Benefits of physical training on exercise capacity, inspiratory muscle function, and quality of life in patients with ventricular assist devices long-term postimplantation.
BACKGROUND
Capacity to exercise may not be fully restored in patients with heart failure even in the long term after ventricular assist device (VAD) implantation. The benefits of exercise training in patients with VAD are unknown.


METHODS
Fifteen patients, aged 38.3 ± 15.9 years, bridged to heart transplantation with left ventricular assist device or biventricular assist device were randomized at a ratio of 2 : 1 to a training group (TG, n = 10) or a control group (n = 5), 6.3 ± 4 months after implantation. Both the groups were advised to walk 30–45 min/day. TG also underwent moderate-intensity aerobic exercise using a bike or treadmill for 45 min, three to five times a week, combined with high-intensity inspiratory muscle training using a computer-designed software to respiratory exhaustion, two to three times a week for 10 weeks. The patients were tested using cardiopulmonary exercise testing, 6-min walk test, spirometry and electronic pressure manometer for inspiratory muscle strength (Pimax) and endurance (sustained Pimax) measurement. Quality of life was assessed with the Minnesota Living with Heart Failure questionnaire.


RESULTS
TG improved peak oxygen consumption (19.3 ± 4.5 vs. 16.8 ± 3.7 ml/kg per min, P = 0.008) and VO2 at ventilatory threshold (15.1 ± 4.2 vs. 12 ± 5.6 ml/kg per min, P = 0.01), whereas the ventilation/carbon dioxide slope decreased (35.9 ± 5.6 vs. 40 ± 6.5, P = 0.009). The 6-min walk test distance increased (527 ± 76 vs. 462 ± 88 m, P = 0.005) and quality of life was improved (38.2 ± 11.6 vs. 48.9 ± 12.8, P = 0.005), as well as Pimax (131.8 ± 33 vs. 95.5 ± 28cmH2O, P = 0.005), sustained Pimax (484 ± 195 vs. 340 ± 193cmH2O/s/103, P = 0.005), and inspiratory lung capacity (2.4 ± 0.9 vs. 1.7 ± 0.7 L, P = 0.008) were improved. No significant changes were noted in the control group.


CONCLUSIONS
Our findings indicate that exercise training may improve the functional status of VAD recipients even at a later period after implantation and thus, may have additional importance in cases of destination therapy.
Laoutaris
Ioannis D
ID
Stress Testing and Cardiac Rehabilitation Laboratory, Onassis Cardiac Surgery Center, 356 Sygrou Blv., 176 74, Athens, Greece. ylaoutaris@yahoo.gr
Dritsas
Athanasios
A
Adamopoulos
Stamatis
S
Manginas
Athanassios
A
Gouziouta
Aggeliki
A
Kallistratos
Manolis S
MS
Koulopoulou
Maria
M
Voudris
Vasilis
V
Cokkinos
Dennis V
DV
Sfirakis
Petros
P
D000328:Adult; D001642:Bicycling; D001945:Breathing Exercises; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006115:Greece; D006333:Heart Failure / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D001239:Inhalation; D016014:Linear Models; D008168:Lung / Q000503:physiopathology; D008297:Male; D008365:Manometry; D008875:Middle Aged; D053580:Muscle Strength; D010101:Oxygen Consumption; D010807:Physical Endurance; D011788:Quality of Life; D020127:Recovery of Function; D012132:Respiratory Muscles / Q000503:physiopathology*; D013147:Spirometry; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D016138:Walking; D055815:Young Adult