The effect of cardiac rehabilitation on functional capacity, psychological symptoms and quality of life in patients with left ventricular assist devices

Objectives: In this prospective randomized trial, we aimed to study the effects of cardiac rehabilitation on functional capacity, depression and quality of life, in patiens undergone left ventricular assist device (LVAD) implantation for the treatment of heart failure. We also aimed to compare the effectiveness of home and hospital based exercise programs. Materials and method: 42 patients who had received LVAD implants in our university hospital were included in the study. After the subjects were randomized into hospital exercise group (n=20) and home exercise group (n=22). They were enrolled in a cardiac rehabilitation program for 8 weeks, which lasted for one hour, three times per week in hospital and at home respectively. All subjects were assessed at baseline and after the 8th week. Findings: In our study we detected a significant improvement in peak oxygen expenditure (peak VO2), six minute walk test values and in Minnesota living with heart failure quentionnaire, state-trait anxiety inventory, state anxiety subscore in the hospital exercise group (p<0,05). Home exercise group did not improve significantly in any of the parameters except in the pain subscore of Short Form-36 (p<0,05). When we compared the changes seen in the parameters over time, hospital group showed significantly more improvement than the home exercise group in peak VO2, six-minute walk test, Minnesota living with heart failure questionnaire and trait anxiety subscore of the state trait anxiety inventory (p<0,05). Age (r=-0,39, p<0,01) and the duration of heart failure (r=-0,35, p< 0,05) both showed a negative correlation with changes in six minute walk test and FEV1. Duration of heart failure showed a negative correlation with both the increase in 6-minute walk test (r=-0,25, p<0,01) and the increase in FEV1 values (r=-0,19, p< 0,05). Better improvement in peak VO2 correlated with better improvement in six-minute walk test (r=0,54,p>0,01) and FEV1(r=0,14, p>0,05) scores. Discussion: End stage heart failure is increasingly being treated with LVAD implantation. Safety of cardiac rehabilitation in patients with LVAD have been proven in other studies. In this study we detected a positive effect of supervised hospital exercise program on functional capacity, quality of life and anxiety in patients with implanted LVADs. Previous studies have shown similar results regarding the efficacy of cardiac rehabilitation in both hospital and home exercise groups. But patients enrolled in these studies were mainly New York Heart Association grade 1 patients who had better functional status. In our study, exercise adherence was worse in the home exercise group. There is still need for more studies focusing on patiens with LVAD and comparing the effects of home and hospital exercise programs. There is also need for more long term follow-up to show the long term efficacy of cardiac rehabilitation in LVAD patients.