130 N . E . Portuguez Jaramillo et al .: J Extra Corpor Technol 2024 , 56 , 128 – 135
Figure 1 . Study selection flowchart .
sumption from 13.6 to 15.3 ml / kg / min , and 6MWT distance from 350.1 ± 64.7 to 402.4 ± 89.3 m compared to no EP or physiological improvements in the control group . Marko et al . [ 16 ] implemented a 32 ± 6-day strength training protocol , focusing on lower limbs , dividing participants based on underlying heart disease , age , and post-operative conditions . In one group ( n = 15 ), ergo-spirometry was performed at the start and end of CR , showing an increase in VO 2 peak from 11.3 ± 4.1 to 14.5 ± 5.2 ml / min / kg . Thirty-nine patients performed lower limb strength training , with an average of 6.4 sessions , showing a significant increase in the weight lifted across all evaluated muscle groups . Other improvements included exercise duration from 14 ± 2 min to 19 ± 4 min and ergometer bike intensity from 2.0 ± 1.9 W to 6.2 ± 2.8 W .
On the other hand , Schmidt et al . [ 17 ] used a muscular endurance rehabilitation protocol lasting 3 – 5weeks , 5 – 7days per week , with three sets of 20 repetitions , including lower limb training and ergometer biking . Significant improvements were noted in the 6MWT distance from 325 ± 106 m to 405 ± 77 m . Additionally , they evaluated the peak workload in a cardiopulmonary exercise test ( CPET ) at the end of CR , reporting an average peak workload of 62.2 ± 19.3 W , corresponding to 38 % of the total calculated for the population , and an average relative VO 2 peak of 10.6 ± 2.9 ml / kg / min , corresponding to 37 % of the predicted VO 2 peak .
The average intervention duration was 5.57 weeks for the seven included studies , totalling an average of 25.42 sessions . The longest protocol was by Moreno et al . [ 12 ] with 12 weeks and 36 sessions , whereas Alvarez Villela et al . [ 14 ] conducted 15 sessions over 5 weeks , the shortest protocol . One study conducted its intervention in an inpatient setting with two sessions per day over 4 weeks , totalling 48 sessions [ 13 ]. Three of the seven studies had participants engage in sessions three times a week [ 11 , 12 , 14 ], while the others had near-daily sessions .
Notably , Scaglione et al . [ 13 ] included laboratory tests such as haemoglobin levels , mean corpuscular volume , creatinine , and other serological follow-ups pre-intervention and postdischarge , confirming the infrequency of events such as bleeding and no significant serological findings potentially influenced by CR . Schmidt et al . [ 17 ] supplemented their protocol with measures of anaerobic thresholds , 12-lead ECG tracings , and lactate levels , evaluating cardiac electrical activity and lactate exportation in response to increased metabolic demands .
Discussion
This study reviewed 07 studies employing various CR strategies in patients who underwent VAD implantation . These devices serve as a treatment option for patients unresponsive to