Safety and efficacy of cardiac rehabilitation for patients with continuous flow left ventricular assist devices.
BACKGROUND
Despite the increasing use of left ventricular assist devices (LVADs) in terminal heart failure, cardiac rehabilitation protocols have not yet been documented in larger LVAD patient cohorts. The aim of this study was to investigate safety and efficacy of exercise training during a rehabilitation programme after post-operative discharge of LVAD patients.


METHODS
Rehabilitation data obtained between 2010-2012 from 41 LVAD patients (mean age 54.8 ± 11.6 years; 20% female) were retrospectively analysed. The exercise protocol consisted of strength exercises for lower limbs, bicycle ergometry, walking and gymnastics. The numbers of training sessions, their duration and intensity as well as adverse events were documented. Spiroergometry was performed at least once and twice in a subgroup of 15 patients (at the beginning and end of rehabilitation).


RESULTS
Rehabilitation started 48 ± 38 days post LVAD implantation with an average duration of 32 ± 6 days. An increase in exercise capacity was observed. Duration (19 ± 4 vs 14 ± 2 min, p < 0.001) and intensity of bicycle ergometry increased (module number 6.2 ± 2.8 vs 2.0 ± 1.9, p < 0.001) as well as muscular strength all muscle groups trained (e.g. 33.6 ± 15.2 vs 26.6 ± 11.9 kg at the leg press, p = 0.002). Spiroergometry revealed an increase of maximal oxygen consumption (14.5 ± 5.2 vs 11.3 ± 4.1 ml/min/kg, p = 0.007) in the subgroup that underwent two examinations. In the whole population the average increase was lower (12.81 ± 4.35 ml/min/kg). One training-related adverse event (non-sustained ventricular tachycardia) was observed.


CONCLUSIONS
Exercise training for LVAD patient as part of a multidisciplinary rehabilitation programme is effective and safe. This warrants the broad application of exercise training after LVAD implantation.
Rehabilitation Center Felbring, Austria christiane.marko@pensionsversicherung.at.
Christiane
C
Marko
Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria Ludwig Boltzmann Cluster for Cardiovascular Research, Austria.
Georg
G
Danzinger
Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria Ludwig Boltzmann Cluster for Cardiovascular Research, Austria.
Michael
M
Käferbäck
Rehabilitation Center Felbring, Austria.
Thomas
T
Lackner
Pensionsversicherungsanstalt, Austria.
Rudolf
R
Müller
Ludwig Boltzmann Cluster for Cardiovascular Research, Austria Department of Cardiac Surgery, Medical University of Vienna, Austria.
Daniel
D
Zimpfer
Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria Ludwig Boltzmann Cluster for Cardiovascular Research, Austria Department of Cardiac Surgery, Medical University of Vienna, Austria.
Heinrich
H
Schima
Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria Ludwig Boltzmann Cluster for Cardiovascular Research, Austria.
Francesco
F
Moscato
D000328:Adult; D000368:Aged; D001642:Bicycling; D003131:Combined Modality Therapy; D005080:Exercise Test; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D006173:Gymnastics; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011474:Prosthesis Design; D020127:Recovery of Function; D055070:Resistance Training; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016138:Walking; D055815:Young Adult
Continuous flow left ventricular assist devices; cardiac rehabilitation; exercise capacity; exercise training