N . E . Portuguez Jaramillo et al .: J Extra Corpor Technol 2024 , 56 , 128 – 135 129
Scientific evidence strongly recommends cardiac rehabilitation ( CR ) for patients diagnosed with HF to improve functional capacity , quality of life , and reduce mortality risk [ 4 ]. The exercise prescription ( EP ) component within CR has demonstrated physiological changes that contribute to the favourable outcomes of CR [ 5 ].
However , EP can pose a significant challenge in HF patients with VADs due to the unique pathophysiological characteristics of this population . For instance , in patients with VADs , the ability of each device to adjust the flow rate according to workload during exercise remains enigmatic and depends on its flow control mechanism . Therefore , there is currently no clear consensus on intervention strategies for EP in patients with VADs [ 6 , 7 ].
Consequently , intervention strategies aimed at improving physiological parameters related to adequate cardiovascular function and meeting metabolic demands in patients with VADs should be based on quantifiable and measurable objectives .
This scoping review aimed to explore scientific reports on the EP used in adult patients with VADs participating in a CR programme , focusing on exercise modalities and observable changes in physiological variables related to symptom reduction , aerobic capacity improvement , and cardiorespiratory fitness .
Materials and methods
A scoping review was conducted following the methodology described in the Joanna Briggs Institute Manual [ 8 ], the protocol presented by Arksey and O ’ Malley [ 9 ], and the improvements suggested by Levac et al . [ 10 ]. This review included defining the research question , conducting systematic searches , study selection , review , and qualitative synthesis .
The review addressed the question : What are the EP strategies used in CR for patients with ventricular assist devices ( VADs )? The inclusion criteria were as follows : population : Patients over 18 years old with recently implanted VADs . Concept : Types of EP strategies implemented in CR . Search Limits : Epidemiological designs including controlled and uncontrolled clinical trials , prospective cohorts , including single-blind , double-blind , and / or randomised studies , published between 2013 and 2023 in English .
During the systematic search , keywords such as “ ventricular assist device ,”“ cardiac rehabilitation heart transplant ,” and “ exercise training ” were included , along with the following search equation : ( ventricular assist device OR Centrimag OR VAD OR HeartMate II ) AND ( cardiac rehabilitation OR exercise OR exercise training ) AND ( heart transplant OR left ventricular failure OR right ventricular failure OR biventricular assist device OR heart pump OR implantable ventricular assist system ).
Two researchers independently conducted systematic searches in the databases : PubMed , SCOPUS , ScienceDirect , and PEDro . Notably , PEDro was highlighted for its value as a comprehensive and reliable source providing high-quality evidence in the field of rehabilitation , including CR .
After removing duplicates , two researchers independently reviewed the titles and abstracts resulting from the search and included studies that described the types of training during
CR in the previously described population . Subsequently , the full text of 136 studies was reviewed to determine how each responded to the research question . Following this , a consensus among all researchers led to the inclusion of seven articles . Data extraction was then performed , capturing study aspects in a digital spreadsheet ( authors , year of publication , number of patients , type of training , description of training , intervention duration , and post-intervention changes ) ( Figure 1 ).
In the final review stage , the content of the included studies was synthesised into Table 1 , and the analysis focused on the different strategies used and post-intervention changes in CR programmes . This final point was of high importance for the authors , who sought to provide a theoretical basis for the variation in physiological parameters through EP .
Results Characteristics of the studies and target population The included studies were conducted in North America , Europe , and Oceania , with the oldest study published in 2014 [ 11 ]. The studies by Kerrigan et al . [ 11 ], Moreno et al . [ 12 ], and Scaglione et al . [ 13 ] were designed as experimental studies , whereas the studies by Alvarez Villela et al . [ 14 ], Schmidt et al ., and Marko et al . [ 15 – 17 ] opted for a quasi-experimental design . A total of 226 participants were analysed , including 149 males and 32 females , excluding the studies by Kerrigan and Moreno where the population specifics were not provided . Strategies used during cardiac rehabilitation and post-intervention changes
Three studies employed aerobic resistance training , specifically high-intensity interval training ( HIIT ). Moreno et al . [ 12 ] prescribed sessions of four sets , each lasting 4 min , with an intensity of 80 – 90 % of VO 2 peak , alternating with 3 minat lower intensities around 50 % of VO 2 peak . This resulted in a significant improvement in VO 2 peak from 15.6 to 18.4 ml / kg / min compared to the control group , which performed continuous training for 28 min at 50 – 60 % of VO 2 peak , increasing from 16.2 to 17.2 ml / kg / min . Alvarez Villela et al . [ 14 ] established a protocol with progressive intensity increments , starting at 80 % workload with 30 % recovery periods , and increasing to 100 % with 40 % recovery by the fourth session , showing a significant improvement in VO 2 peak from 7.1 to 8.5 ml / kg / min and left ventricular end-diastolic volume from 159 to 168 ml .
Similarly , Schmidt et al . [ 15 ] implemented a HIIT protocol with intensity measured in watts , starting at 10 / 25 W and ending at 14 / 35 W . Significant improvements were reported in the six-minute walk test ( 6MWT ) distance from 367 to 449 m , VO 2 peak from 10.0 to 11.9 ml / kg / min , maximum workload from 62.4 to 83.0 W , and handgrip strength from 29.2 to 34.7 kg , though these were not statistically significant .
Two additional studies also used aerobic resistance training . Kerrigan et al . [ 11 ] established a six-week protocol with three sessions per week , involving 18 sessions of aerobic exercise at 60-80 % of maximum heart rate . Improvements were seen in treadmill test duration from 7.9 to 11.9 min , oxygen con-