High-Intensity Interval Training in Heart Transplant Recipients: A Systematic Review with Meta-Analysis

Abstract

Heart transplantation (HTx) is considered an efficient and gold-standard procedure for patients with end-stage heart failure. After surgery, patients have lower aerobic power (VO2max) and compensatory hemodynamic responses. The aim of the present study was to assess through a systematic review with meta-analysis whether high-intensity interval training (HIIT) can provide benefits for those parameters. This is a systematic review with meta-analysis, which searched the databases and data portals PubMed, Web of Science, Scopus, Science Direct and Wiley until December 2016 (pairs). The following terms and descriptors were used: “heart recipient” OR “heart transplant recipient” OR ”heart transplant” OR “cardiac transplant” OR “heart graft”. Descriptors via DeCS and Mesh were: “heart transplantation’’ OR “cardiac transplantation”. The words used in combination (AND) were: “exercise training” OR “interval training” OR “high intensity interval training” OR “high intensity training” OR “anaerobic training” OR “intermittent training” OR “sprint training”. The initial search identified 1064 studies. Then, only those studies assessing the influence of HIIT on the post-HTx period were added, resulting in three studies analyzed. The significance level adopted was 0.05. Heart transplant recipients showed significant improvement in VO2peak, heart rate and peak blood pressure in 8 to 12 weeks of intervention.

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

“…Exercise-based cardiac rehabilitation in HTX patients (Table 6) 79 may be effective in reversing the pathophysiological consequences associated with cardiac denervation and prevent immunosuppressioninduced adverse effects; moreover, it ensures shortterm gains in exercise capacity, with uncertainty and need of further evidence about the longer-term benefits of exercise programmes. 80,81 During the in-hospital phase, early mobilizationparticularly in phase 1 but also in phase 2 cardiac rehabilitation -can be initiated as soon as haemodynamic reestablishment and weaning from post-transplant intravenous drugs occurs.…”

“…HIIT is a feasible, safe and effective way, as well. 79 This type of exercise should be introduced and used more frequently among a broader audience; however, HTX patients seem to respond differently, resulting mainly in peripheral improvements rather than improved cardiac function.…”

Diretriz Brasileira de Reabilitação Cardiovascular – 2020

“…230 Immunosuppression may predispose HTx recipients to a higher risk of other complications, 231 and these patients may develop HTN, diabetes mellitus, and CAD. 232 Conversely, physical exercise is known to be an excellent therapy for management of these chronic diseases 93,233 and is effective in optimizing autonomic control. 230,234 Physical training after HTx contributes to an increase in VO 2 peak and improvements in hemodynamic control, muscle strength, and bone mineral density, [233][234][235][236] thus improving prognosis.…”

“…232 Conversely, physical exercise is known to be an excellent therapy for management of these chronic diseases 93,233 and is effective in optimizing autonomic control. 230,234 Physical training after HTx contributes to an increase in VO 2 peak and improvements in hemodynamic control, muscle strength, and bone mineral density, [233][234][235][236] thus improving prognosis. 19 Although there are countless possibilities for training prescription, the recommended method remains aerobic exercise, which can be performed continuously or, in specific cases, at intervals and at different intensities, 170 combined with resistance training whenever possible.…”

“…In a crossover study, Dall et al 244 found a greater effect of HIIT compared to MICT on VO 2 peak, with an additional gain of 2.3 ml.kg -1 .min -1 and superior improvement in quality of life. One meta-analysis 233 included three randomized controlled trials that compared HIIT (intense blocks: 80 to 100% of VO 2 peak or 85 to 95% of peak HR) to usual care. Post-HTx patients randomized to HIIT showed an increase in VO 2 peak of 4.45 ml.kg -1 .min -1 after the intervention period, which ranged from 8 to 12 weeks of three to five weekly sessions.…”