagnoses or procedures qualify an individual for CR (Table 1).While this list may seem robust to some, it is only a fraction of the chronic health conditions that physical activity and lifestyle interventions (ie, education, counseling, and social support) have been shown to benefit. Specifically, exercise is beneficial for individuals with conditions that are strongly associated with CVD including chronic kidney disease (CKD) [6][7][8][9][10][11] and breast cancer (BC). [12][13][14][15] Given the observed associations between these diseases and CVD, it seems appropriate to consider the inclusion of these individuals in CR as a strategy to help manage their CVD risk.Additionally, some patients who attend CR present with cardiovascular comorbid conditions (eg, spontaneous coronary artery dissection, [SCAD]; left ventricular assist device, [LVAD]), not easily identified in Table 1. Often, these individuals will make up a relatively small proportion of the populations that traditionally participate in CR and thus professionals may be less familiar with the current guidelines for patient-centered care.The purpose of this review is to present relevant information for the CR practitioner about patient populations that either do not currently qualify for (ie, chronic and end-stage CKD, BC survivor) or who are eligible but less commonly cared for in CR (ie, SCAD and LVAD). We also address special CR-related considerations and expected outcomes to better inform clinicians and researchers. Additionally, randomized control trials and clinical trials from the past decade, which support the benefits of exercise programming for CKD, SCAD and LVAD patient populations, have been summarized in Tables 2, 3, and 4. While not a systematic review, our tables provide important references for CR professionals to better understand the potential benefits of exercise for these populations. A summary for BC survivors was not provided, as a recent systematic review by Furmaniak et al 16 provides the information CR professionals would find beneficial regarding this population.

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“…However, if a recent GXT is not available, the use of the rating of perceived exertion of 11 to 14 on the Borg scale is appropriate. Parenthetically, patients on LVAD support who are paced have a weaker heart rate to VO 2 association; therefore, use of the Borg for this patient population should be considered first (11).…”

Section: Exercise Trainingmentioning

confidence: 99%

Exercise Training and Testing of an Advanced Heart Failure Patient – From LVAD to Transplant

Kerrigan¹,

Sciamanna²,

Cowger³

et al. 2018

Journal of Clinical Exercise Physiology

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Heart Rate and V˙O2 Concordance in Continuous-Flow Left Ventricular Assist Devices

Abstract: In patients with LVAD who are not paced during exercise, the use of %HRR is a good predictor of %V˙O2R. However, for patients in this population who are also paced during exercise, RPE is a suitable surrogate measure of exercise intensity.

Cited by 12 publications

References 15 publications

Ophthalmological Evaluation of Integrated Resistance and Aerobic Training During 70-Day Bed Rest

Ophthalmological Evaluation of Integrated Resistance and Aerobic Training During 70-Day Bed Rest

Rethinking Rehabilitation

Exercise Training and Testing of an Advanced Heart Failure Patient – From LVAD to Transplant

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