Exercise Rehabilitation of Cardiac Transplant Recipients

  • E. W. Derman
  • K. L. Derman
  • T. D. Noakes


Patients with chronic heart failure have impaired exercise tolerance. An expected outcome of cardiac transplantation in such patients is an improvement in functional capacity. However, despite normal left ventricular ejection fraction after cardiac transplantation, compared to control subjects the exercise capacity of these patients remains impaired both during symptom-limited maximal exercise and during static exercise[1]’[6]. Indeed, the exercise capacity of patients after cardiac transplantation is often comparable to that of patients with medically stabilized heart failure[7]. The reasons for this phenomenon remain unclear, but it could indicate that the exercise capacity of these patients is limited by peripheral alterations, perhaps in skeletal muscle, which develop during heart failure and which are not reversed immediately after cardiac transplantation.


Transplant Recipient Exercise Training Cardiac Transplant Ventilatory Threshold Heart Transplant Recipient 
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  1. 1.
    Kavanagh T, Yacoub MH, Mertens DH et al. Cardiorespiratory responses to exercise training alter orthotopic eardiac transplantation. Circulation. 1988;77:162.PubMedGoogle Scholar
  2. 2.
    Morgan BJ, DeBoer LW, Pease MO et al. Forearm vascular resistance increases during static exercise in heart transplant recipients. J Appl Physiol. 1991;71:2224.PubMedGoogle Scholar
  3. 3.
    Niset G, Hermans L, Depelchin P. Exercise and heart transplantation: a review. Sports Med. 1992;12:359.Google Scholar
  4. 4.
    Pope SK, Stinson EB, Daughters GT et al. Exercise response of the denervated heart in long-term cardiac transplant recipients. Am J Cardiol. 1980;46:213.PubMedCrossRefGoogle Scholar
  5. 5.
    Savin WM, Haskell WL, Schroeder JS, Stinson KB. Cardiorespiratory responses of cardiac transplant patients to graded. Symptom-limited exercise. Circulation. 1980;62:55.PubMedGoogle Scholar
  6. 6.
    Tucker KJ, Redberg KF, Ploss D et al. Noninvasive assessment of the pulmonary artery pressure response to exercise after uncomplicated heart transplantation. J Heart Lung Transplant. 1993;12:604.PubMedGoogle Scholar
  7. 7.
    Stevenson LW, Sietsema K, Tillisch JH et al. Exercise capacity for survivors of cardiac transplantation or sustained medical therapy for stable heart failure. Circulation, 1990;81:78.PubMedGoogle Scholar
  8. 8.
    Deitrck JH, Whedon GD, Shorr E, Effects of immobilization upon various metabolic and physiologic functions of normal men. Am J Med. 1948;4:3.CrossRefGoogle Scholar
  9. 9.
    Dock W. The evil sequelae of complete bed rest. J Am Med Assoc. 1994;125:1083.Google Scholar
  10. 10.
    Harrison TK. Abuse of rest as a therapeutic measure for patients with cardiovascular disease. J Am Med Assoc. 1944;125:1075Google Scholar
  11. 11.
    Issekutz B, Blizzard JJ, Birkhead NC, Rodall K. Effect of prolonged bedrest on urinary calcium output, J Appl Physiol. 1966;21:1013.PubMedGoogle Scholar
  12. 12.
    Saltin B, Blomqvist G, Mitchell JH et al. Response to exercise alter bedrest and after training. A longitudinal study of adaptive changes in oxygen transport and body composition. Circulation. 1968;38(Suppl.VII):1.Google Scholar
  13. 13.
    Braith KW, Limacher MC, Leggell SH, Pollock ML. Skeletal muscle strength in heart transplant recipients. J Heart Lung Transplant. 1993;12:1018.PubMedGoogle Scholar
