Table 2.
Characteristics of reviewed studies on VHD and exercise training.
|
Author (Year) |
Study group Patient characteristics |
CR variety CR length Intervention |
Primary endpoint | Main results and adverse events | Conclusion |
|---|---|---|---|---|---|
| Zanettini (2014) [84] | N=60; None; Age 83.5; Female 53%; TAVI CD - mentioned; Time to CR - 10,6 ± 3.4 d. |
CR inpatient; Length 18.3 ± 5.6 days; Intervention: 6d/w (1) Intensity according to clinical condition, 6MWT, disability (2) In pts with mild disability interval or steady-state aerobic training and callisthenics was used. |
(1) to determine the in-hospital and mid-term outcomes of these patients. | AE: NA 6MWT at discharge was significantly higher and corresponded to the 64% ± 23% of the predicted vs. 49% ± 21% in the admission test. |
Most patients showed significant improvement in functional status, QoL, and autonomy, which remained stable in the majority of subjects during mid-term follow-up. |
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| Russo (2014) [85] |
N=158; TAVI = 78; SAVR = 80; Age 82.1; Female 60%; TAVI, SAVR; Time to CR - 13,7 ± 11.7 d |
CR inpatient; Length 2 w; Intervention: 70% predicted max HR, RPE 3 sets of exercises, 6 d/w: 30 min of respiratory workout, aerobic session on a cycle and 30 min of callisthenic exercises. Aerobic session 10 min⟶30min |
(1) The safety and efficacy of a structured, exercise-based CR program | AE: none All enhanced autonomy; 6MWT did not significantly differ (272.7±108 vs. 294.2±101 m, p. 0.42), neither peak-VO2 12.5±3.6 vs. 13.9± 2.7 ml/kg/min, p. 0.16. |
CR is feasible, safe and effective in octogenarian patients after TAVI as well as after traditional surgery. CR rehabilitation programme enhances independence, mobility and functional capacity and should be highly encouraged |
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| Pardaens (2014) [86] | N=145; VHD, risk, type of surgery; Age 64; Female 48,9%; AVR, MVR; CD - mentioned; Time to CR - 43±22 d |
CR outpatient; Length 12-20 weeks; Intervention: 2-3/w for 60 min. Aerobic training, an intensity of the HR at AT combined with RPE. Strengthening exercises (15 minutes) at 60% of 1-RM for 2 sets of 15 to 20 repetitions. |
(1) difference in exercise capacity early after VHD surgery (2) whether the functional improvement after training was affected by risk or type of surgery |
AE: NA (1) Higher risk had a worse postoperative exercise capacity, higher VE/VCO2 (2) Exercise training - significant improvement in WL, peak VO2, AT, and 6MWD in each risk group (p <0.01). (3) Significant decrease in the VE/VCO2 in the medium- and high-risk patient groups (p <0.05). |
(1) Exercise capacity after VHD surgery is related to the preoperative risk and to the type of surgery. (2) Similar benefit from exercise training can be obtained, independent of the preoperative risk class or the type of surgery. (3) ET should be offered to all patients after valvular surgery, regardless of their EuroSCORE risk or type of surgery |
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| Fauchere (2014) [87] | N=112; TAVI vs SAVR; Age 79; Female 60%; TAVI, SAVR; CD - mentioned; Early phase CR. |
CR inpatient; Length 3 weeks; Intervention: Training 2–3/d., 6 d./w. of supervised gymnastics, aerobic and respiratory workout sessions. Low/medium intensity (RPE). |
(1) improvement during the CD in FIM-score, HADS-score and 6-MWT | AE: NA (1) 6-MWT in TAVI and SAVR patients (84.2 m ± 68.7 m vs. 82.8 m ± 65.1 m; p = 0.92) (2) total FIM score in TAVI and SAVR patients (9.9 ± 6.1 vs 12.2 ± 10.9; p=0.34). |
(1) Patients in TAVI group were older and sicker than SAVR (2) Both patient groups did benefit in the same way from a post-acute in-patient rehabilitation program. |
