Supervised exercise training versus usual care in ambulatory patients with left ventricular assist devices: A systematic review

Abstract

Implantation of left ventricular assist devices (LVAD) has increased because of improved safety profile and limited availability of heart transplantation. Although supervised exercise training (ET) programs are known to improve exercise capacity and quality of life (QoL) in heart failure (HF) patients, similar data is inconclusive in LVAD patients. Thus, we performed a systematic review on studies that incorporated supervised ET and measured peak oxygen uptake in LVAD patients. A total of 150 patients in exercise and 55 patients in control groups were included from 8 studies selected from our predefined criteria. Our systematic review suggests supervised ET has an inconsistent effect on exercise capacity and QoL when compared to control groups undergoing usual care. A quantitative sub-analysis was performed with 4 studies that provided enough data to compare peak oxygen uptake and QoL at baseline and at follow-up. After at least 6 weeks of training, LVAD patients undergoing supervised ET demonstrated significant improvement in exercise capacity (standardized mean difference [SMD] = 0.735, 95% Confidence Interval-[CI], 0.31–1.15 units of the standard deviation, P = 0.001) and QoL scores (SMD = 1.58, 95% CI 0.97–2.20 units of the standard deviation, P <0.001) when compared to the usual care group, with no serious adverse events with exercise. These results suggest that supervised ET is safe and can improve patient outcomes in LVAD patients when compared to the usual care.

LVAD Pump Flow Does Not Adequately Increase With Exercise

“…LVAD patients from our center perform cardiac rehabilitation to restore and improve aerobic work capacity, physical strength, and mobility after LVAD implantation . Exercise training for LVAD patients is safe and effective with significant improvements in exercise capacity and quality of life scores after at least 6 weeks of training . However very heterogeneous inter‐individual exercise and functional capacities were reported, which are due to the different severities of heart failure and the presence of other organs’ dysfunction .…”

Exercise training in patients with a left ventricular assist device (Ex‐VAD): rationale and design of a multicentre, prospective, assessor‐blinded, randomized, controlled trial

“…At present, data on ET in LVAD are scarce . From the few published trials, none has investigated differences in indication (bridging vs. destination therapy), duration from LVAD implantation to start of ET, or impact of pump settings on ET under controlled conditions.…”

“…From the few published trials, none has investigated differences in indication (bridging vs. destination therapy), duration from LVAD implantation to start of ET, or impact of pump settings on ET under controlled conditions. Underlying disease leading to LVAD implantation, indication and co‐morbidities have often not been reported in previous trials . Also, due to small sample sizes and predominately male patients receiving LVAD support, gender differences have not been assessed.…”

“…Several small single‐centre randomized ET intervention trials have previously been conducted in advanced HF patients treated by LVAD therapy . These trials demonstrated that ET is feasible, safe and tends to improve maximal and submaximal exercise capacity (peakVO 2 , 6 min walk distance), muscle strength and QoL in patients with LVAD.…”

“…However, due to low sample sizes, low number of training sessions and short intervention periods, these trials showed conflicting results with ET. Overall, data on ET in LVAD are rare …”