Cardiac rehabilitation in a heart failure patient after left ventricular assist device insertion and subsequent heart transplantation: A case report

Table 1 Results of serial cardiopulmonary exercise tests

	Post-LVAD1, 81 d (August 8, 2019)	Post-LVAD, 207 d (December 12, 2019)	Post-HT1, 116 d (April 13, 2020)	Post-HT, 162 d (May 29, 2020)
Protocol	Modified Bruce	Modified Bruce	Modified Bruce	Modified Bruce
Duration	7 min 44 s	12 min 23 s	9 min 55 s	14 min 06 s
VO2 peak, mL/min/kg (% of the predicted)	18.01 (47%)	20.20 (57%)	17.24 (47%)	22.29 (62%)
VO2 at AT, mL/min/kg	15.81	15.97	13.03	16.78
METs	5.2	5.7	5.0	6.4
Resting HR, bpm	100	85	86	88
Maximum HR, bpm (% of the predicted)	140 (83%)	159 (95%)	107 (64%)	129 (77%)
HRR after 1 min	-4	-14	+2	+5
Resting BP, mmHg	NM	NM	115/88	119/86
Maximum BP, mmHg	NM	NM	130/67	147/88
VE/VCO2 slope	29.7	30.6	34.0	31.6
RER	1.02	0.98	1.01	1.11

¹LVAD was conducted on May 20, 2019, and HT was conducted on December 20, 2019.

LVAD: Left ventricular assist device; HT: Heart transplantation; VO_{2 peak}: Peak oxygen consumption; VO₂ at AT: Oxygen uptake at the anaerobic threshold; MET: Metabolic equivalent task; HR: Heart rate; HRR-1 min: Heart rate recovery in one minute; BP: Blood pressure; V_E: Minute ventilation; V_CO2: The volume of exhaled carbon dioxide; RER: Respiratory exchange ratio; NM: Not measurable.

Table 2 Rehabilitation program

Aerobic exercise	Exercise type	Intensity	Duration of one session	Sessions/d	Days/wk
Post LVAD
Phase I	Supervised indoor walking	HR < resting HR + 20 or RPE of 12	5-10 min, increase up to 20-30 min	2	3
	Lower limb ergometer	10-20 Watt
Phase II	Lower limb ergometer, treadmill, box step up	40%-55% based on the Karvonen formula	Warm-up 10 min, main exercise 20 min, cool-down 10 min	1	2
Post HT
Phase I	Supervised indoor walking	RPE of 12	5-10 min, increase up to 20-30 min	2	3
	Lower limb ergometer	10-20 Watt
Phase II	Lower limb ergometer	RPE of 13	Warm-up 10 min, main exercise 20 min, cool-down 10 min	1	2
	Treadmill
	Box step up
Resistance training	Exercise type	Strength % of 1RM	Repetitions per set	Sets per exercise/d	Days/wk
Phase I	Resistance band exercises	20%-30%	8-15	3-5	2-3
Phase II	Overhead press, biceps curl, leg press machine, squat	40%-60%	8-15	3-5	2-3

LVAD: Left ventricular assist device; HT: Heart transplantation; HR: Heart rate; RPE: Rating of perceived exertion; RM: Repetition maximum.