Approaches to improving exercise capacity in patients with left ventricular assist devices: an area requiring further investigation

ABSTRACT

Introduction: Left ventricular assist device (LVAD) implantation has become a well-established treatment option for patients with end stage heart failure (HF) who are refractory to medical therapy. While LVADs implantation does effectively improve hemodynamic performance many patients still possess peripheral pathological adaptations often present in end-stage HF. Therefore, increased attention has been placed on investigating the effects of exercise training for patients with LVADs to improve clinical outcomes. However, the available evidence on exercise training for patients with LVADs is limited.

Areas covered: The purpose of this narrative review is to summarize: 1) The evolution of LVAD technology and usage; 2) The physiological responses to exercise in patients with LVADs; 3) The available evidence regarding exercise training; 4) Potential strategies to implement exercise training programs for this patient population.

Expert opinion: The available evidence for exercise training to improve physical function and clinical outcomes for patients with LVADs is promising but limited. Future research is needed to further elucidate the ideal exercise training parameters, method of delivery for exercise training, and unique barriers and facilitators to exercise training for patients receiving LVAD implantation.

KEYWORDS:

• LVAD
• heart failure
• exercise training
• cardiac rehabilitation
• exercise testing
• left ventricular assistive devices
• cardiac transplantation

Article Highlights

• Peak exercise capacity typically improves following LVAD implantation when compared to pre‐implantation values; however, LVAD recipients often fail to attain age and sex predicted normative values.

• The available evidence for exercise training to improve physical function, exercise capacity, and clinical outcomes for patients with LVADs is promising but limited.

• Cardiac rehab has been shown to be an effective model for delivering exercise training to improve peak exercise capacity, and other clinical outcomes in LVAD patients.

• The prognostic value of peak VO2 on survivorship following LVAD implantation requires further inquiry, as the use of LVAD as a destination therapy continues to increase.

• Clinicians and clinical researchers should collaborate with policymakers to identify and develop solutions to barriers regarding cardiac rehab participation by LVAD patients.

Acknowledgments

The authors would like to acknowledge Sam Bond (Department of Biomedical Visualization, College of Applied Health Sciences, University of Illinois, Chicago) for the Illustration of Figure 1.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The work of the authors is funded by National Institute of Health, T32-HL-139439.