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| Baldasseroni (2016) [88] |
N=160; Performance >15 vs. <15%; Age 80; Female 29,4%; CABG, HVS, CABG+HVS, ACS; CD - mentioned; Time to CR - 12 ± 10 d. |
CR outpatient; Length 4 weeks; Intervention: 5d/w aerobic training program at an 60–70% of VO2 peak, RPE 11–13. Progressive increase in resistance on the basis of RPE, reevaluated weekly. |
(1) effects of an exercise-based CR program on exercise tolerance and muscle strength (2) the independent predictors of changes in physical performance | AE: none Physical performance improved (VO2 peak, 10.9%; 6MWT, 11.0%; peak torque, 11.5%). higher baseline values predicting less improvement (VO2 peak: OR=0.86, 95% (CI)=0.77– 0.97; 6MWT: OR= 0.99, 95% CI=0.99–1.00; peak torque: OR=0.96, 95% CI=0.94–0.98). |
(1) An exercise-based CR program was associated with improvement in all domains of physical performance even in older adults after an acute coronary event or cardiac surgical intervention, particularly in those with poorer baseline performance. |
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| Voller (2015) [89] | N=442; TAVI = 76; SAVR = 366; Age 69.94; Female 38%; TAVI, SAVR; CD - mentioned; Early phase CR. |
CR inpatient; Length 3 weeks; Intervention: 4-5/w. Aerobic exercise depending on the initial exercise intensity, outdoor walking, gymnastics and resistance training of the lower extremities |
(1) the effect of CR on in patients after TAVI in comparison to patients after sAVR | AE: NA (1) 6-MWT and exercise capacity significantly increased in both groups (p<0,05). (2) After adjustment, changes were not significantly different between SAVR and TAVI, with the exception of 6-MWT (p. 0.004). |
(1) Patients after TAVI benefit from CR despite their older age and comorbidities. (2) CR is a helpful tool to maintain independency for daily life activities and participation in socio-cultural life. |
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| Savage (2015) [90] |
N=576; HVS vs CABG vs CABG+HVS; Age 64.9; Female 22%; CABG, HVS; CD - mentioned. |
CR outpatient; Length 12-20 weeks; Intervention: Aerobic training at 70- 85% of peak HR and/or RPE 12-14 for 45-60 min. Resistance training 1 set of 10 rep. |
(1) If patients after HVD benefit similarly CR as CABG. | AE: NA (1) Peak VO2 increased 19.5% from 17.4±4.4 to 20.8±5.5 mL/O2/kg/min (p<0.0001). (2) |
CABG and VHD patients experienced similar improvements in strength, and self-reported physical function and depression scores. Improvements in peak VO2 were similar between all groups |
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| Pressler (2016) [91] | N=30; Intervention = 13; Control = 14; Age 81; Female 44%; TAVI; CD - mentioned; Time to CR 83 ± 34d |
CR outpatient; Length 8 weeks; Intervention: 2-3/w 20min at 40%VO2 peak ⟶ 45 min at 70%VO2 peak by 8 week. (2) Resistance training in 2nd w 2/w at 30% 1-RM ⟶ 3 sets with 15 rep. at 50-60% 1-RM. |
(1) difference in change in VO2 peak from baseline (2) Change in muscular strength, 6MWT, NYHA, QoL |
AE: 3, not related (1) Significant changes in favor of Int. were observed for Peak VO2 (group difference, 3.7 mL/min per kg), muscular strength, components of QoL and 6MWT. |
In patients after TAVI, ET appears safe and highly effective with respect to improvements in exercise capacity, muscular strength, and quality of life. |
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| Sibilitz (2016) [92] |
N=147; Intervention = 72; Control = 75; Age 62; Female 24%; Valve surgery; CD - mentioned; Time to CR - 1 mo |
