Exercise training in patients after heart transplantation

The post-cardiac transplantation patient is frequently debilitated as a result of "end-stage" heart disease and typically demonstrates muscle wasting, with a reduced work capacity, maximum heart rate and peak oxygen uptake. At submaximal effort perceived exertion and ventilation are higher, and the absolute ventilatory threshold lower, than in normals. A number of published studies have now shown that an exercise rehabilitation programme can induce a good training effect, although possibly not complete restoration of physiological function. The prescription of exercise must take into account the denervated heart's peculiar response to effort, and rely more on perceived exertion and metabolic measurements for defining intensity of training rather than target training heart rates. Changes in mood and personality have also been noted in these patients, and while these may improve spontaneously with the passage of time, there is some evidence that a rehabilitation programme can help in this regard.