Exercise as it relates to Disease/Exercise post heart transplant

=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.

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.

Benefits of Exercise
Exercise can assist post-cardiac transplant recipients by:
 * 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:
 * 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:
 * 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
 * 2-4 days per week
 * Arm exercises should not be started until full healing after sternotomy (2 months)
 * Within 2 months of surgery; patients should feel increased muscle strength and endurance of the legs; and beginning resistance work on the upper body

Aerobic Training Goals

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

Considerations and Precautions
While research has shown the safety of resistance and cardiovascular exercises; professional advice should be taken:
 * 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

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

Recommended Reading
American Heart Association

International Society for Heart and Lung Transplantation (See: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates for information)

Australia and New Zealand Cardiothoracic Organ Transplant Registry