title: Early progressive mobilization of patients with left ventricular assist devices is safe and optimizes recovery before heart transplantation.
abstract: BACKGROUND
  As early perioperative survival with left ventricular assist device support improves, additional emphasis must be placed on patient rehabilitation. Especially as mean left ventricular assist device support times exceed 100 days, it is essential for health professionals to mobilize patients to prevent the incidence of the deleterious effects of bedrest. The timing of optimal functional performance and the safety of rehabilitation has not been described.
  
  
  METHODS
  We retrospectively studied patients surviving left ventricular assist device implantation (34 of 41 patients; 27 men, 7 women; age 51 +/- 11 years). Physical therapy consisted of progressive mobilization leading to treadmill exercise or cycling. All patients exercised in the "pump on full" mode with flows >or= 3.0 L/min.
  
  
  RESULTS
  Twenty of thirty-four patients initiated ambulation at 7 to 10 days with independent ambulation by 14 days in 55% of the group. Treadmill exercise was tolerated by 82% of the patients, begun at postoperative day 21 by eighteen patients. The greatest improvement in exercise performance was seen by 6 to 8 weeks (20 to 30 minutes at 3.17 +/- 0.79 metabolic equivalents). Maximal functional capacity achieved was influenced by medical complications. A total of 1878 treatment sessions lasting 1390 hours was performed. Only four minor incidents occurred representing 2.9 incidents/1000 patient hours; all involved a transient decrease in pump flow. None of these events resulted in an increase in morbidity or mortality.
  
  
  CONCLUSIONS
  Progressive mobilization in patients with left ventricular assist device is safe. Patients return to independence in activities of daily living and tolerate prolonged workloads of up to 5 metabolic equivalents. There is rapid improvement in functional capacity until 6 weeks after operation. Delay in transplantation until this time may optimize postoperative recovery.
authors.affiliation: Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York, N.Y., USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Morrone
authors.forename: L A
authors.initials: LA
authors.lastname: Buck
authors.forename: K A
authors.initials: KA
authors.lastname: Catanese
authors.forename: R L
authors.initials: RL
authors.lastname: Goldsmith
authors.forename: L P
authors.initials: LP
authors.lastname: Cahalin
authors.forename: M C
authors.initials: MC
authors.lastname: Oz
authors.forename: H R
authors.initials: HR
authors.lastname: Levin
mesh_terms: D000203:Activities of Daily Living; D004434:Early Ambulation; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006333:Heart Failure / Q000534:rehabilitation*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors