Cardiac Rehabilitation Issues After Heart Transplantation

Pishgahi A. MDPhysiatrist

Tabriz University of Medical Science

Introduction • After heart transplantation, patients present

physical exercise intolerance.

• Physical activity has demonstrated to be of great relevance in the post-transplantation rehabilitation, improving the exercise capacity,

Introduction • Although life expectancy is greatly improved,

survival is reduced, mainly due to the increased frequency of late complications.

• Additionally, the patient’s exercise capacity and health-related quality of life (HRQoL) are reduced compared with the general population.

Reduced exercise capacity

Reduced exercise capacity

Chronotropic Incompetency

• Denervated Heart• Higher resting HR and reduced HR response• Sympathetic and para-sympathetic

denervation• Catecholamine release from adrenal glands

Reduced VO2 max

• In most studies, the peak oxygen uptake (VO2peak) levels range from 50% to 70% of the general population.

• Surgical technique• Systolic and diastolic dysfunction• Metabolic abnormalities• Immunosuppressive agents

Phase 1

• Pain relief (surgical site)• Respiratory Physiotherapy(pre and post op.)• Range of motion exercises (Day 2)• Gentle Stretches exercises (Day 2)• Mattress training• Walking around the room

Phase 2

Phase 2- intensity

• Most used variable is VO2• Cardiopulmonary exercise test with gas

analysis• Lower threshold HR : 50 % of VO2 max• Upper threshold HR : 80 % of VO2 max

• Expensive method

Cycle Ergometry

• Incremental or ramp• 10 minutes• Pedaling frequency of 60 rpm• 1-3 minutes resting

Treadmill Balk Protocol 2mph, 0% gradeThe grade is increased 2-3 % every minute

Bruce Protocol1.7 mph, 10% gradeIncrease 0.8 mph and 2 % grade every 3 minutes

Comparison

Treadmill Cycle

Higher Lower Vo2 max

Less limiting Often limits Leg muscle fatigue

Estimation Yes Work rate quantification More Less Weight bearing in obese

More Less Noise and artifact

More Less Safety issues

HIT

Resistance exercise

• Increase muscle mass• Increase bone density

Summary

Summary

Summary

Benefits

Thanx...