Course Description:

HTx is a surgical option for end-stage heart disease or failure. Patients who are candidates for the procedure typically have severely diminished functional capacity that limits their ability to perform daily tasks. These individuals will be unable to carry out any physical activity without symptoms. After successful HTx, patients will have an increase in life expectancy, but they will continue to have lower peak oxygen uptake (VO2peak) when compared to healthy age- and gender-matched individuals. With the donor heart, sympathetic neural stimulation is lost due to autonomic denervation. This results in a blunted chronotropic response, which is the ability of the body to increase heart rate (HR) at the onset of exercise and then to maintain it throughout submaximal- or maximal-effort exercise. Along with diminished sympathetic neural stimulation, the use of immunosuppressive medication to prevent heart donor rejection in recipients of a heart transplant increases susceptibility to infection. The extensive list of contraindications and precautions to testing requires that clinicians be familiar with how to properly exercise test and rehabilitate this patient population. The aim of physical therapy is to reduce coronary risk factors and improve VO2peak, while also increasing functional capacity and quality of life. Understanding how to appropriately structure an exercise prescription for recipients of a heart transplant will ensure safety and maximize outcomes.