[Sports after heart transplantation]

Heart transplantation has the potential to change a patient with a life-threatening illness into an active healthy person with a potentially excellent quality of life. Survival with excellent allograft function for 10 years is now common for the majority of patients. However, exercise performance remains impaired when compared to healthy subjects. Reasons include a decrease of maximal heart rate, cardiac output and oxygen uptake, which are present after heart transplantation. The role of these abnormalities may differ as a function of time after surgery. Possible reasons like cardiac denervation, diastolic dysfunction, and endothelial dysfunction are discussed in this article. Furthermore, exercise capacity may be diminished because of peripheral limitations associated with physical deconditioning, abnormal muscle structure and function or pharmacological side effects. Endurance and strength training may greatly improve muscle function and maximal aerobic performance as well as reduce side effects of immunosuppressive therapy. Exercise should be considered a valuable tool in the long-term treatment after heart transplantation.