Exercise-Based Cardiac Rehabilitation in Heart Transplant Recipients

Summary

A Cochrane review [Abstract] 1 included 10 studies with a total of 300 adult subjects who had received a heart transplant. The mean age of subjects was 54.4 years, and fewer than 25% were women. Nine studies compared exercise-based rehabilitation to no exercise and one study compared high-intensity interval training with continued moderate-intensity training. Findings for all studies were reported at their longest follow-up (median 12 weeks).

Exercise-based cardiac rehabilitation increased exercise capacity (VO_2peak) compared with no exercise control (MD 2.49 mL/kg/min, 95% CI 1.63 to 3.36; 9 studies, n=284). High-intensity interval exercise training was more effective in improving exercise capacity than continuous moderate-intensity exercise (MD 2.30 mL/kg/min, 95% CI 0.59 to 4.01; 1 study, n=16). Health-related quality of life (HRQoL) was not meta-analyzed due to the variation in outcomes and methods of reporting. There was no evidence of a difference between exercise-based cardiac rehabilitation and control in 18 of 21 health-related quality of life (HRQoL) domains reported, or between high and moderate intensity exercise in any of the 10 HRQoL domains reported. One adverse event was reported by one study in the comparator group (a myocardial infarction resulting in heart failure) and none in the intervention group.

A multicentre randomized controlled trial 2 assessed safety and efficacy of high-intensity interval training (HIIT) after heart transplantation(n=81). At the 1-year follow-up, the HIIT group demonstrated greater improvements than the moderate-intensity continuous training group; the groups showed significantly different changes in the Vo_2peak (mean difference between groups, 1.8 mL/kg/min), the anaerobic threshold (0.28 L/min), the peak expiratory flow (11%), and the extensor muscle exercise capacity (464 J). The 1.8 mL/kg/min difference was equal to 0.5 metabolic equivalents, which is regarded as clinically meaningful and relevant. Health-related quality of life was similar between the groups, as indicated by results from the Short Form-36, Hospital Anxiety and Depression Scale, and a visual analog scale.