CR outpatient/home based; Length 12 w; Intervention: 3/w. (1) supervised training (69%) or (2) home-based training (31%). Intensity according to RPE increasing up to 12 w. The strength exercises; (2) cont. group not allowed to |
(1) Improved physical capacity (VO2 peak) (2) Improved mental health. |
AE: Int.:13pts vs cont. 3pts, not related (1) CR compared with cont. had a beneficial effect on VO2 peak at 4 months (24.8 mL/kg/min vs 22.5 mL/kg/min, p=0.045); (2) did not affect SF-36 MC at 6 mo (53.7 vs 55.2 points, p=0.40); |
CR after HVD surgery significantly improves VO2 peak at 4 months but has no effect on mental health and other measures of exercise capacity and self-reported outcomes. |
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| Genta (2017) [93] | N=135; TAVI vs SAVR; Age 80; Female 63%; TAVI, SAVR; CD - mentioned; Early phase CR. |
CR inpatient; Length 4 w; Intervention: (1) 2/d. 30-min cycling/treadmill 6 d./w., starting at min⟶up to 14 RPE (2) OR 2/d. 30 min of walking along the 6MWT and pedal exerciser (0W) (3) 40-min 1/d respiratory exercise. (4) early mobilization |
(1) Improved BI (2) Decreased risk of falls (3) Improved functional capacity |
AE: 9pts (not related) (1) BI improved for all p<0,05 (from 73±23, to 90±16) (2) MFS decreased to all p<0,05 (from 30±21, to 25±17) (3) 6MWT improved for all p<0,05 (from 193 ±87, to 292±103) |
(1) Intensive CR after TAVI is safe, well tolerated, and leads to a net improvement in disability, risk of falls, and exercise capacity, similar to that observed in less disabled SAVR patients. |
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| Pollman (2017) [94] |
N=168; None; Age 63; Female 16%; HVS, TAVI; CD - mentioned. |
CR outpatient; Length 12 w; Intervention: 2/w 90 min and aerobic interval training at 60-80% VO2 peak; resistance training with 3 sets of 15 rep of 60% 1RM |
(1) the effect of CR after VHD surgery on VO2 peak, long term morbidity, mortality | AE: none (1) VO2 peak improved by 16% from 21.6 to 24.8 mL/kg/min ( P < 0.0001) and 6MWT by 13% from 349 to 393 m (P = 0.0016). |
CR after VHD surgery improved exercise capacity and was associated with reduced morbidity. Elderly were less likely to attend or complete CR and deserve special attention |
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| Eichler (2017) [40] |
N=136; None; Age 80.6; Female 52,5%; TAVI; CD - mentioned; Time to CR - 17.7±9,9 d. |
CR inpatient; Length 3 Intervention: 5d/w 30 min the continuous/interval Patients (> 1.0 W/kg) strength training at 30–50% 1RM Outdoor walking, gymnastics, aqua gymnastics and spinal gymnastics in groups |
(1) effect of a multicomponent inpatient CR after TAVI (2) predictors for the change in physical capacity, QoL. |
AE: NA (1) 6MWD - 56.3 - 65.3m (2) max WL increased by 8.0 - 14.9 wat (p<0.001). (2) Higher cognition, nutrition and autonomy positively influenced the physical scale of SF-12. (3) baseline values of SF-12 had an inverse impact on the change during CR. |
CR can improve functional capacity as well as QoL and reduce frailty in patients after TAVI. |
Intervention. AVR: aortic valve replacement, MVR: mitral valve replacement, PTMC: Percutaneous Trans Mitral Commissurotomy, TAVI: Transcatheter Aortic Valve Implantation, CABG: coronary artery bypass graft, HVS: heart valve surgery, ACS: acute coronary syndrome.
Patients and Study Characteristics. CR: cardiac rehabilitation, RPE: rate of perceived exertion, CD: comorbidities, HR: heart rate, 1-RM: 1 repetition maximum.
Results. AE: adverse events, WL: workload, CV: cardiovascular, AT: anaerobic threshold, QoL: quality of life, ET: exercise training, MFS: Morse fall scale, HR: hazard ratio, CI: confidence interval, OR: odds ratio, NYHA: New York Heart Association, 6MWT: six-minute walking test.