  14. 14.
    Capaccio JA, Gallasi TM, Hickson RC. Unaltered aerobic power and endurance following glucoeorticoid-induced muscle atrophy. Med Sci Sports Exerc. 1985;17:380.PubMedGoogle Scholar
  15. 15.
    Kempeneers OLG, Myburyh KH, Wiggins T et al. The effect of an exercise training program on renal transplant recipients. Transplantation. 1988;20(Suppl. I):381.Google Scholar
  16. 16.
    Morris PJ. Kidney transplantation: principles and practices. New York. Grune & Stratton; 1979.Google Scholar
  17. 17.
    Pleasure DE, Walsh GO, Engel WK. Atrophy of skeletal muscles in patients with Cushing’s syndrome. Arch Neurol. 1970;22:118.PubMedGoogle Scholar
  18. 18.
    Enget AG. Electron microscopic observations in thyrotoxic and corticosteroid-induced myopathies. Mayo Clin Proc. 1966;41:785.Google Scholar
  19. 19.
    Afifi AK, Bergman RA, Harvey JC. Steroid myopathy: clinical, histological and eytological observations. Johns Hopkins Med. 1968;123:158.Google Scholar
  20. 20.
    Askari A, Vignos PJ, Moskowitz RW. Steroid myopathy in connective tissue discases. Am J Med. 1976;61:485.PubMedCrossRefGoogle Scholar
  21. 21.
    Derman EW, Selley KL, Emms M et al. The improvement in skeletal muscle function antedates histological improvement following cardiac transplantation. Med Sci Sports Exerc. 1993;25(Suppl.5)S4: 24.Google Scholar
  22. 22.
    Savin WM, Gordon E, Green S et al. Comparison of exercise training in cardiac denervaled and innervated humans. J Am Coll Cardiol. 1983;1:722.Google Scholar
  23. 23.
    Sehroeder JS. Hemodynamic performance of the human transplanted heart. Transplant Proc. 1979;11:304.Google Scholar
  24. 24.
    Banner NR, Patel N, Cox AP et al. Altered sympathoadrenal response to dynamic exercise in cardiac transplant recipients. Cardiovasc Res. 1989;23:965.PubMedCrossRefGoogle Scholar
  25. 25.
    Degre SGL, Nisei GL, DeSmet JM et al. Cardiorespiratory response to early exercise testing after orthotopic cardiac transplantation. Am J Cardiol. 1987;60:926.PubMedCrossRefGoogle Scholar
  26. 26.
    Perini R, Orizio C, Gamba A, Veicsteinas A. Kinetics of hearl rate and cate-cholamines during exercise in humans. The effect of heart denervation. Hur J Appl Physiol Occup Physiol. 1993;66:500.CrossRefGoogle Scholar
  27. 27.
    Roca J, Caturla MC, Hjemdahl P et al. Left ventricular dynamics and plasma cale-cholamines during isometric exercise in patients following cardiac transplantation. Eur Heart J. 1991;12:928.PubMedGoogle Scholar
  28. 28.
    Cerretelli P, Grassi B, Colombini A, Cam B, Marconi C. Gas exchange and metabolic transients in heart transplant recipients. Respir Physiol. 1988;74:355.PubMedCrossRefGoogle Scholar
  29. 29.
    Pflugfelder PW, McKenzie FN, Kostuk WJ. Hemodynamic profiles at rest and during supine exercise after orthotopic cardiac transplantation. Am J Cardiol. 1988;61:1328.PubMedCrossRefGoogle Scholar
  30. 30.
    Stinson KB, Griepp RB, Sehroeder JS, Dong E, Shumway NE. Hemodynamic observations one and two years after cardiac transplantation in man. Circulation. 1972;45:1183.PubMedGoogle Scholar
  31. 31.
    Bexton RS, Milne JR, Cory-Pearce R, English TAH, Camm AJ. Effect of beta blockade on exercise response after cardiac transplantation. Br Heart J. 1983;49:584.PubMedGoogle Scholar
  32. 32.
