A controlled trial of exercise rehabilitation after heart transplantation

Background In patients who have received a cardiac transplant, the denervat ed donor heart responds abnormally to exercise and exercise tolerance is re duced. The role of physical exercise in the treatment of patients who have undergone cardiac transplantation has not been determined. We assessed the effects of training on the capacity for exercise early after cardiac transp lantation. Methods Twenty-seven patients who were discharged within two weeks after re ceiving a heart transplant were randomly assigned to participate in a six-m onth structured cardiac-rehabilitation program (exercise group, 14 patients ) or to undergo unstructured therapy at home (control group,13 patients). E ach patient in the exercise group underwent an individualized program of mu scular-strength and aerobic training under the guidance of a physical thera pist, whereas control patients received no formal exercise training. Cardio pulmonary stress testing was performed at base line (within one month after heart transplantation) and six months later. Results As compared with the control group, the exercise group had signific antly greater increases in peak oxygen consumption (mean increase, 4.4 mi p er kilogram of body weight per minute [49 percent] vs. 1.9 ml per kilogram per minute [18 percent]; P = 0.01) and workload (mean increase, 35 W [59 pe rcent] vs. 12 W [18 percent]; P = 0.01) and a greater reduction in the vent ilatory equivalent for carbon dioxide (mean decrease, 13 [20 percent] vs. 6 [11 percent]; P = 0.02). The mean dose of prednisone, the number of patien ts taking antihypertensive medications, the average number of episodes of r ejection and of infection during the study period, and weight gain did not differ significantly between the groups. Conclusions When initiated early after cardiac transplantation, exercise tr aining increases the capacity for physical work. (N Engl J Med 1999;340: 27 2-7.) (C) 1999, Massachusetts Medical Society.