Performance Limitations in Heart Transplant Recipients

Tucker, Wesley J.; Beaudry, Rhys; Samuel, T. Jake; Nelson, Michael D.; Halle, Martin; Baggish, Aaron L.; Haykowsky, Mark J.

doi:10.1249/jes.0000000000000149

Cited by 37 publications

(43 citation statements)

References 83 publications

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“…Our findings clearly demonstrate the importance of postoperative CR participation in improving functional capacity and implications of survival following HTx. Specifically following HTx, the benefits of CR involvement are widespread for this clinically unique population; including counteracting marked deconditioning and skeletal muscle weakness associated with end-stage HF, corticosteroid treatment, and surgical recovery [18,34,35,36]. Although the predictive quality of CR session attendance has not been previously reported, the increase in VO 2peak following CR in HTx patients is well-documented [15,19,20,37,38].…”

Section: Discussionmentioning

confidence: 99%

“…One such study found a 5% lower risk of all-cause mortality or hospitalization for every 6% increase in VO 2peak , thereby highlighting the importance of even seemingly small improvements in VO 2peak on long-term clinical outcomes [7]. It should be noted, however, that despite significant functional improvements observed following HTx, VO 2peak values still remain abnormal in HTx patients compared to age-matched control subjects [34,41,42]. Further understanding of the demographic, clinical, and rehabilitative components that predict post-HTx VO 2peak values offers greater insight into the complex cardiopulmonary and peripheral adaptations occurring following HTx.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Rehabilitative Predictors of Peak Oxygen Uptake Following Cardiac Transplantation

Uithoven

Smith

Medina‐Inojosa

et al. 2019

JCM

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The measurement of peak oxygen uptake (VO2peak) is an important metric for evaluating cardiac transplantation (HTx) eligibility. However, it is unclear which factors (e.g., recipient demographics, clinical parameters, cardiac rehabilitation (CR) participation) influence VO2peak following HTx. Consecutive HTx patients with cardiopulmonary exercise testing (CPET) between 2007–2016 were included. VO2peak was measured from CPET standard protocol. Regression analyses determined predictors of the highest post-HTx VO2peak (i.e., quartile 4: VO2peak > 20.1 mL/kg/min). One hundred-forty HTx patients (women: n = 41 (29%), age: 52 ± 12 years, body mass index (BMI): 27 ± 5 kg/m2) were included. History of diabetes (Odds Ratio (OR): 0.17, 95% Confidence Interval (CI): 0.04–0.77, p = 0.021), history of dyslipidemia (OR: 0.42, 95% CI: 0.19–0.93, p = 0.032), BMI (OR: 0.90, 95% CI: 0.82–0.99, p = 0.022), hemoglobin (OR: 1.29, 95% CI: 1.04–1.61, p = 0.020), white blood cell count (OR: 0.81, 95% CI: 0.66–0.98, p = 0.033), CR exercise sessions (OR: 1.10, 95% CI: 1.04–1.15, p < 0.001), and pre-HTx VO2peak (OR: 1.17, 95% CI: 1.07–1.29, p = 0.001) were significant predictors. Multivariate analysis showed CR exercise sessions (OR: 1.10, 95% CI: 1.03–1.16, p = 0.002), and pre-HTx VO2peak (OR: 1.16, 95% CI: 1.04–1.30, p = 0.007) were independently predictive of higher post-HTx VO2peak. Pre-HTx VO2peak and CR exercise sessions are predictive of a greater VO2peak following HTx. These data highlight the importance of CR exercise session attendance and pre-HTx fitness in predicting VO2peak post-HTx.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical and Rehabilitative Predictors of Peak Oxygen Uptake Following Cardiac Transplantation

Uithoven

Smith

Medina‐Inojosa

et al. 2019

JCM

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“…What induces the "high-intensity interval training effect" is still unclear. In the adult maintenance heart transplant population, the improved peak oxygen consumption seems to rely on mostly peripheral changes such as improved muscle strength and function [11,[14][15][16][17]. In the de novo heart transplant population, the peak oxygen consumption improvement during the first year is more complex to describe, but seems to be associated with both central and peripheral factors [10].…”

Section: Discussionmentioning

confidence: 99%

Effect of high-intensity interval training in young heart transplant recipients: results from two randomized controlled trials

