Psychosocial and Physical Rehabilitation after Heart Transplantation: 1-Year Follow-Up

Niset, Georges; Coustry-Degré, Cécile; Degré, Serge

doi:10.1159/000174391

Cited by 47 publications

(12 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A number of physical conditioning programs have been described 72,[82][83][84][85][86][87][88] . In 1983, Squires et al 82 started a two-month supervised program six weeks following cardiac transplantation in two patients.…”

Section: Work Rate Adaptation To Exercise Following Cardiac Transplanmentioning

confidence: 99%

“…In general, transplanted subjects should exercise three to five times a week at between 50 and 75% VO 2 and Borg's scale between 13 and 15. Innumerable benefits of posttransplantation physical conditioning have been reported: reduced heart rate and arterial pressure during rest, decreased heart rate, arterial pressure, ventilartory equivalent for oxygen, ventilatory equivalent for carbon dioxide in submaximal exercise; increased heart rate, systolic arterial pressure, VO 2 , pulmonary ventilation, and reduction in arterial diastolic pressure at peak exercise; increased aerobic threshold, retardation of lactate elevation during exercise, reduction in effort perception by the Borg scale 72,[82][83][84][85][86][87] .…”

Section: Work Rate Adaptation To Exercise Following Cardiac Transplanmentioning

confidence: 99%

See 1 more Smart Citation

Adaptation to exercise following cardiac transplantation

Af¹,

Ja²

2000

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Cardiac transplantation has been the treatment of choice for patients with terminal cardiac insufficiency, increasing survival time by more than 80% in the first year 1 and by more than 50% over ten years 2 . Following cardiac transplantation, the quality of life improves considerably, and many transplanted patients return to work becoming reintegrated into the community 3 . During regular activity, transplanted subjects have shown physical conditioning similar to that of healthy individuals 4-7 . Starling's axiom, "today's physiology will be tomorrow's medicine" 8 , emphasizes the need for knowledge about post-transplantation cardiovascular adaptations, to serve as the basis for clinical treatment and rehabilitation. The present article has the aim of discussing the state-of -the-art of this subject.Aerobic capacity -Aerobic capacity is the total amount of O 2 capable of being metabolized by an organism. Aerobic potency is the amount of 0 2 consumed per unit of time (VO 2 ). Maximal O 2 consumption (VO 2 max.) or maximal aerobic potency is the maximum VO 2 obtained in an endurance (of progressive loads) test, in which VO 2 reaches a maximal value without additional increase due to an additional work load. In tests in which the patient does not reach maximum oxygen consumption, as frequently occurs in cardiopathy patients and transplanted subjects, peak VO 2 is defined as the highest value of VO 2 obtained. Following cardiac transplantation, patients progress with a reduction of peak VO 2 9-15 of 30-50% [16][17][18][19][20][21][22] . In our study 6,7 , deficits were 32.4% and 25.7% at peak exercise and at the anaerobic threshold, respectively. Marzo et al 18 found a 35% reduction in the absolute values of the anaerobic threshold. Degré et al 23 reported an early and intense accumulation of lactate during exercise, attributed to increased production in active tissues and reduced clearance secondary to decreased blood flow in the liver and other inactive tissues. In our study 7 , VO 2 in light to moderate submaximal exercise (40 watt load) below the anaerobic threshold was 12.34 and 12.38ml/kg/ min, in transplanted and healthy subjects, respectively, without significant differences between these groups. Meyer et al 24 , working with a load of 50 watts, reported a VO 2 of 0.96 ±0.1 and 0.95±0.08 L/min -1 in transplanted and control subjects, respectively.The reduction of peak VO 2 is due to multiple factors, both central and peripheral. Chronotropic incompetence and alteration in diastolic function are central factors 21,22,25,26 . At the peripheral level, reduction of peripheral oxygen extraction occurs 17,21,22,[27][28][29] . An exaggerated neuroendocrine response 19 and reduced capacity of pulmonary diffusion 20,30 also seem to be involved in decreased tolerance to exercise.Heart Rate -Heart rate values at rest have been observed to be higher in transplanted compared with healthy individuals due to the absence of parasympathetic innervation and corresponding to the intrinsic frequency of the sinus node 17,23,[31...

show abstract

Section: Work Rate Adaptation To Exercise Following Cardiac Transplanmentioning

confidence: 99%

Section: Work Rate Adaptation To Exercise Following Cardiac Transplanmentioning

confidence: 99%

Adaptation to exercise following cardiac transplantation

Af¹,

Ja²

2000

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

show abstract

“…Some become "insurance disabled" because they cannot find a job with health insurance adequate to make it feasible to give up disability and hledicaid support [5,36]. In European countries and Australia, more than 60% of recipients are reported to return to full-time work; an additional number work part-time [45,46].…”

Section: Long-term Follow-up and Quality Of Lifementioning

confidence: 99%

Psychosocial Effects of Cardiac Transplantation

Dressler¹

1991

J Intensive Care Med

View full text Add to dashboard Cite

As more cardiac transplant procedures are performed, the psychosocial implications of the procedure can be identified and investigated. The process of cardiac transplant can be viewed as a series of stages and adaptive tasks which begin with the proposal of transplant and progress to successful postoperative adaptation. The suggestion of transplant may evoke feelings of anxiety and ambivalence as patients realize that transplant may be their only option for long-term survival. The evaluation process determines the need for transplant and whether there are circumstances that might limit post-transplant survival. Psychosocial evaluation is important as survival depends in part on the recipient's ability to cope with stressors and comply with a complex medical regimen. This evaluation is not standardized, and research continues to identify reliable predictors of postoperative behavioral and psychiatric complications. The wait for a donor may be the most stressful of all stages as candidates deal with increasing symptoms, increasingly intensive medical management and the fear of a donor will not be found in time. Following successful surgery, heart recipients and their families express feelings of joy and relief. During convalescence, adjustment difficulties may arise in the form of transient depression or body image concerns. After recipients are discharged from the hospital, they must comply with intensive medical follow-up to monitor their health. They continue to be vulnerable to physical, emotional and financial problems.(ABSTRACT TRUNCATED AT 250 WORDS)

show abstract

“…As to physical aspects, exercise helps reduce a patient's resting blood pressure, increases maximum heart rate, and increases the maximal or peak oxygen consumption and exercise workload (Kavanagh et al 1988, Block et al 1990, Keteyian et al 1991, Badenhop 1995, Kobashigawa et al 1999. As to mental aspects, exercise helps improve a patient's quality of life, increases the compatibility of the newly transplanted heart to the body, increases mental and social functioning (Kavanagh et al 1988, Niset et al 1988, Block et al 1990, Keteyian et al 1991, Badenhop 1995, and even improves a satisfactory body image (Chen et al 2001).…”

Section: Introductionmentioning

confidence: 99%