Rehabilitation after cardiac transplantation
- Ileana L Piña, MD, MPH
Ileana L Piña, MD, MPH
- Professor of Medicine and Epidemiology/Population Health
- Albert Einstein College of Medicine
- Associate Chief of Cardiology for Academic Affairs
- Montefiore-Einstein Medical Center
In spite of dramatic advances in the survival of cardiac transplant recipients, published reports have consistently shown abnormal levels of functional capacity. Although there is a rapid rise in exercise capacity that occurs at approximately two months post-transplant , and many patients return to their normal activities with improved quality of life, exercise function remains 30 to 40 percent below normal [2,3]. Unfortunately in the United States, participation in cardiac rehabilitation is low and varies by region and yet could reduce readmissions. This observation in 2531 post-transplant patients associating participation in cardiac rehabilitation with a lower one-year readmission for Medicare beneficiaries adds a significant layer of benefit .
Prior studies describing persistently abnormal exercise capacity in the early post-transplant period suggested several possible explanations, including :
●Marked deconditioning prior to transplant due to heart failure (HF) or due to extended mechanical assistance with a left ventricular assist device. (See "Skeletal muscle dysfunction and exercise intolerance in heart failure" and "Intermediate- and long-term mechanical circulatory support" and "Practical management of long-term mechanical circulatory support devices".)
●Surgical denervation of the heart 
●Corticosteroid therapy-related myopathy (see "Glucocorticoid-induced myopathy")
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- EXERCISE CAPACITY AND REHABILITATION POST-TRANSPLANTATION
- - Exercise capacity
- - Effect of early rehabilitation
- - Exercise capacity
- - Effect of later rehabilitation
- TIMING OF CARDIAC REHABILITATION REFERRAL
- THE TRANSPLANT CARDIAC REHABILITATION PROGRAM
- Immediate post-transplantation rehabilitation
- Myopathy and resistance training
- Posthospital exercise prescription