Exercise Recommendations - Post Cardiac Transplant

Background

A cardiac transplant involves the surgical placement of a donor’s healthy heart into the recipient with end-stage heart disease. Some diseases linked with heart transplants are those such as cardiomyopathy and heart failure.^[1]

Heart Transplants are surgeries of life-saving technology which was started as a radical experimental surgery in 1984 which now plays a detrimental role in end-stage heart disease patients. Since 1984, The St. Vincent’s Hospital of Sydney, The Royal Children’s in Melbourne, Royal Perth Hospital, and The Prince Charles Hospital in Brisbane and The Alfred in Melbourne have offered heart transplant programs.^[2]

Benefits of Exercise

Exercise can assist post-cardiac transplant recipients by:^[3]

Decreased blood lactate concentrations at the given work rate
Improved aerobic characteristics of skeletal muscle
Improved endothelial function
Decreased resting heart rate and blood pressure
Increased VO2 peak and VO2 at ventilator threshold
Increased muscle force production
Increased bone mineral density
Prevention of steroid-induced muscle wasting and weakness

Cardiac Transplant patients can have decreased results post surgery if:^[4]

Inactivity before surgery
Reduced aerobic characteristics of skeletal muscle
Decreased skeletal muscle mass and force production
Pulmonary diffusion abnormalities
Left ventricular dysfunction

Resistance and Cardiovascular Exercise Guidelines

Recommended exercise programs are progressive and aimed in:^[5]

improving cardiorespiratory fitness
improve muscle endurance and force production
re-establish self efficacy and improve quality of life

Resistance Training Goals

Low to moderate intensity exercise; 1-2 sets of 10-15reps ^[6]
2-4 days per week ^[7]
Arm exercises should not be started until full healing after sternotomy (2 months) ^[8]
Within 2 months of surgery; patients should feel increased muscle strength and endurance of the legs; and beginning resistance work on the upper body ^[9]

Aerobic Training Goals

15 – 60 minute sessions ^[10]
4 -7 days per week at 40-80% VO2 max ^[11]
After 6 months, recipients should have increase cardiovascular fitness and improvements against risk factors such as insulin sensitivity etc.^[12]

Considerations and Precautions

While research has shown the safety of resistance and cardiovascular exercises; professional advice should be taken:^[13]

discuss physical activity with your doctor or physiotherapist to determine what may be appropriate
do not exercise or stop immediately if unwell, dizzy, lightheaded, faint, cold sweats, nausea or chest pain
do not begin to exercise if you are having an episode of rejection
avoid exercise in extreme temperatures or conditions ^[14]

Ensure to monitor all medications; as it can cause some disruptions to exercise – seek medical advice.

References

↑ Cardiothoracic Surgery - Patient’s Guide to Heart Transplant Surgery http://www.cts.usc.edu/ht-pg-exercise.html
↑ The international society of heart and lung transplantation guidelines for the care of heart transplant recipients – Long term care of heart transplant recipients. (Aug 6, 2010) http://www.ishlt.org
↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
↑ The international society of heart and lung transplantation guidelines for the care of heart transplant recipients – Long term care of heart transplant recipients. (Aug 6, 2010) http://www.ishlt.org
↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
↑ Cardiothoracic Surgery - Patient’s Guide to Heart Transplant Surgery http://www.cts.usc.edu/ht-pg-exercise.html
↑ The international society of heart and lung transplantation guidelines for the care of heart transplant recipients – Long term care of heart transplant recipients. (Aug 6, 2010) http://www.ishlt.org

[1] Cardiothoracic Surgery - Patient’s Guide to Heart Transplant Surgery http://www.cts.usc.edu/ht-pg-exercise.html

[2] The international society of heart and lung transplantation guidelines for the care of heart transplant recipients – Long term care of heart transplant recipients. (Aug 6, 2010) http://www.ishlt.org

[3] Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106

[4] Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106

[5] The international society of heart and lung transplantation guidelines for the care of heart transplant recipients – Long term care of heart transplant recipients. (Aug 6, 2010) http://www.ishlt.org

[6] Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106

[7] Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106

[8] Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106

[9] Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106

[10] Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106

[11] Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106

[12] Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106

[13] Cardiothoracic Surgery - Patient’s Guide to Heart Transplant Surgery http://www.cts.usc.edu/ht-pg-exercise.html

[14] The international society of heart and lung transplantation guidelines for the care of heart transplant recipients – Long term care of heart transplant recipients. (Aug 6, 2010) http://www.ishlt.org

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Exercise as it relates to Disease/Exercise post heart transplant