Standardizing Exercise Prescription Parameters for Patients with LVAD Placement as a Destination Device: A Scoping Review of Effectiveness and Impact on Functional Capacity and Quality of Life

Abstract

<h3>Objective(s)</h3> To summarize current knowledge regarding the impact of exercise training in patients supported by LVADs and serve as a foundation for clinicians to reference when tailoring interventions to improve FC in patients treated with modern durable LVADs. <h3>Data Sources</h3> Author searched PubMed, Ovid, CCTR, CDSR, CINAHL, Proquest, and Google Scholar starting on January 31, 2021. <h3>Study Selection</h3> Studies from 2015 to current, written in English, subjects at least 18 years of age with end-stage HF, ineligible for heart transplantation, who received an LVAD with the intent of destination or terminal therapy, and various forms of publication (systematic reviews, RCT, cohort studies, cross-sectional studies, observational studies, meta-analyses, retrospective studies, and case reports), were included. <h3>Data Extraction</h3> Arksey and O'Malley's framework and the PRISMA Extension for Scoping Reviews guided data synthesis. Collected data independently extracted by one owner. <h3>Data Synthesis</h3> 15,179 articles found in the three search strategy attempts, 22 were included. Studies assessing the impact of exercise training on quality of life (QofL) reported that moderate intensity is safe and effective in improving cardiopulmonary outcomes and is associated with favorable QofL parameters. Majority of included studies also indicated that LVADs can support submaximal exercise, but are not sufficient during peak exertion. <h3>Conclusions</h3> Cardiac rehabilitation programs for patients with LVAD placement as a destination therapy require a multimodal approach with specific exercise training parameters. Methods of delivery should encompass both aerobic exercises and aerobic strength training with special attention to working at a moderate level intensity in order to improve cardiopulmonary outcomes without adverse events. In addition, implementation of a cardiac rehabilitation program can lead to major improvement in patient's perceived QofL. <h3>Author(s) Disclosures</h3> No conflicts of interest.