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

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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.

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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

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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.

Author information

Authors and Affiliations

  1. Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada

    Liza Grosman-Rimon, Maureen Pakosh, Paul Oh & Sherry L. Grace

  2. Western University, London, ON, Canada

    Spencer D. Lalonde

  3. School of Kinesiology and Health Science, Faculty of Health, York University, Bethune 368, 4700 Keele St, Toronto, ON, M3J 1P3, Canada

    Nina Sieh & Sherry L. Grace

  4. University of Toronto, Toronto, ON, Canada

    Vivek Rao & Sherry L. Grace

  5. Cardiovascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada

    Vivek Rao

Authors
  1. Liza Grosman-Rimon
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  2. Spencer D. Lalonde
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  3. Nina Sieh
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Correspondence to Sherry L. Grace.

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Conflict of interest

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

Additional information

What is already known about this subject?

Ventricular assist device (VAD) recipients have persistently reduced functional capacity and hence low quality of life. Early data suggest that exercise rehabilitation may improve both functional capacity and quality of life.

What does this study add?

Through meta-analysis, exercise rehabilitation was shown to result in significantly improved functional capacity (peak VO2 and 6-min walk test distance) when compared to usual care. Benefits were also observed in quality of life and chronotropic responses, but not exercise physiology parameters.

How might this impact on clinical practice?

These results provide support for clinical practice recommendations that VAD recipients receive exercise training. Cardiac rehabilitation societies should develop education programs for professionals to increase capacity to treat this population.

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Grosman-Rimon, L., Lalonde, S.D., Sieh, N. et al. Exercise rehabilitation in ventricular assist device recipients: a meta-analysis of effects on physiological and clinical outcomes. Heart Fail Rev 24, 55–67 (2019). https://doi.org/10.1007/s10741-018-9695-y

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