Background: A hospital-based cardiac rehabilitation program can significantly improve the cardiopulmonary endurance and quality of life (QOL) in patients after orthotopic heart transplantation (OHT). Home-based programs for these patients have advantages of low cost and high accessibility, but little is known about their efficacy. This prospective study was designed to evaluate the effect of an 8-week home-based exercise program on muscular strength and endurance of lower limbs, aerobic capacity and QOL in OHT recipients. Methods: Thirty-seven OHT recipients were randomized into exercise (n = 14) or control (n = 23) groups. Exercise group subjects were to exercise at least 3 times a week for 8 weeks. Each subject was evaluated by Cybex testing of right quadriceps strength and endurance, 1-min sit-to-stand test, a symptom-limited maximal exercise test and QOL assessment before and after 8 weeks. Results: Subjects in the exercise group improved significantly in sit-to-stand test, fatigue index of the right quadriceps, maximal workload achieved and physical domain of QOL compared to controls after 8 weeks, regardless of older age and lower value for sit-to-stand test at baseline. Conclusions: OHT recipients can significantly improve their muscular endurance, sit-to-stand test scores and QOL after a medically directed home-based exercise program.

1.
Braith RW, Limacher MC, Leggett SH, Pollock ML: Skeletal muscle strength in heart transplant recipients. J Heart Lung Transplant 1993;12:1018–1023.
2.
Bussieres LM, Pflugfelder PW, Taylor AW, Noble EG, Kostuk WJ: Changes in skeletal muscle morphology and biochemistry after cardiac transplantation. Am J Cardiol 1997;79:630–634.
3.
Chen SY, Lan C, Ko WJ, Chou NK, Hsu RB, Chen YS, et al: Cardiorespiratory response of heart transplantation recipients to exercise in the early postoperative period. J Formos Med Assoc 1999;98:165–170.
4.
Marconi C, Marzorati M: Exercise after heart transplantation. Eur J Appl Physiol 2003;90:250–259.
5.
Notarius CF, Levy RD, Tully A, Fitchett D, Magder S: Cardiac versus noncardiac limits to exercise after heart transplantation. Am Heart J 1998;135:339–348.
6.
Savin WM, Haskell WL, Schroeder JS, Stinson EB: Cardiorespiratory responses of cardiac transplant patients to graded, symptom-limited exercise. Circulation 1980;62:55–60.
7.
Bussieres LM, Pflugfelder PW, Menkis AH, Novick RJ, McKenzie FN, Taylor AW, et al: Basis for aerobic impairment in patients after heart transplantation. J Heart Lung Transplant 1995;14:1073–1080.
8.
Braith RW, Mills RM, Welsch MA, Keller JW, Pollock ML: Resistance exercise training restores bone mineral density in heart transplant recipients. J Am Coll Cardiol 1996;28:1471–1477.
9.
Kavanagh T, Yacoub MH, Mertens DJ, Kennedy J, Campbell RB, Sawyer P: Cardiorespiratory responses to exercise training after orthotopic cardiac transplantation. Circulation 1988;77:162–171.
10.
Keteyian S, Shepard R, Ehrman J, Fedel F, Glick C, Rhoads K, et al: Cardiovascular responses of heart transplant patients to exercise training. J Appl Physiol 1991;70:2627–2631.
11.
Kobashigawa JA, Leaf DA, Lee N, Gleeson MP, Liu H, Hamilton MA, et al: A controlled trial of exercise rehabilitation after heart transplantation. N Engl J Med 1999;340:272–277.
12.
Lampert E, Mettauer B, Hoppeler H, Charloux A, Charpentier A, Lonsdorfer J: Skeletal muscle response to short endurance training in heart transplant recipients. J Am Coll Cardiol 1998;32:420–426.
13.
Braith RW, Welsch MA, Mills RM Jr, Keller JW, Pollock ML: Resistance exercise prevents glucocorticoid-induced myopathy in heart transplant recipients. Med Sci Sports Exerc 1998;30:483–489.
14.
