title: Exercise performance increases coincident to body weight over the first two years following cardiac transplantation.
abstract: BACKGROUND
  To determine whether exercise performance changed over time once patients stabilized after heart transplantation, metabolic stress testing was performed in patients one and two yr post-heart transplantation.
  
  
  METHODS
  The patient cohort includes those transplanted in our program who survived at least two yr and were able to perform metabolic stress tests during their one- and two-yr annual evaluations. Standard stress test parameters were assessed, including weight, body surface area, rest and exercise heart rate (HR) and blood pressure (BP), exercise time, anaerobic threshold (AT), and maximum VO2 (MVO2). Ejection fraction by echo was also collected. Each patient served as their own control and data were compared using paired t-testing.
  
  
  RESULTS
  Fifty patients were included in the cohort, 48 of whom were able to exercise to at least AT. Patient weight increased from year 1 to year 2 (82.4 ± 15.1 vs. 85.0 ± 17.0 kg, p = 0.035). Systolic BP increased approximately 40 mmHg with exercise with no change in diastolic BP, and there was no difference between years 1 and 2. HR increased approximately 25 bpm with exercise. There was no difference in resting HR but exercise HR increased significantly between yrs (148 ± 15 bpm vs. 154 ± 18 bpm, p = 0.017). Both VO2 at AT and MVO2 increased significantly from year 1 to year 2 (1116 ± 347 mL/min vs. 1192 ± 313 mL/min, p = 0.049 and 1523 ± 337 mL/min vs. 1599 ± 356 mL/min, p = 0.012, respectively) but when corrected for body weight, there were no differences (VO2-AT 13.6 ± 4.0 mL/kg/min vs. 14.0 ± 4.0 mL/kg/min; MVO2 18.7 ± 4.2 mL/kg/min vs. 18.8 ± 4.1 mL/kg/min). All other measured parameters were not different. There was a weak but statistically significant correlation between change in peak HR and change in VO2 at AT between one and two yr post-transplantation (r = 0.30, p = 0.04).
  
  
  CONCLUSIONS
  We conclude that exercise performance as measured by VO2 can increase over time post-heart transplantation and in our cohort appears to be related to both an increase in body weight and an increase in HR from years 1 and 2.
authors.affiliation: Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL 32224, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Chaudry
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Yip
authors.forename: Tanya
authors.initials: T
authors.lastname: Bush
authors.forename: Virginia
authors.initials: V
authors.lastname: Reynolds
authors.forename: Lorraine
authors.initials: L
authors.lastname: Witzke
authors.forename: Virginia
authors.initials: V
authors.lastname: Taylor
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Hosenpud
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001835:Body Weight; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011379:Prognosis; D012189:Retrospective Studies