J Extra Corpor Technol 2024 , 56 , 128 – 135 Ó The Author ( s ), published by EDP Sciences , 2024 https :// doi . org / 10.1051 / ject / 2024017
Available online at : ject . edpsciences . org
REVIEW ARTICLE
Effects of cardiac rehabilitation in patients with ventricular assist devices : a scoping review
Nelson Esteban Portuguez Jaramillo ( PT ) 1 ,* , Angely Paola Ceron ( PT ) 2 , Jose Luis Piñeros Álvarez ( PT ) 3 , Eleonora Giron Ruiz ( PT ) 4 , and Carolina Castro Gómez ( PT ) 1 , 5
1 Faculty of Health , Universidad Santiago de Cali , Cl . 5 # No . 62-00 , 760035 Cali , Colombia 2 Physical Medicine and Rehabilitation E . S . E ., Hospital Universitario Evaristo Garcia ESE , Cl . 5 # 36-00 , 760042 Cali , Colombia 3 Basic Sciences Department , Institución Universitaria Colegios de Colombia Unicoc-Cali , 760045 Cali , Colombia 4 Coordination of Research , Innovation and Teaching Service , Clínica Colombia , Cra . 46 # 9c-58 , 760036 Cali , Colombia 5 Fundación Valle del Lili , Medicina física y rehabilitación , Carrera . 98 # 18-49 , 760032 Cali , Colombia
Received 19 February 2024 , Accepted 18 June 2024
Abstract – Introduction : Ventricular assist devices represent a treatment option for patients with advanced heart failure , offering control over various haemodynamic variables . Similarly , the prescription of exercise within a cardiac rehabilitation programme for heart failure patients is recommended to reduce symptoms , and hospitalisations , improve cardiorespiratory fitness , and increase exercise tolerance . Therefore , exercise prescription can impact those with ventricular assist devices . Given the limited evidence on exercise-based cardiac rehabilitation programmes for this population , this review aims to describe the most commonly used strategies and their health benefits when physical exercise is included in a cardiac rehabilitation programme for patients with ventricular assist devices . Materials and methods : An exploratory review was conducted through searches in the databases : PubMed , SCOPUS , PeDro , and ScienceDirect . The search was limited to studies published between 2013 and 2023 . Filters were applied independently by title , abstract , and full text . The included articles were analysed based on the description of the types of cardiac rehabilitation strategies used in patients with ventricular assist devices . Results : Seven articles were included . Each programme employed a cardiopulmonary exercise test before prescribing physical exercise . The most commonly used strategy was aerobic exercise , predominantly high-intensity interval training ( HIIT ) with intensities close to 90 % of peak VO 2 , followed by continuous moderate-intensity exercise . Limb strength exercises were included in three programmes . Conclusions : The analysed literature suggests that cardiac rehabilitation in patients with ventricular assist devices is safe and can provide benefits in cardiorespiratory fitness and exercise tolerance . High-intensity interval training is identified as an appropriate strategy for achieving results , offering short-term improvements .
Key words : Cardiac rehabilitation , Ventricular assist devices , Oxygen consumption , Exercise tolerance , Exercise prescription , High-intensity interval training , Exercise programmes .
Introduction
In healthy individuals , the increased peripheral demand for oxygen during physical activity is met with an increase in cardiac output , facilitated by physiological variables such as preload , ventricular contractility ( Frank-Starling mechanism ), heart rate , and afterload [ 1 ]. However , in patients with advanced or end-stage heart failure ( HF ), there is a significant compromise in meeting cardiometabolic demand , resulting in reduced cardiac output , hypoperfusion , increased intracardiac pressures , and severe deterioration of functional capacity [ 2 , 3 ].
With a prevalence of HF of at least 2 % in developed countries , the condition has a significant public health impact , affecting synthetic health indicators and presenting a long road to heart transplantation as the reference intervention . Advances in ventricular assist devices ( VADs ) have allowed them to be considered as an alternative for candidates awaiting transplantation , during the transplant process , and for recovery [ 3 ]. The goal of VADs is to restore tissue perfusion and enhance systemic blood supply . Different types of VADs exist with varying mechanisms of action , classified according to the type of support provided , either left ventricular , right ventricular , or biventricular . Additionally , mechanical circulatory systems are classified by usage duration : short-term devices include intra-aortic balloon pumps , IMPELLA , TANDEM-Heart , and CentriMag , while long-term devices include HeartMate II and , more recently , HeartMate III [ 3 ].
* Corresponding author : nelson . portuguez00 @ usc . edu . co
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https :// creativecommons . org / licenses / by / 4.0 ), which permits unrestricted use , distribution , and reproduction in any medium , provided the original work is properly cited .