    Yusuf S, Theodoropoulos S, Dhalla N et al. Influence of beta-blockade on exercise capacity and heart rate response after human orthotopic and heterotopic cardiac transplantation. Am J Cardiol. 1989;64:636.PubMedCrossRefGoogle Scholar
  33. 33.
    Haywood GA, Counihan PJ, Sneddon JF et al. Increased renal and forearm vasocon-striction in response to exercise after heart transplantation. Br Heart J. 1993;70:247.PubMedGoogle Scholar
  34. 34.
    Fink LI, Wilson JR, Fcrraro N. Exercise ventilation and pulmonary artery wedge pressure in chronic stable congestive heart failure. Am J Cardiol. 1986;57:249.PubMedCrossRefGoogle Scholar
  35. 35.
    Buller NP, Poole-Wilson PA. Mechanism of the increased ventilatory response to exercise in patients with chronic heart failure. Br Heart J. 1990;63:281.PubMedGoogle Scholar
  36. 36.
    Braith RW, Limacher MC, Staples ED, Pollock ML. Blood gas dynamics at the onset of exercise in heart transplant recipients. Chest. 1993;103:1692.PubMedGoogle Scholar
  37. 37.
    Banner NR, Lloyd NH, Hamilton RD et al. Cardiopulmonary response to dynamic exercise after heart and combined heart-lung transplantation. Br Heart J. 1989;61:215.PubMedGoogle Scholar
  38. 38.
    Ehrman J, Keteyian S, Fedel F et al. Cardiovascular responses of heart transplant recipients to graded exercise testing. J Appl Physiol. 1992;73:260.PubMedGoogle Scholar
  39. 39.
    Harvison A, Jones BM, McBride M et al. Rehabilitation after heart transplantation: the Australian experience. J Heart Transplant. 1988;7:337.PubMedGoogle Scholar
  40. 40.
    Hotta SS. Cardiac rehabiliation programs (Review). Health Technol Assessment Rep. 1991;3:1.Google Scholar
  41. 41.
    Kavanagh T, Yacoub MH, Mertens DJ, Campbell RB, Sawyer P. Exercise rehabilitation after heterotopic cardiac transplantation. J Cardiopul Rehab. 1989;9:303.CrossRefGoogle Scholar
  42. 42.
    Pashkow PJ. Rehabilitation strategies for the complex cardiac patient (Review). Cleveland Clin J Med. 1091;58:70.Google Scholar
  43. 43.
    Roos R. Exercise training for heart transplant patients. Phys Sports Med. 1986;14:165.Google Scholar
  44. 44.
    Shephard RJ. Responses to acute exercise and training after cardiac transplantation: a review (Review). Can J Sport Sci. 1991;16:9.PubMedGoogle Scholar
  45. 45.
    Squires RW. Exercise training after cardiac transplantation (Review). Med Sci Sports Exerc. 1991;23:686.PubMedGoogle Scholar
  46. 46.
    Bigland-Ritchie B, Furbish F, Woods JJ. Fatigue of intermittent submaximal voluntary contractions: central and peripheral factors. J Appl Physiol. 1986;61:421.PubMedGoogle Scholar
  47. 47.
    American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for cardiac rehabilitation programs. Champaign, IL: Human Kinetic Books; 1991.Google Scholar
  48. 48.
    Sadowsky HS, Rohrkemper KF, Quon SYM. Rehabilitation of cardiac and cardiopulmonary recipients. An introduction for physical and occupational therapists. Stanford University Hospital; 1986 (Thesis).Google Scholar
  49. 49.
    Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehab Med. 1970;2:92.Google Scholar
  50. 50.
    Dehne PA, Protas EJ. Oxygen consumption and heart rate responses during five active exercises. Phys Ther. 1986;66:1215.PubMedGoogle Scholar
  51. 51.
    Constant J, Prognostic information from early post-infarction exercise testing. Am J Med. 1986;81:655.PubMedCrossRefGoogle Scholar
  52. 52.
    Squires RW, Arthur PR, Gan GT, Muri A, Lambert WB. Exercise after cardiac transplantation: a report of two cases. J Cardiac Rehab. 1983;3:570.Google Scholar
