Multimodal prehabilitation: a promising strategy in patients listed for heart transplantation

Abstract

Introduction Prehabilitation programs designed to improve functional status showed efficacy to increase functional capacity and to prevent postoperative complications in selected high-risk surgical populations. Patients awaiting heart transplantation (HT) usually exhibit poor quality of life and this situation usually progresses while waiting for HT. Objective to evaluate the effect of a multimodal prehabilitation program on quality of life and functional capacity in patients waiting HT. Methods Adult patients listed for HT were included. Exclusion criteria were hospitalized patients, clinical instability, refusal to participate and living far away or not availability for transportation to the hospital twice weekly. The prehabilitation program was initiated after baseline assessment and all participants were reassessed after having completed 8 weeks of program. The intervention consisted in exercise training and promotion of physical activity, nutritional counselling and whey protein supplementation when necessary and coping of the psychological stress using mindfulness therapy. The exercise training consisted in 2 sessions of 1 hour per week of personalized monitored supervised moderate to high-intensity interval training and endurance strength training at the hospital's outpatient gym during 8 weeks. All patients were instructed on breathing exercises with an incentive inspirometer. After 8 weeks, and until HT, patients followed a maintenance program consisted in 1 session per week of supervised training and were empowered to maintain their level of physical activity Results 24 patients were included in the study from July 2017 to April 2019 (21 males, Age 56+10). Two patients were transplanted before starting the program and 8 patients before the 8-weeks assessment. None of the patients withdrew from the study. Over the duration of the study, 9 enrolled patients were successfully transplanted. One patient asked to opt out from the HT waiting list after having completed the program. No complications occurred during the program. Discussion This study suggests that a multimodal prehabilitation program in patients awaiting HT is feasible, safe and may increase functional capacity and quality of life.