Regular training in a hospital in patients with left ventricle assist device (LVAD): influence on exercise capacity, muscular strength and complex coordination

Abstract

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

Hand grip strength in patients with LVADs: A scoping review

“…In fact, HGS was better in those subjects attending a postoperative rehabilitation program, as given in Table 3. Nonetheless, HGS evaluated as ≥25% of body weight was similar during the pre‐implantation phase to the values found in patients attending postoperative rehabilitation; this could be explained by the hypothesis that those able to perform ≥25% of body weight probably arrived at implantation in better conditions, shadowing those completing a 4–5 week rehabilitation program 20 . In addition, patients participating in a postoperative rehabilitation program and showing higher HGS values were also able to increase the distance walked at the 6‐MWT, 20 (Table 1).…”

“…More specifically, it can be gathered that the 6‐MWT improved significantly in those studies where even HGS increased; for instance, in both the Falls et al and Smolis‐Bak et al's studies, the increased walked distance (from 300.1 to 404.8 m, and 56.6 to 83.8 m, respectively) was correlated with increased HGS (Tables 1–3). 12,20 Therefore, these two studies illustrated the predictivity of HGS regarding a specific rehabilitative outcome. In addition, in one study, HGS was lower in those patients who died after LVAD implantation 12 .…”

“…Overall, 30 citations were retrieved from the selected databases, and after duplicates removal, 28 documents were screened for eligibility; 5 articles were included in the final analysis, as shown in Figure 1. All the included studies were observational designs 12,13,19,20,23 . In three of them, HGS was evaluated before implantation 12,13,19 .…”

“…Of those studies evaluating preoperative HGS, three had at least one follow‐up postoperatively 12,13,23 . Eventually, two studies were conducted during the postoperative course, and HGS measurements were taken before and after rehabilitation 20,23 . Only one study 19 described the assessment procedure; patients were asked to perform maximal isometric hand contraction three times while supine.…”

“…Nevertheless, in stating the above, we do not think there are substantial differences in the merits of measurement procedures between patients with left ventricular assist devices (LVADs) and other patient populations 18 . Initial clinical experiences describe HGS as a predictive measure of functional outcomes in patients with advanced heart failure undergoing LVADs implantation 12,13,19,20 . So far, a definition of the HGS cut‐off values in patients with LVADs is not available yet.…”