Exercise rehabilitation in cardiac transplantation patients: a comprehensive review

Cardiac transplant recipients are often severely deconditioned, the result of their presurgical disease state, and as a consequence are prime candidates for exercise-based rehabilitation. The training regimen, however, needs to take into account the patient's atypical central and peripheral responses to exercise. This review deals with these changes, describes typical exercise testing and training protocols, with some reference to the Toronto practice, and summarizes training-induced benefits as well as long-term residual effects. The evidence for sympathetic reinnervation is reviewed, with the conclusion that while it may occur over time, it is inconsistent, and partial in nature.