How Effective Is Aerobic Exercise Training in Improving Aerobic Capacity After Heart Transplant? A Systematic Review and Meta-analysis

Supplemental Digital Content is Available in the Text. Purpose: Studies suggest that additional exercise (Ex) training beyond “usual care” increases peak VO2 in people post-heart transplant (HTx); however, no recent studies have quantified improvements or compared moderate-intensity aerobic Ex (MOD) to high-intensity interval training (HIIT). The purpose of this study was to quantify improvements in VO2 for patients post-HTx undergoing additional Ex training and compare effectiveness of MOD to HIIT. Methods: Inclusion criteria were: randomized clinical trials, systematic reviews, or meta-analyses published between 2008 to 2018, subjects post-HTx, participated in an aerobic Ex program beyond usual care, and reported peak VO2. Results: A total of 242 records were obtained and 7 randomized clinical trials were reviewed. The average PEDro score was 4.86 (range 2–7). The within-group weighted mean difference (WMD) in peak VO2 comparing baseline to post-training for the Ex group = 3.3 (0.5) ml/kg/min and for the control group = −0.2 (0.2) ml/kg/min. The between-group WMD in peak VO2 = 3.5 (7.9) ml/kg/min, Hedge's g = 0.606 (95% confidence intervals = 0.337–0.874), P < .001, favoring Ex. Comparison between Ex protocols indicated that there was no difference between HIIT and MOD (Q = 1.83, P = .176). Conclusions: Physical therapists should challenge patients post-HTx with aerobic Ex that goes beyond usual post-HTx care and should consider incorporating HIIT into the treatment plan or home program to maximize the benefits of rehabilitation when possible.