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Previous Volume 340:272-277 January 28, 1999 Number 4 Next

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ABSTRACT

Background In patients who have received a cardiac transplant, the denervated donor heart responds abnormally to exercise and exercise tolerance is reduced. The role of physical exercise in the treatment of patients who have undergone cardiac transplantation has not been determined. We assessed the effects of training on the capacity for exercise early after cardiac transplantation.

Methods Twenty-seven patients who were discharged within two weeks after receiving a heart transplant were randomly assigned to participate in a six-month structured cardiac-rehabilitation program (exercise group, 14 patients) or to undergo unstructured therapy at home (control group, 13 patients). Each patient in the exercise group underwent an individualized program of muscular-strength and aerobic training under the guidance of a physical therapist, whereas control patients received no formal exercise training. Cardiopulmonary stress testing was performed at base line (within one month after heart transplantation) and six months later.

Results As compared with the control group, the exercise group had significantly greater increases in peak oxygen consumption (mean increase, 4.4 ml per kilogram of body weight per minute [49 percent] vs. 1.9 ml per kilogram per minute [18 percent]; P=0.01) and workload (mean increase, 35 W [59 percent] vs. 12 W [18 percent]; P=0.01) and a greater reduction in the ventilatory equivalent for carbon dioxide (mean decrease, 13 [20 percent] vs. 6 [11 percent]; P=0.02). The mean dose of prednisone, the number of patients taking antihypertensive medications, the average number of episodes of rejection and of infection during the study period, and weight gain did not differ significantly between the groups.

Conclusions When initiated early after cardiac transplantation, exercise training increases the capacity for physical work.

Source Information

From the Divisions of Cardiology and Cardiothoracic Surgery, University of California at Los Angeles School of Medicine (J.A.K., M.P.G., H. Liu, M.A.H., J.D.M., N.K., K.E., H. Laks); the West Los Angeles Veterans Affairs Medical Center (D.A.L.); and the Department of Rehabilitation Services, University of California at Los Angeles Medical Center (N.L., E.H.) — all in Los Angeles.

Address reprint requests to Dr. Kobashigawa at the Division of Cardiology, Center for Health Sciences 47-123, UCLA Medical Center, 10833 LeConte Ave., Los Angeles, CA 90095, or at jonk{at}mednet.ucla.edu.

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