Basic movements for postoperative exercise in patients with left ventricular assist devices

Patients with advanced heart failure refractory to medical therapy can be treated with left ventricular assist devices, implanted to augment or replace left ventricular function. The most common postoperative complications are infection; bleeding; thromboembolic events; device malfunction; depression, and neurological dysfunction (stroke, transient ischemic attacks, encephalopathy). Their onset contributes to the interruption and delay in commencing a physiotherapy program. During the initial postoperative phase, patients with left ventricular assist devices are not generally able to tolerate an intensive rehabilitative programme, but they may be able to do so in a more advanced stage of recovery. Physiotherapy in the early period prepares the patient for a more complex and articulated rehabilitation, usually scheduled after hospital discharge. Supervised exercise should be implemented once the patient has been thoroughly instructed on how the device works and after a checklist to ensure that the patient understands the workings of the device, has been signed off. Although several studies have been published discussing postoperative rehabilitation in LVAD patients, to date it is not available yet an illustrated guide describing basic movements. Here, we describe a series of supervised physical exercises that can be executed daily. We aimed to illustrate a set of basic movements preparatory to a more complex and articulated exercise programme. A range of exercises involving all body parts is described as lying, sitting and standing postures.