Nytrøen

Rolid

Yardley

et al. 2020

BMC Sports Sci Med Rehabil

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Background: Little is known about the effect of exercise in young heart transplant recipients, and results on group level is lacking. This study summarizes the findings of the youngest participants in two previous randomized controlled trials. Method: This is a hypothesis-generating study reporting the main results from the youngest participants in two larger randomized controlled trials investigating the effect of high-intensity interval training (HIT). The article summarizes the main results from 28 young participants (< 40 year of age) who have participated in two previous studies which evaluated the effect of HIT vs. controls in adult heart transplant recipients. One of the studies included de novo heart transplant recipients and the other included maintenance heart transplant recipients. All study tests were performed in-hospital, in the specialist health care setting, but the exercise intervention was carried out locally, in cooperation with the primary health care. In both studies the exercise intervention lasted for 9-12 months. In one study, HIT (85-95% of peak effort) was compared to controls (no specific intervention), and in the other study HIT was compared to moderate, continuous exercise (MICT, 60-80% of peak effort). The main outcome measure was peak oxygen uptake (VO 2peak) and a secondary endpoint was muscle strength. Results: The summarized findings from the youngest heart transplant recipients in these two studies demonstrated mainly that the improvement in peak oxygen uptake among the younger recipients (< 40 years) was much larger (4.7 vs. 1.2 ml/kg/min and 7.0 vs. 2.2 ml/kg/min) compared to the improvement among the older recipients (≥ 40 years), and in accordance with results from adult heart transplant populations: HIT, compared to MICT, induced the largest improvement in peak oxygen consumption, also in the younger heart transplant recipients. Conclusions: These results suggest that young heart transplant recipients have a greater effect of HIT than of MICT and may also suggest that younger recipients benefit more from high-intensity interval training than their older copatients. However, larger randomized studies focusing on the young heart transplant population is strongly needed to confirm this hypothesis. Trial registration: Clinical trial registrations: NCT01796379 and NCT01091194.

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“…In the adult maintenance heart transplant population, the improved peak oxygen consumption seems to rely on mostly peripheral changes such as improved muscle strength and function. 10,[14][15][16] In the de novo heart transplant population, the peak oxygen consumption improvement during the first year is more complex to describe, but seems to be associated with both central and peripheral factors. 11 This is also reflected in the current young HITTS population where the high-intensity interval training group had a borderline significantly higher O 2 pulse (Table 2), which again by some is associated with a higher stroke volume.…”

Section: Discussionmentioning

confidence: 99%

Effect of high-intensity interval training in young heart transplant recipients: results from two randomized controlled trials

Nytrøen

Rolid²,

Yardley³

et al. 2020

Preprint

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Background Little is known about the effect of exercise in young heart transplant recipients, and results on group level is lacking. This study summarizes the findings of the youngest participants in two previous randomized controlled trials. Method This is a hypothesis-generating study reporting the main results from the youngest participants in two larger randomized controlled trials investigating the effect of high-intensity interval training (HIT). The article summarizes the main results from 28 young participants (< 40 year of age) who have participated in two previous studies which evaluated the effect of HIT vs. controls in adult heart transplant recipients. One of the studies included de novo heart transplant recipients and the other included maintenance heart transplant recipients. All study tests were performed in-hospital, in the specialist health care setting, but the exercise intervention was carried out locally, in cooperation with the primary health care. In both studies the exercise intervention lasted for 9-12 months. In one study, HIT (85%-95% of peak effort) was compared to controls (no specific intervention), and in the other study HIT was compared to moderate, continuous exercise (MICT , 60-70% of peak effort). The main outcome measure was peak oxygen uptake (VO 2peak ) and a secondary endpoint was muscle strength. Results The summarized findings from the youngest heart transplant recipients in these two studies demonstrated mainly that the improvement in peak oxygen uptake among the younger recipients (< 40 years) was much larger (4.7 vs. 1.2 ml/kg/min and 7.0 vs. 2.2 ml/kg/min) compared to the improvement among the older recipients (≥ 40 years), and in accordance with results from adult heart transplant populations: HIT, compared to MICT, induced the largest improvement in peak oxygen consumption, also in the younger heart transplant recipients. Conclusions These results suggest that young heart transplant recipients have a greater effect of HIT than of MICT and may also suggest that younger recipients benefit more from high-intensity interval training than their older co-patients. However, larger randomized studies focusing on the young heart transplant population is strongly needed to confirm this hypothesis.

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Performance Limitations in Heart Transplant Recipients

Cited by 37 publications

References 83 publications

Clinical and Rehabilitative Predictors of Peak Oxygen Uptake Following Cardiac Transplantation

Clinical and Rehabilitative Predictors of Peak Oxygen Uptake Following Cardiac Transplantation

Effect of high-intensity interval training in young heart transplant recipients: results from two randomized controlled trials

Effect of high-intensity interval training in young heart transplant recipients: results from two randomized controlled trials

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