# Exercise Recommendations - Post Cardiac Transplant
## Background

A cardiac transplant involves the surgical placement of a donor’s healthy heart into the recipient with end-stage heart disease. Some diseases linked with heart transplants are those such as cardiomyopathy and heart failure.
Heart Transplants are surgeries of life-saving technology which was started as a radical experimental surgery in 1984 which now plays a detrimental role in end-stage heart disease patients. Since 1984, The St. Vincent’s Hospital of Sydney, The Royal Children’s in Melbourne, Royal Perth Hospital, and The Prince Charles Hospital in Brisbane and The Alfred in Melbourne have offered heart transplant programs.

## Benefits of Exercise

Exercise can assist post-cardiac transplant recipients by:
   * Decreased blood lactate concentrations at the given work rate
   * Improved aerobic characteristics of skeletal muscle
   * Improved endothelial function
   * Decreased resting heart rate and blood pressure
   * Increased VO2 peak and VO2 at ventilator threshold
   * Increased muscle force production
   * Increased bone mineral density
   * Prevention of steroid-induced muscle wasting and weakness
Cardiac Transplant patients can have decreased results post surgery if:
   * Inactivity before surgery
   * Reduced aerobic characteristics of skeletal muscle
   * Decreased skeletal muscle mass and force production
   * Pulmonary diffusion abnormalities
   * Left ventricular dysfunction

## Resistance and Cardiovascular Exercise Guidelines

Recommended exercise programs are progressive and aimed in:
   * improving cardiorespiratory fitness
   * improve muscle endurance and force production
   * re-establish self efficacy and improve quality of life

### Resistance Training Goals

   * Low to moderate intensity exercise; 1-2 sets of 10-15reps
   * 2-4 days per week
   * Arm exercises should not be started until full healing after sternotomy (2 months)
   * Within 2 months of surgery; patients should feel increased muscle strength and endurance of the legs; and beginning resistance work on the upper body

### Aerobic Training Goals

   * 15 – 60 minute sessions
   * 4 -7 days per week at 40-80% VO2 max
   * After 6 months, recipients should have increase cardiovascular fitness and improvements against risk factors such as insulin sensitivity etc.

## Considerations and Precautions

While research has shown the safety of resistance and cardiovascular exercises; professional advice should be taken:
   * discuss physical activity with your doctor or physiotherapist to determine what may be appropriate
   * do not exercise or stop immediately if unwell, dizzy, lightheaded, faint, cold sweats, nausea or chest pain
   * do not begin to exercise if you are having an episode of rejection
   * avoid exercise in extreme temperatures or conditions
Ensure to monitor all medications; as it can cause some disruptions to exercise – seek medical advice.

## Recommended Reading

American Heart Association
International Society for Heart and Lung Transplantation (See: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates for information)
Australia and New Zealand Cardiothoracic Organ Transplant Registry

## References

* ↑ Cardiothoracic Surgery - Patient’s Guide to Heart Transplant Surgery http://www.cts.usc.edu/ht-pg-exercise.html
* ↑ The international society of heart and lung transplantation guidelines for the care of heart transplant recipients – Long term care of heart transplant recipients. (Aug 6, 2010) http://www.ishlt.org
* ↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
* ↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
* ↑ The international society of heart and lung transplantation guidelines for the care of heart transplant recipients – Long term care of heart transplant recipients. (Aug 6, 2010) http://www.ishlt.org
* ↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
* ↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
* ↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
* ↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
* ↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
* ↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
* ↑ Durstine, Larry J., Moore, Geoffrey E., Painter, Patricia L., Roberts, Scott O., (2009). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities. Ed.3. p99-106
* ↑ Cardiothoracic Surgery - Patient’s Guide to Heart Transplant Surgery http://www.cts.usc.edu/ht-pg-exercise.html
* ↑ The international society of heart and lung transplantation guidelines for the care of heart transplant recipients – Long term care of heart transplant recipients. (Aug 6, 2010) http://www.ishlt.org