Exercise Therapy for Cardiac Transplant Recipients
Section snippets
Background information
The first successful human heart transplantation (HT) was performed by Barnard1 in Cape Town, South Africa, in 1967. Although the patient lived only 18 days, the resulting publicity and enthusiasm spurred a number of surgical centers to perform the operation. Long-term survival was poor, and the procedure did not enjoy widespread application during the 1960s and 1970s. Developments at Stanford University, including improved techniques for preservation of the donor organ, the transvenous right
Responses to exercise
The responses of HT recipients to acute exercise is unique and related, in part, to the following factors7, 8, 9:
- 1.
The transplanted heart is surgically denervated and receives no direct efferent input from the autonomic nervous system and provides no direct afferent signals to the central nervous system. Months after HT, some patients demonstrate signs of partial cardiac reinnervation. This will be discussed later.
- 2.
During organ harvesting and with transplantation, the donor heart has experienced
Graded exercise testing
Exercise testing after HT is helpful in determining the exercise capacity, prescribing exercise training (ET), and in counseling patients regarding the timing of return to work or school, or resumption of avocational pursuits. The electrocardiogram (ECG) of HT recipients commonly demonstrates right bundle-branch block and nonspecific repolarization abnormalities. The sensitivity of the exercise ECG in detecting ischemia due to the presence of allograft vasculopathy is poor (<25%), unless
Responses to ET
Recipients of HT are excellent candidates for progressive ET for several reasons: pre-HT syndrome of chronic HF with poor exercise capacity due to central and peripheral circulatory abnormalities, skeletal muscle pathology, deconditioning, the healing process with open-heart surgery similar to that observed with coronary or valvular surgery, and post-HT use of corticosteroid medications with resultant skeletal muscle atrophy and weakness.
Pretransplant graded exercise testing and training
As part of the evaluation process for HT, ambulatory patients undergo cardiopulmonary exercise testing. Peak VO2 is a powerful prognostic indicator: patients with an aerobic capacity of 14 mL kg−1 min−1 (4 METs) or below experience a markedly reduced 1-year survival, independent of left ventricular ejection fraction.47
Based on the results of the exercise test, an ET prescription may be developed for the patient with the goal of maintaining or even improving cardiorespiratory fitness while
Statement of Conflict of Interest
The author declares that there is no conflict of interest.
References (48)
- et al.
The development of cardiac transplantation
Mayo Clin Proc
(1992) - et al.
The changing face of heart transplantation
J Am Coll Cardiol
(2008) - et al.
Quality of life after heart and heart-lung transplantation
Transplant Proc
(2001) - et al.
Exercise response of the denervated heart in long-term cardiac transplant recipients
Am J Cardiol
(1980) - et al.
Structure of skeletal muscle in heart transplant recipients
J Am Coll Cardiol
(1996) - et al.
Exercise-induced hypoxemia in heart transplant recipients
J Am Coll Cardiol
(1993) - et al.
Partial normalization of the heart rate response to exercise after cardiac transplantation: frequency and relationship to exercise capacity
Mayo Clin Proc
(2002) - et al.
Chronotropic competence in endurance trained heart transplant recipients: heart rate is not a limiting factor for exercise capacity
J Am Coll Cardiol
(1999) Heart transplant recipient climbs the Matterhorn
Lancet
(2003)- et al.
Heart transplant recipient completes ironman triathlon 22 years after surgery
J Heart Lung Transplant
(2009)
Evolution of the chronotropic response to exercise after cardiac transplantation
Am J Cardiol
Exercise stress tests after cardiac transplantation
Am J Cardiol
Skeletal muscle response to short endurance training in heart transplantation recipients
J Am Coll Cardiol
Resistance exercise training restores bone mineral density in heart transplant recipients
J Am Coll Cardiol
Effect of exercise training on leukocyte subpopulations and clinical course in cardiac transplant patients
Transplant Proc
Cardiac transplantation: Surgical considerations and early postoperative management
Mayo Clin Proc
The operation: A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town
S Afr Med J
The registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult transplant report—2010
J Heart Lung Transplant
Sirolimus as primary immunosuppressant reduces left ventricular mass and improves diastolic function of the cardiac allograft
Transplantation
Cardiac rehabilitation issues for heart transplantation patients
J Cardiopulmonary Rehabil
Determinants of peak aerobic capacity after heart transplantation
Eur Heart J
Exercise after heart transplantation
Eur J Appl Physiol
Transplant
Cardiac transplant
Cited by (28)
Cardiac rehabilitation for heart transplant patients: Considerations for exercise training
2022, Progress in Cardiovascular DiseasesContemporary review of exercise in heart transplant recipients
2021, Transplantation ReviewsCitation Excerpt :It is difficult to make precise recommendations about the duration, frequency, and intensity of the training due to a lack of comparable studies. In general, recommended aerobic training lasting 20–60 min, 3–5 times a week at an intensity of 80% to 90% HRmax or 60% to 70% VO2peak [23,24]. Studies have demonstrated a beneficial effect from interval training, which in several parameters showed to be more effective than continuous training in HTx [11,12].
The Role of Cardiac Rehabilitation in Reducing Major Adverse Cardiac Events in Heart Transplant Patients
2020, Journal of Cardiac FailureCitation Excerpt :Patients participated in 20 to 45 minutes of structured aerobic activity in a monitored setting, with an additional 10 to 15 minutes of resistance training during a standard CR exercise session. As heart rate is not considered an optimal method for determining exercise intensity following HTx due to of denervation;29 the primary method for monitoring intensity following HTx was the rating of perceived exertion. Additionally, patients were encouraged to engage in light to moderate physical activity for at least 30 minutes on all days of the week outside of CR attendance.
Chronic Medical Conditions: Pulmonary Disease, Organ Transplantation, and Diabetes
2020, Braddom's Physical Medicine and RehabilitationCardiac rehabilitation and readmissions after heart transplantation
2018, Journal of Heart and Lung TransplantationChronic Medical Conditions
2018, Braddom's Rehabilitation Care: A Clinical Handbook
Statement of Conflict of Interest: see page 435.