title: Supervised exercise training versus usual care in ambulatory patients with left ventricular assist devices: A systematic review.
abstract: Implantation of left ventricular assist devices (LVAD) has increased because of improved safety profile and limited availability of heart transplantation. Although supervised exercise training (ET) programs are known to improve exercise capacity and quality of life (QoL) in heart failure (HF) patients, similar data is inconclusive in LVAD patients. Thus, we performed a systematic review on studies that incorporated supervised ET and measured peak oxygen uptake in LVAD patients. A total of 150 patients in exercise and 55 patients in control groups were included from 8 studies selected from our predefined criteria. Our systematic review suggests supervised ET has an inconsistent effect on exercise capacity and QoL when compared to control groups undergoing usual care. A quantitative sub-analysis was performed with 4 studies that provided enough data to compare peak oxygen uptake and QoL at baseline and at follow-up. After at least 6 weeks of training, LVAD patients undergoing supervised ET demonstrated significant improvement in exercise capacity (standardized mean difference [SMD] = 0.735, 95% Confidence Interval-[CI], 0.31-1.15 units of the standard deviation, P = 0.001) and QoL scores (SMD = 1.58, 95% CI 0.97-2.20 units of the standard deviation, P <0.001) when compared to the usual care group, with no serious adverse events with exercise. These results suggest that supervised ET is safe and can improve patient outcomes in LVAD patients when compared to the usual care.
authors.affiliation: Division of Cardiology, Medical Service, Veterans Affairs Medical Center, Providence, Rhode Island, United States of America.|Division of Cardiology, Dept. of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Harsha V
authors.initials: HV
authors.lastname: Ganga
authors.affiliation: Division of Cardiology, Medical Service, Veterans Affairs Medical Center, Providence, Rhode Island, United States of America.|Division of Cardiology, Dept. of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Amanda
authors.initials: A
authors.lastname: Leung
authors.affiliation: Division of Cardiology, Medical Service, Veterans Affairs Medical Center, Providence, Rhode Island, United States of America.|Division of Cardiology, Dept. of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jantz
authors.affiliation: Division of Cardiology, Medical Service, Veterans Affairs Medical Center, Providence, Rhode Island, United States of America.|Division of Cardiology, Dept. of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Choudhary
authors.affiliation: Center for Cardiac Fitness, Miriam Hospital, Providence, Rhode Island, United States of America.
authors.forename: Loren
authors.initials: L
authors.lastname: Stabile
authors.affiliation: Division of Cardiology, Dept. of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Levine
authors.affiliation: Division of Cardiology, Medical Service, Veterans Affairs Medical Center, Providence, Rhode Island, United States of America.|Division of Cardiology, Dept. of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Satish C
authors.initials: SC
authors.lastname: Sharma
authors.affiliation: Division of Cardiology, Medical Service, Veterans Affairs Medical Center, Providence, Rhode Island, United States of America.|Division of Cardiology, Dept. of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.|Center for Cardiac Fitness, Miriam Hospital, Providence, Rhode Island, United States of America.
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
mesh_terms: D016001:Confidence Intervals; D015444:Exercise / Q000502:physiology*; D006333:Heart Failure / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D011788:Quality of Life