Table 1.
Exercise training interventions in patients with an LVAD
| Study | Participant Characteristics | Training Protocol | Outcomes | Events |
|---|---|---|---|---|
| Home Based | ||||
| Laoutaris et al. 201150 | LVAD/BiVAD recipients - EG=10, CG=5 patients, 38.3±15.9 yr old - Time since LVAD 6.3±4 months - All participated in an inpatient rehabilitation program (details not available) before discharge |
Exercise Group - Bike or treadmill exercise at home for 45 minutes, moderate intensity (12–14 Borg scale), 3–5 times/wk. - Performed high intensity inspiratory muscle training at 60% of maximal sustained inspiratory muscle strength 2–3 days/week - 10 wk training period Control Group - Advised to walk every day for 30–45 minutes. |
Exercise Group Peak VO2 (ml·kg−1·min−1)* Pre 16.8±3.7; Post 19.3±4.5 VE/VCO2* Pre 40±6.5; Post 35.9±5.6 6MWD (m)* Pre 462±88; Post 527±76 MLwHFQ* Pre 48.9±12.8; Post 38.2±11.6 SPimax (cmH2O/s/103) Pre 340±193; Post 484±195 Control Group Peak VO2 (ml−1·kg−1·min−1) Pre 14.9±4; Post 14.8±4.2 VEVCO2 Pre 41.4±8.1; Post 40.2±7.3 6MWD (m) Pre 430±41; 448±55 MLwHFQ Pre 49.8±9.5; Post 50.8±10.3 SPimax (cmH2O/s/103) Pre 326±140; Post 299±114 |
Not reported |
| Kugler et al. 201251 | 70 LVAD recipients - Intervention group: 52±2 yr old, 85.4% men - Control group: 51±2 yr old, 87.5% men - Recruited 6 weeks post implantation |
Exercise Group (n=34) - Home aerobic training, performed every other day, consisting of 6 minute warm-up, 20 min at 10% less than anaerobic threshold, 2 min cool down - Also received dietary counselling and psychosocial support. - Duration of 18 months Control Group (n=36) - Recommendation for healthy diet and exercise |
Exercise Group - Significant increase in peak workload and SF-36 score Control Group - No significant changes in peak workload or SF-36 score |
Not reported |
| Adamopoulos et al. 201372 | LVAD/BiVAD recipients 11 in the exercise group, 39.7±4.3 yr old, 90.9% men 11 in the control group, 40.9±4.9 yr old, 81.8% men |
Exercise Group - Home-based aerobic training, 4 days/wk, 45 min at an intensity of 12–14 on the Borg scale. - Supervised high-intensity IMT, 3 times/week. - Duration: 12 weeks Control Group advised to walk every day |
Exercise Group Peak VO2 (ml−1·kg−1·min−1)* Pre 12.9±1.2; Post 18.0±0.8 Control Group Peak VO2 (ml−1·kg−1·min−1)* Pre 12.0±0.8; Post 13.7±0.7 |
Not reported |
|
Center Based |
||||
| Hayes et al. et al.32 | - 14 patients who underwent LVAD implantation. - Recruited to the study when they were able to independently walk 70 meters - Randomized at a mean of 32 days after LVAD implantation |
All participants - Mobilization protocol: walk for 60 minutes at an RPE of 13 on the Borg scale, 5 days/wk until discharge. Exercise training protocol (n=7) - 3 days/wk for 8 week - 15 min stationary cycling at 50% of VO2 reserve; 15 min treadmill at a speed 60% of 6MWT walking speed. RPE maintained at 13 on the Borg scale - RE: 3 upper and 3 lower limb exercises, 2 sets of 10 reps Control group (n=7) - Advised to walk 5 days per week |
Exercise Group Peak VO2 (ml·kg−1·min−1)* Pre 10.5±2.3; Post 14.8±4.9 6MWD (m)* Pre 351±77; Post 531±131 SF-36* Pre 30.4±10.7; Post 59.6±24.2 Control Group Peak VO2 (ml·kg−1·min−1)* Pre 12.4±1.7; Post 15.3±4.4 6MWD (m)* Pre 367±129; Post 489±95 SF-36* Pre 36.7±12.2; Post 53.0±6.2 |
No adverse events |
| Kerrigan et al. 201424 | - 24 patients (7 women, 55±13 years old) - 1–6 months post LVAD implantation |
Exercise Training (n=16) - 3 sessions/wk for 6 weeks - 5-min warm up followed by 15 minutes of treadmill exercise and 15 minutes of a secondary modality (i.e., stationary cycle, arm ergometer, recumbent stepper). - 60% of heart rate reserved and encouraged to progress to 80% of heart rate reserve. Control group (n=7) - Continue to follow physician instructions regarding care, including standard recommendation to perform daily walking. |
Exercise Group Peak VO2 (ml·kg−1·min−1)* Pre 13.6±3.3; Post 15.3±4.4 6MWD (m)* Pre 350±64; Post 402±89 KCCQ: significant increase Significant improvement in leg strength Control Group Peak VO2 (ml·kg−1·min−1) Pre 11.2±2.0; Post 11.8±2.0 6MWD (m) Pre 336±59; Post 356±51 KCCQ: no change No change in leg strength |
1 untoward event that required an ED admission due to a syncopal episode occurring immediately following a completed exercise session. 3 other patients in the CR group required ED admission outside of exercise sessions. 4 control patients required ED admission |
| Karapolat et al. 201353 | 11 LVAD recipients - 45.57±14.05 yr old, 85.7% men - 2.8±2.13 months post implantation |
Exercise Training - Site based 8-week intervention, 3 days/wk - 30 min aerobic exercise at 60–70% of VO2max or 12–14 on Borg scale - Strengthening exercises (.25 – .5 kg, upper/lower body, 8 muscle groups) |
Peak VO2 (ml−1·kg−1·min−1)* Pre 14.7±3.6; Post 15.1±3.4 FeV1%* Pre 67.7±30.9; Post 77.9±26.9 FVC%* Pre 72.0±25.3; Post 82.2±22.8 SF-36 Improvements in physical function, pain, vitality, emotional role, mental health |
Not reported |
| Marko et al. 201552 | 41 LVAD recipients - 54.8±11.6 yr old, 80% men - 48±34 days post implantation |
Exercise Training - The exercise intervention lasted on average of 32±6 days - Interval cycle training: 1 min higher intensity, 20 second recovery, gradually increased interval repetitions and intensity across program (see article for details) - Walking: group walking taking place on paths covering different distances, elevations, and times (see article for details) - Coordination, strength and balance training |
Peak VO2 (ml·kg−1·min−1)* Pre 11.3±4.1; Post 14.5±5.2 VE/VCO2* Pre 37.8±7.9; Post 33.7±5.8 Improved leg strength |
1 training-related adverse event (non-sustained ventricular tachycardia) in ∼1,600 training sessions |
CR, cardiac rehabilitation; ED, emergency department; FeV1, forced expiratory volume; FVC, forced vital capacity; IMT, inspiratory muscle training; KCCQ, Kansas City Cardiomyopathy Questionnaire; MLwHFQ, Minnesota Living with Heart Failure Questionnaire; MWD, minute walk distance; MWT, minute walk test; RE, resistance exercise; SF-36, 36 Item Short Form Survey; SPimax, maximal inspiratory pressure; VE/VCO2, ventilation to carbon dioxide ration
*
significant difference from pre