  53. 53.
    Brubaker PH, Berry MJ, Brozena SC et al. Relationship of lactate and ventilatory thresholds in cardiac transplant patients. Med Sci Sports Exerc. 1993;25:191.PubMedGoogle Scholar
  54. 54.
    Keteyian S, Shcphard R, Ehrman J et al. Cardiovascular responses of heart transplant patients to exercise training. J Appl Physiol. 1991;70:2627.PubMedGoogle Scholar
  55. 55.
    Ekblom B, Goldbarg AN. The influence of physical training and other factors on the subjective rating of perceived exertion. Acta Physiol Scand. 1971;83:399PubMedCrossRefGoogle Scholar
  56. 56.
    Birk TJ, Birk CA. Use of ratings of perceived exertion for exercise prescription. Sports Med. 1987;4;1.PubMedGoogle Scholar
  57. 57.
    Kelemen MH. Resistive training: safely and assessment guidelines for cardiac patients. Med Sci Sports Exerc. 1989;21:675.PubMedGoogle Scholar
  58. 58.
    Sparling PB, Cantwell JD. Strength training guidelines for cardiac patients. Phys Sports Med. 1989;17:190.Google Scholar
  59. 59.
    Stewart KJ. Resistive training effects on strength and cardiovascular endurance in cardiac and coronary prone patients. Med Sci Sports Exerc. 1989;21:678.PubMedGoogle Scholar
  60. 60.
    Noakes TD. Heart disease in marathon runners. A review. Med Sci Sport Exerc. 1987;19:187.Google Scholar
  61. 61.
    Van Camp SP, Peterson RA. Cardiovascular complications of outpatient cardiac rehabilitation programs. J Am Med Assoc. 1986;256:1160.CrossRefGoogle Scholar
  62. 62.
    Ehsani AA, Heath GW, Hagberg JM, Sobel BE, Holloszy JO. The effects of twelve months of intense training on ischaemic ST segment depression in patients with coronary artery disease. Circulation. 1986;64:1116.Google Scholar
  63. 63.
    Hagberg JM. Physiologic adaptations to prolonged high intensity exercise training in patients with coronary artery disease. Med Sci Sports Exerc. 1991;23:645.Google Scholar
  64. 64.
    Angermann CE, Spes CH, Dominiak P et al. Effects of graded exercise on blood pressure, heart rate, and plasma hormones in cardiac transplant recipients before and during antihypertensive therapy. Clin Invest. 1992;70:14.CrossRefGoogle Scholar
  65. 65.
    Braith RW, Wood CE, Limaeher MC et al. Abnormal neuroendocrine responses during exercise in heart transplant recipients. Circulation. 1992;86:1453.PubMedGoogle Scholar
  66. 66.
    Ohvari MT, Antolick A, Ring WS. Arterial hypertension in heart transplant recipients treated with triple-drug immunosuppressive therapy. J Heart Transplant. 1989;8:34.Google Scholar
  67. 67.
    Scott JP, Higenbottam TW, Large S, Wallwork J. Cyclosporine in heart transplant recipients: an exercise study of vasopressor effects. Eur Heart J. 1992;13:531.PubMedGoogle Scholar
  68. 68.
    Nitenberg A, Tavolaro O, Loisance D et al. Severe impairment of coronary reserve during rejection in patients with orthotopic heart transplant. Circulation. 1989;79:59.PubMedGoogle Scholar
  69. 69.
    Derman EW, Selley KL, Emms M et al. Exercise performance and skeletal muscle pathology improve after cardiac transplantation and exercise training. Eur Heart J. 1993;14:118 (abstract).Google Scholar

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© Kluwer Academic Publishers 1996

Authors and Affiliations

  • E. W. Derman
  • K. L. Derman
  • T. D. Noakes

There are no affiliations available

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