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Exercise rehabilitation in ventricular assist device recipients: a meta-analysis of effects on physiological and clinical outcomes

  • Liza Grosman-Rimon
  • Spencer D. Lalonde
  • Nina Sieh
  • Maureen Pakosh
  • Vivek Rao
  • Paul Oh
  • Sherry L. Grace
Article

Abstract

Exercise rehabilitation in heart failure patients has been shown to improve quality of life (QoL) and survival. It is also recommended in clinical practice guidelines for ventricular assist device (VAD) recipients. However, there have only been two meta-analyses on the effects of exercise rehabilitation in VAD patients, on only two outcomes. The objective of the review was to quantitatively evaluate the effect of exercise rehabilitation in VAD recipients on functional capacity, exercise physiology parameters, chronotropic responses, inflammatory biomarkers and neurohormones, heart structure and function, and clinical outcomes. The following databases were systematically searched: CCTR, CDSR, CINAHL, EMBASE, PsycInfo, and Medline through to November 2015, for studies reporting on VAD recipients receiving ≥ 2 sessions of aerobic training. Citations were considered for inclusion, and data were extracted in included studies as well as quality assessed, each by two investigators independently. Random-effects meta-analyses were performed where possible. The meta-analysis showed that compared to usual care, exercise rehabilitation significantly improved peak VO2 (n = 74, mean difference = 1.94 mL kg−1 min−1, 95% CI 0.63–3.26, p = 0.004) and 6-min walk test distance (n = 52, mean difference = 42.46 m, 95% CI 8.45–76.46, p = 0.01). No significant differences were found for the ventilatory equivalent slope (VE/VCO2) or ventilatory anaerobic threshold (VAT). In the six studies which reported QoL, exercise rehabilitation was beneficial in four, with no difference observed in two studies. Exercise rehabilitation is associated with improved outcomes in VAD recipients, and therefore should be more systematically delivered in this population.

Keywords

Cardiac rehabilitation Heart-assist devices Exercise therapy Oxygen consumption 

Abbreviations

HF

Heart failure

VADs

Ventricular assist devices

LVAD

Left ventricular assist device

QoL

Quality of life

Peak VO2

Maximal oxygen consumption (ml/kg/min)

VE/VCO2

Ventilatory equivalent

VAT

Ventilatory anaerobic threshold

Notes

Acknowledgements

We wish to thank Dr. Dennis J. Kerrigan and Dr. Kate Hayes who kindly provided additional data for the meta-analysis. We also gratefully acknowledge Dr. Susan Marzolini for advice on analyses.

Compliance with ethical standards

Conflict of interest

Dr. Vivek Rao is a consultant to CorMatrix, and Heart-Ware. The other authors have no conflicts of interest to disclose.

Supplementary material

10741_2018_9695_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 16 kb)
10741_2018_9695_MOESM2_ESM.docx (29 kb)
ESM 2 (DOCX 28 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Liza Grosman-Rimon
    • 1
  • Spencer D. Lalonde
    • 2
  • Nina Sieh
    • 3
  • Maureen Pakosh
    • 1
  • Vivek Rao
    • 4
    • 5
  • Paul Oh
    • 1
  • Sherry L. Grace
    • 1
    • 3
    • 4
  1. 1.Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada
  2. 2.Western UniversityLondonCanada
  3. 3.School of Kinesiology and Health Science, Faculty of HealthYork UniversityTorontoCanada
  4. 4.University of TorontoTorontoCanada
  5. 5.Cardiovascular SurgeryToronto General Hospital, University Health Network, University of TorontoTorontoCanada

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