The Effect of Individualized Exercise Parameters Applied to Two Patients Recovering from Implanted Left Ventricular Assist Devices in Korea

Yong Gon Seo; Ji Dong Sung; Won Hah Park

doi:10.5763/kjsm.2016.34.1.78

Journal List > Korean J Sports Med > v.34(1) > 1054581

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Seo, Sung, and Park: The Effect of Individualized Exercise Parameters Applied to Two Patients Recovering from Implanted Left Ventricular Assist Devices in Korea

Case Report

Korean J Sports Med 2016;34(1):78-82.

Published online: 19 January 2016

DOI: https://doi.org/10.5763/kjsm.2016.34.1.78

The Effect of Individualized Exercise Parameters Applied to Two Patients Recovering from Implanted Left Ventricular Assist Devices in Korea

Yong Gon Seo¹, Ji Dong Sung², Won Hah Park^1,

¹Division of Sports Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University Rehabilitation and Prevention Center, Division of Cardiology Korea

²Department of Medicine, School of Medicine, Seoul, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence: Won Hah Park Division of Sports Medicine, Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3847, Fax: +82-2-3410-6689 E-mail: yongon79@naver.com

Received 22 March 2016 Revised 21 March 2016 Accepted 22 March 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Left ventricular assist devices (LVADs) are a treatment option for patients with severe chronic heart failure. These patients are referred to an inpatient cardiac rehabilitation after implantation to improve an aerobic capacity and quality of life (QOL). Several studies have reported that an exercise therapy, which is a component of cardiac rehabilitation, improves exercise capacity and QOL. The LVADs were implanted successfully in a destination therapy in two Korean patients, and these patients were enrolled in the cardiac rehabilitation. After an individualized intervention, they were discharged from improved exercise functional capacity and QOL. This is the first report showing a benefit of the individualized exercise therapy using different parameters after LVADs implantation in Korea.

Keywords: Exercise therapy, Heart failure, Ventricular assist devices

REFERENCES

1.Roger VL., Go AS., Lloyd-Jones DM, et al. Executive summary: heart disease and stroke statistics— 2012 update: a report from the American Heart Association. Circulation. 2012. 125:188–97.

2.Ministry of Health and Welfare. Ministry of health and welfare statistical year book 2013 [Internet]. Sejong (KR): Ministry of Health and Welfare; [cited 2016 May 1]. Available from:. http://stat.mohw.go.kr/front/statData/mohwAnnalsWpView.jsp?menuId=14&bbsSeq=1&nttSeq=21132&nttClsCd=01&searchKey=&searchWord=&nPage=1.

3.Slaughter MS., Rogers JG., Milano CA, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009. 361:2241–51.

4.Hayes K., Leet AS., Bradley SJ., Holland AE. Effects of exercise training on exercise capacity and quality of life in patients with a left ventricular assist device: a preliminary randomized controlled trial. J Heart Lung Transplant. 2012. 31:729–34.

5.Ueno A., Tomizawa Y. Cardiac rehabilitation and artificial heart devices. J Artif Organs. 2009. 12:90–7.

6.Scheiderer R., Belden C., Schwab D., Haney C., Paz J. Exercise guidelines for inpatients following ventricular assist device placement: a systematic review of the literature. Cardiopulm Phys Ther J. 2013. 24:35–42.

7.Maciver J., Ross HJ. Quality of life and left ventricular assist device support. Circulation. 2012. 126:866–74.

8.Wells CL. Physical therapist management of patients with ventricular assist devices: key considerations for the acute care physical therapist. Phys Ther. 2013. 93:266–78.

9.Ross RM., Murthy JN., Wollak ID., Jackson AS. The six minute walk test accurately estimates mean peak oxygen uptake. BMC Pulm Med. 2010. 10:31.

10.Kirklin JK., Naftel DC., Kormos RL, et al. Third INTERMACS Annual Report: the evolution of destination therapy in the United States. J Heart Lung Transplant. 2011. 30:115–23.

Fig. 1.

Chest X-ray view after implantation. The successful implantation of the continuous flow left ventricular assist device (HeartMate II) was showed in the figure. First case (A), second case (B).

Fig. 2.

The 6-minute walk test results for the patients (bar). There was improvement to walk distance in our cases. It means that these patients were improved exercise capacity after the intervention. Pre: pre-rehabilitation, Post: post-rehabilitation.

Fig. 3.

Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was showed. All scores of post-rehabilitation (Post) were decreased that means quality of life was improved relative to pre-rehabilitation (Pre). First case (A), second case (B).

Table 1.

Demographic data for patients

Characteristics	Case A	Case B
Sex	Male	Male
Age (yr)	76	66
Height (cm)/weight (kg)	167/50	164/63
Blood pressure (mm Hg)	93/57	76/48
Heart rate (bpm)	99	81
Body mass index (kg/m²)	21.3	23.1
Diagnosis	Systolic heart failure	Ischemic cardiomyopathy
LVEF (%)	20.0	22.3
NYHA class	II	III
Medication	Spironolactone 25 mg, Furosemide 40 mg,	Furosemide 40 mg,
	Amiodarone 100 mg, Cilostazole 50 mg,	Cefixime 200 mg,
	Clonazepam 0.6 mg, Isosorbide mono 20 mg	, Beszyme,
	Warfarin 2 mg, Loperamide oxide,	Lactulose syrup 15 mL,
	Enoxaparin 60 mg	Cough syrup 20 mL
Echocardiogram	Markedly LV dilation with severe	Ischemic heart disease with severe
	LV systolic dysfunction	LV systolic dysfunction
	Moderate TR	Dilated LV
	Mild MR	Dilated RV with decrease RV dysfunction
	Both atrial enlargement	Mild MR
	Dilated aortic root (43 mm) &	Mild AR
	ascending aorta (39 mm)	Diastolic dysfunction grade 3
		with LV filling pressure
		Both atrial enlargement

LVEF: left ventricular ejection fraction, NYHA: New York Heart Association, LV: left ventricle, TR: tricuspid regurgitation, MR: mitral regurgitation, RV: right ventricle, AR: aortic regurgitation.

Table 2.

Clinical exercise data for exercise intervention

Variable	Case A	Case B
Initial time of rehabilitation	POD 3	POD 3
Transferred to the ward	POD 10	POD 10
Exercise frequency	5/wk	5/wk
Exercise intensity	Target HR＋30 bpm: 109 bpm	Target HR＋30 bpm: 118 bpm
	RPE: 11−14 is more suitable	RPE: 11−14
	or modified Borg scale (3−5)
Exercise time (min/day)	30−60	30−60
ICU walking	POD 5	POD 5
Corridor walking	POD 10	POD 10
Step up and down	POD 27	POD 18
Stationary bike	POD 19 (level 0−1)	POD 19 (level 0−1)
Treadmill	POD 90 (speed 2.7 km/hr, grade 2)	POD 26 (speed 4.0 km/hr, grade 2)
Postoperative complication	Aspiration pneumonia,	Post OP bleeding tendency → massive
	delayed wound healing, NSVT	transfusion, hematoma or effusion,
		LVAD site hematoma (＋)
LOS in the ICU (day)	10	10
LOS in the ward (day)	126	29

POD: postoperative day, HR: heart rate, RPE: rating of perceived exertion, ICU: intensive care unit, NSVT: non sustain ventricular tachycardia, OP: operation, LVAD: left ventricular assist device, LOS: length of stay.

TOOLS

Similar articles