Importance of physical capacity and the effects of exercise in heart transplant recipients

Figure 1. Physical capacity, as assessed by VO2peak after heart transplantation from published studies, illustrated by years after surgery. Black line at 12 mL/kg per minute, show the threshold to be candidates for HTx, dotted line at 20 mL/min per kilogram, show the start of Weber function class A, representing good physical condition. The measurements are carried out from exercise tests from; Bernandi et al[85], Carter et al[86], Dall et al[35], Ewert et al[87], Givertz et al[88], Gullestad et al[89], Habedank et al[90], Haykowski et al[91], Hermann et al[36], Hognestad et al[92], Karpolat et al[93], Kavanagh et al[94], Kemp et al[95], Kobashigawa et al[96], Nytrøen et al[37], Osada et al[5], Renlund et al[97], Schwaiblmair et al[98], Squires et al[99], Tegtbur et al[100], Wu et al[77]. HTx: Heart transplantation.

Figure 2. Illustration of the increase in peak VO2 from pre heart transplantation to 36 mo post heart transplantation. The data presented in the figure is from the unpublished Schedule trial.

Figure 3. Illustration of two different exercise modalities. A: Illustration of a session with high-intensity interval training (HIT). HIT is an exercise strategy with alternating short periods of intense endurance exercise with less-intense recovery periods. A usual HIT session may include 4 × 4 min periods with high intensity (85%-95% of maximal capacity), with active recovery periods of 3min between each interval (with 60%-70% of maximal capacity); B: Illustration of a session with moderate intensity continuous training (MICT). MICT is an exercise strategy with moderate intensity (60%-70% of maximal capacity) of endurance exercise in periods for usually 25-30 min, with no recovery periods.

Figure 4. Heart rate during exercise 3 mo post heart transplantation. Patient from our hospital, 3 mo post-HTx: HR curve during warm-up, two high-intensity intervals divided by one recovery period and cool-down. The curve shows a typical pattern of impaired HR responses in the early stage after HTx. HTx: Heart transplantation.

Figure 5. Heart rate during exercise 12 mo post heart transplantation. The same patient 12 mo post-HTx: Heart rate curve during warm-up four high-intensity intervals divided by 3 recovery periods and cool-down. The curve shows a largely normalized HR, with immediate HR adaptions to exercise intensity. HTx: Heart transplantation.

Figure 6. Measurements of VO2peak at baseline, 1-year and 5-year follow-up. 1Significant changes between groups; 2Significant changes from baseline to 5-year follow-up within group.