Large multicentre study on exercise for LVAD patients

Dr. Anna Feuerstein (Charité Hospital, Berlin) addressed sport and exercise activities for left ventricular assist device users at the Sports, Medicine and Health Summit 2021.

At the Sports, Medicine and Health Summit 2021, the session "Exercise Therapy in Cardiovascular Diseases" also dealt with sport and exercise with left ventricular assist devices (LVADs). Dr. Anna Feuerstein from the Charité Hospital in Berlin gave a presentation on this topic.

Heart failure is a common disease with an increasing incidence in men and women of older age - worldwide. Because the heart is not strong enough to supply the body with oxygen-rich blood, patients suffer from reduced performance and shortness of breath. Treatment options have improved, both in terms of drugs and devices. Nevertheless, exacerbations occur again and again. Patients end up in hospital repeatedly, have to take more medication but their health is not restored. In terminal heart failure, the next step is heart transplant.

However, it is well known how few transplant organs are available. The waiting list is long. And many patients die during the waiting period. To survive the waiting time, many patients are implanted with left ventricular assist devices. This pump improves the reduced cardiac output.

Who gets an LVAD?

Goals of the LVAD

The increasing number of destination therapies is also changing the goals of assist device therapy. The aim is to give patients the opportunity to return home, pursue hobbies or work, or even travel on holiday - which significantly improves their quality of life.

After implantation of the LVAD, there is a short-term improvement in physical performance during rehabilitation. However, after a certain period of time, reduced performance and thus a reduced quality of life return.

What should be done?

The ESC (European Society of Cardiology) and DGK (Deutsche Gesellschaft für Kardiologie, German Cardiac Society) clearly recommend exercise therapy for patients with heart failure. The studies here are very good. The guideline clearly states: Regular aerobic endurance training serves to improve functional capacity and symptoms.

However, the data for LVAD patients is still limited. Therefore, there is no recommendation for these patients. A paper from 2017 (Ganga et al.) compiled and evaluated relevant studies. The studies, some of which are very old, usually involve few test subjects and short observation periods. One study (Kerrigan et al. 2014) demonstrates the success of exercise therapy on peak VO2 in LVAD during six weeks of training.

Regarding the safety of exercise therapy, all studies show that there were no serious exercise-associated adverse events. Overall, across all studies, there were two incidents - one syncope after exercise and one cardiac arrhythmia during exercise. The speaker concludes that exercise therapy for LVAD seems to be safe - despite the severely ill patient population.

Which exercise therapy is the right one?

A combined training of:

Not recommended

In 2018, there was a position paper from the ESC. A Review of Evidence and Practical Advice was written together with the Committee for Exercise Physiology and the Committee for Advanced Heart Failure. It states that physical training can lead to a benefit and that more studies are needed to understand and consolidate this in more detail.

Summary

Outlook

Large, multicentre studies are needed. This is exactly what is currently happening at the Charité: Ex-VAD will be the first large, multi-centre study on physical training in LVAD patients. Patients will be randomised, trained for three months with an adapted programme of endurance and strength training, and then followed up for another three months.

Reference:
SMHS 21.4. 2021, Bewegungstherapie bei Herz-Kreislauferkrankungen (Exercise Therapy for Cardiovascular Disease)

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