Importance of physical capacity and the effects of exercise in heart transplant recipients

Abstract

One of the most important prognostic factors in heart failure patients is physical capacity. Patients with very poor physical performance and otherwise eligible, may be listed as candidates for heart transplantation (HTx). After such surgery, life-long immunosuppression therapy is needed to prevent rejection of the new heart. The dark side of immunosuppression is the increased risk of infections, kidney failure, cancer and advanced atherosclerosis (cardiac allograft vasculopathy), with the two latter conditions as the main causes of later mortality. In a worldwide perspective, 50% of the HTx patients survive past 10 years. Poor aerobic capacity prior to graft deterioration is not only limited to the failing heart, but also caused by peripheral factors, such as limited function in the skeletal muscles and in the blood vessels walls. Exercise rehabilitation after HTx is of major importance in order to improve physical capacity and prognosis. Effects of high-intensity interval training (HIT) in HTx recipients is a growing field of research attracting worldwide focus and interest. Accumulating evidence has shown that HIT is safe and efficient in maintenance HTx recipients; with superior effects on physical capacity compared to conventional moderate exercise. This article generates further evidence to the field by summarizing results from a decade of research performed at our center supported by a broad, but not strict formal, literature review. In short, this article demonstrates a strong association between physical capacity measured after HTx and long-term survival. It describes the possible “HIT-effect” with increased levels of inflammatory mediators of angiogenesis. It also describes long-term effects of HIT; showing a positive effect in development of anxiety symptoms despite that the improved physical capacity was not sustained, due to downregulation of exercise and intensity. Finally, our results are linked to the ongoing HITTS study, which investigates safety and efficiency of HIT in de novo HTx recipients. Together with previous results, this study may have the potential to change existing guidelines and contribute to a better prognosis for the HTx population as a whole.

An Update on the Role of Cardiorespiratory Fitness, Structured Exercise and Lifestyle Physical Activity in Preventing Cardiovascular Disease and Health Risk

“…12 documented beneficial health effects of CR in all patients, participation rates remain discouragingly low [66][67][68][69] . Members of the Million Hearts Cardiac Rehabilitation Collaborative have recently outlined effective strategies (automated referrals and strong physician endorsement) that clinicians can take to increase participation rates from ~20% -70% by the year 2022 70 .…”

A szívbetegek rehabilitációjának sportos arca

“…A tízéves túlélés esélye 50% körüli. Az érfunkciók romlása nagyban függ a perifériától -a fizikai edzés ezen a ponton is javítja az életkilátásokat [17]. Újabban a szívtranszplantáltak körében is kedveltté vált a nagy intenzitású interval edzés (HIIT): rövidebb edzésidővel hatékonyabban növeli az aerob kapacitást, ami a várható túlélés jelzője.…”

“…A hatásmechanizmusban az angiogenezis serkentése lehet az egyik fontos tényező, a gyulladásos mediátorok erre utalnak. A nagyobb terhelhetőség együtt jár a szorongás csökkenésével [17].…”

“…A koreai szívelégtelen, 40% alatti ejekciós frakciójú betegek egy centrumban, nem random módon a kórházban 60%-os intenzitású edzésen vettek részt, míg mások otthonukban, fizioterapeuta vezetésével edzettek három hónapig. A kórházi csoport VO 2 -maximuma 19,4-ről 21,4-re nőtt, az otthon edzőké nem változott (18,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)4). Egyéves követés során nem volt közöttük különbség a szíveseményekben [21].…”

Clinical features and determinants of VO2peakinde novoheart transplant recipients

“…VO 2peak is the gold standard to objectively assess functional limitation and give an assessment of the integrative physiology involving cardiovascular, pulmonary, muscular, cellular and oxidative systems[ 13 , 14 ]. It has also been reported that VO 2peak is a strong predictor for survival in HTx recipients[ 15 , 16 ]. In studies of maintenance HTx patients, VO 2peak seems to be determined by both central (chronotropic incompetence, reduced stroke volume and cardiac output, impaired systolic and diastolic function, pulmonary dysfunction) and peripheral factors (diminished skeletal muscular capacity)[ 1 , 17 - 19 ].…”