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.Cardiothoracic Surgery - Patient’s Guide to Heart Transplant Surgery http://www.cts.usc.edu/ht-pg-exercise.html 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.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 Benefits of Exercise Exercise can assist post-cardiac transplant recipients by: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 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: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 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: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 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 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 2-4 days per week 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 Arm exercises should not be started until full healing after sternotomy (2 months) 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 Within 2 months of surgery; patients should feel increased muscle strength and endurance of the legs; and beginning resistance work on the upper body 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 Aerobic Training Goals 15 – 60 minute sessions 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 -7 days per week at 40-80% VO2 max 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 After 6 months, recipients should have increase cardiovascular fitness and improvements against risk factors such as insulin sensitivity etc.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 Considerations and Precautions While research has shown the safety of resistance and cardiovascular exercises; professional advice should be taken:Cardiothoracic Surgery - Patient’s Guide to Heart Transplant Surgery http://www.cts.usc.edu/ht-pg-exercise.html 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 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 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 References