A safe estimate would be after about 2 months (post-op) in order to allow for adequate sternal healing. Light resistance exercises utilizing lower resistance therabands, sand bags for aerobic training and resisted ergometry may be considered.
Early after transplantation, most patients have a notable improvement in functional capacity compared to their preoperative condition (although exercise capacity usually remains below normal).
Studies of cardiac transplant recipients who have participated in cardiac rehabilitation programs have reported improvements in peak oxygen uptake (VO2) from 16.7 to 20 mL/kg per min after 10 weeks of outpatient exercise training.
The importance of cardiac rehabilitation was illustrated in a study which randomized 27 patients within two weeks of cardiac transplantation to a six month structured rehabilitation program or unstructured therapy at home. Compared to the control group, the exercise group had a greater increase in peak oxygen consumption (49 versus 18 percent) and workload (59 versus 18 percent) and a greater reduction in the ventilatory equivalent for carbon dioxide (20 versus 11 percent).
The often inadequate response to home-based exercise training in cardiac transplant recipients differs from that in patients who have undergone coronary artery bypass graft (CABG) surgery. After an early (within three months of surgery) outpatient program of exercise conditioning, patients who have undergone CABG have levels of functional capacity that are similar to those in cardiac transplant recipients.
Although less well studied in transplant recipients, resistance exercise can be performed safely and will increase strength and flexibility for tasks of daily living. As noted above, a gradually incremental resistance program can improve fiber type in skeletal muscle, as well as increase oxidative capacity to enhance work. It is recommended, therefore, that a resistance program be added to the aerobic training regimen.
Proximal muscle weakness is common in post-transplant patients for a number of reasons, including chronic corticosteroid use and the skeletal muscle changes associated with long-standing heart failure.
The value of resistance training was suggested by a randomized controlled trial with 8 patients in the training group and 8 in the control group. Training began two months after surgery to allow sternal healing. The program included both upper and lower body exercises using a set of variable resistance equipment twice weekly for six months. A set consisted of 10 to 15 repetitions at 50 percent of one repetition maximum. After 15 repetitions were successful, the resistance was gradually increased but not to exceed 15 repetitions. The program had no complications.
Among patients randomized to resistance training, skeletal muscle fibers shifted from the less oxidative Type II to the more fatigue-resistant Type I. In contrast, patients in the control group, who participated in largely aerobic activity, had a further loss of Type I fibers and an increase in Type II. In addition, resistance training produced greater increases in oxidative and glycolytic skeletal muscle enzymes than aerobic training alone.
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