Blackburn GG, Foody JM, Sprecher DL, Park E, Apperson-Hansen C, Pashkow FJ: Cardiac rehabilitation participation patterns in a large, tertiary care center: evidence for selection bias. J Cardiopulm Rehabil 2000;20:189–195.
15.
Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC: Home versus center based physical activity programs in older adults. Cochrane Database Syst Rev 2005, issue 1, Art No. CD004017.
16.
Kodis J, Smith KM, Arthur HM, Daniels C, Suskin N, McKelvie RS: Changes in exercise capacity and lipids after clinic versus home-based aerobic training in coronary artery bypass graft surgery patients. J Cardiopulm Rehabil 2001;21:31–36.
17.
Savage P, Ricci MA, Lynn M, Gardner A, Knight S, Brochu M, et al: Effects of home versus supervised exercise for patients with intermittent claudication. J Cardiopulm Rehabil 2001;21:152–157.
18.
Corvera-Tindel T, Doering LV, Woo MA, Khan S, Dracup K: Effects of a home walking exercise program on functional status and symptoms in heart failure. Am Heart J 2004;147:339–346.
19.
Evangelista LS, Doering LV, Lennie T, Moser DK, Hamilton MA, Fonarow GC, et al: Usefulness of a home-based exercise program for overweight and obese patients with advanced heart failure. Am J Cardiol 2006;97:886–890.
20.
Gary RA, Sueta CA, Dougherty M, Rosenberg B, Cheek D, Preisser J, et al: Home-based exercise improves functional performance and quality of life in women with diastolic heart failure. Heart Lung 2004;33:210–218.
21.
Witham MD, Gray JM, Argo IS, Johnston DW, Struthers AD, McMurdo ME: Effect of a seated exercise program to improve physical function and health status in frail patients > or = 70 years of age with heart failure. Am J Cardiol 2005;95:1120–1124.
22.
Csuka M, McCarty DJ: Simple method for measurement of lower extremity muscle strength. Am J Med 1985;78:77–81.
23.
Yao G, Chung CW, Yu CF, Wang JD: Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. J Formos Med Assoc 2002;101:342–351.
24.
The WHOQOL-Taiwan Group: Introduction to the development of the WHOQOL-Taiwan version. Chinese J Public Health (Taipei) 2000;19:315–324.
25.
Sallis JF, Haskell WL, Wood PD, Fortmann SP, Rogers T, Blair SN, et al: Physical activity assessment methodology in the Five-City Project. Am J Epidemiol 1985;121:91–106.
26.
Bingham SA, Gill C, Welch A, Day K, Cassidy A, Khaw KT, et al: Comparison of dietary assessment methods in nutritional epidemiology: weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br J Nutr 1994;72:619–643.
27.
The WHOQOL-Taiwan Group: The User’s Manual of the Development of the WHOQOL-BREF Taiwan Version. Taipei, WHOQOL-Taiwan Group, 2000.
28.
Schwaiblmair M, von Scheidt W, Uberfuhr P, Ziegler S, Schwaiger M, Reichart B, et al: Functional significance of cardiac reinnervation in heart transplant recipients. J Heart Lung Transplant 1999;18:838–845.
29.
LaPier TK: Glucocorticoid-induced muscle atrophy: the role of exercise in treatment and prevention. J Cardiopulm Rehabil 1997;17:76–84.
30.
Badenhop DT: The therapeutic role of exercise in patients with orthotopic heart transplant. Med Sci Sports Exerc 1995;27:975–985.
31.
Karapolat H, Eyigor S, Zoghi M, Yagdi T, Nalbangil S, Durmaz B: Comparison of hospital-supervised exercise versus home-based exercise in patients after orthotopic heart transplantation: effects on functional capacity, quality of life, and psychological symptoms. Transplant Proc 2007;39:1586–1588.
32.
Grady KL, Jalowiec A, White-Williams C: Improvement in quality of life in patients with heart failure who undergo transplantation. J Heart Lung Transplant 1996;15:749–757.
33.
Grady KL, Jalowiec A, White-Williams C: Predictors of quality of life in patients at one year after heart transplantation. J Heart Lung Transplant 1999;18:202–210.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.