Physical Activity is Higher in Patients With LVAD Compared With CHF

Quick Takes

  • An increasing number of patients with chronic heart failure (CHF) are receiving left ventricular assist devices (LVADs) as destination therapy or bridge to heart transplantation.
  • In this study of 32 participants, LVAD implantation improved physical activity levels by improving exercise capacity compared to well-matched patients with advanced CHF without LVADs.
  • Higher physical activity levels post-LVAD implantation can improve functional capacity and quality of life (QoL) for patients with advanced CHF.

Study Questions:

How do the daily physical activity levels in patients with CHF with LVAD support compare to the physical activity levels in well-matched patients with advanced CHF without LVAD support?

Methods:

Individuals with formerly severe CHF who were LVAD in situ for at least 6 weeks and hemodynamically stable, were matched for age, sex, and New York Heart Association (NYHA) functional class III/IV pre-implantation (LVAD group) with control participants (CHF group) who were either wait-listed for heart transplantation or not eligible for non-cardiac reasons. Daily physical activity energy expenditure was monitored for 7 consecutive days, which included scheduled cardiac rehabilitation sessions and usual free-living physical activity, and then analyzed and converted to metabolic equivalents to determine minutes of sedentary and low-, moderate-, and vigorous-intensity activity times per day. Before and after the 7-day period, aerobic capacity, which included cardiopulmonary treadmill exercise testing and breath-by-breath expired gas analysis to determine peak oxygen consumption (VO2peak), and scales for measuring self-efficacy to participate in physical activity and QoL were assessed.

Results:

A total of 32 participants (16 in the LVAD group and 16 in the CHF group) successfully completed the study. There were no significant differences in age, weight, or NYHA functional class between the LVAD and CHF groups. Preimplantation VO2peak was not significantly different between the groups; however, after implantation, the LVAD group had a significantly higher VO2peak compared to the CHF group. The LVAD group demonstrated 70% higher mean daily physical activity energy expenditure levels, primarily due to more moderate-intensity activity, and significantly less sedentary time compared to the CHF group. There were significantly higher scores in the physical role and physical health domains from the questionnaires with the LVAD group compared to the CHF group but no significant differences in other domains (physical function, pain, general health, vitality, social function, and emotional role) or in the self-efficacy scores. There was a significant correlation between physical activity energy expenditure level and VO2peak for both groups, and a modest correlation between the self-efficacy scale score and physical activity levels approached, but did not reach, significance. There was no significant correlation between time on LVAD support (days postimplant) and physical activity energy expenditure.

Conclusions:

In this study, LVAD implantation benefited the functional rehabilitation of patients with advanced CHF compared to patients who were well-matched in CHF severity. The participants with LVAD in situ demonstrated higher levels of physical activity (due to improved exercise capacity), less time being sedentary, and better QoL in physical component scores on survey.

Perspective:

The improved exercise tolerance imparted by LVAD support in people with advanced CHF provides the opportunity to participate more in healthy physical activity, such as cardiac rehabilitation programs, regular walking, and tasks of daily living. Further studies involving larger numbers of participants and/or longer and later periods of physical activity assessment post-LVAD implantation are needed. Such research could help identify associations between physical activity and self-efficacy/QoL components that would benefit LVAD recipients and other effects, such as changes in fat- and muscle-mass and additional indices of exercise capacity.

Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support, Exercise

Keywords: Heart Failure, Exercise, Exercise Tolerance, Quality of Life, Self Efficacy, Cardiac Rehabilitation, Oxygen Consumption, Heart-Assist Devices


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