The therapeutic role of exercise in patients with orthotopic heart transplant.

January 1995 marked the 27th anniversary of the performance of the first human cardiac transplant in the United States. This followed nearly a decade of laboratory work developing and validating the technique involved. During the past 26 yr, cardiac transplantation has evolved from what was initially considered a radical and experimental form of therapy to one that is currently viewed in most of the world as a valid form of advanced therapy for end-stage heart disease. Today, many patients go home to medical personnel who may not be familiar with all the medical parameters associated with a patient's condition after cardiac transplantation. If patients with a heart transplant are to live in the community and work and enjoy themselves, their ability to lead healthy and active lives needs to be recognized and facilitated by professionals in the field of cardiac rehabilitation. The purpose of this article is to review the clinical considerations related to the physiology of the transplanted human heart. A review of studies conducted to investigate the acute and chronic responses to exercise in the transplanted human heart is presented. Recommendations for exercise testing, exercise prescription, and exercise programming for this patient population based on current data are presented.

Adherence to very-low-fat diet by a group of cardiac rehabilitation patients in the rural southeastern United States.

This 28-week observational study measured adherence to and acceptability of the diet and nutrition component of an Ornish-type program among patients in a rural southern setting. Ten volunteers followed a very-low-fat (10% of energy), total vegetarian diet and participated in a program of exercise, stress management, and group support. Patients made significant dietary changes and found the diet "acceptable." Three patients consumed less than 10% of energy from fat and two additional patients consumed less than 20% of energy from fat. Eighty-five percent of the patients' meals adhered to a near vegetarian diet. Weight loss ranged from 0.1 to 11.7 kg (0.25 to 26 lb). Lipid values were unchanged. At 12 months, without the benefit of the structured program, one patient reported 100%, six reported 85%, and two reported 50% adherence to the dietary principles. We conclude that motivated patients with coronary artery disease can follow a very-low-fat, near vegetarian diet but experience difficulty without a structured program.

Physiological adjustments to higher- or lower-intensity exercise in elders.

A program of physical activity for people over 60 yr of age was developed to determine whether exercising at lower intensities (LI) is a significant conditioning stimulus. In addition, differences in aerobic capacities (VO2max) elicited by training at LI, as opposed to training at higher intensities (HI), were evaluated. Thirty-two volunteers over 60 yr of age (mean = 67.8 yr) participated in a 9-wk exercise program. After initial testing of VO2max on a cycle ergometer, subjects were assigned randomly to the HI, LI, or control group. Endurance training of the two exercise groups on cycle ergometers was maintained at 30-45% (N = 14) or 60-75% (N = 14) of the range (HRR) between the subject's resting and maximum heart rate for 25 min during each exercise session. These training intensities represented 57 and 70% of the VO2max of the LI and HI groups, respectively. Participants averaged three exercise sessions per week. Non-exercising volunteers served as control subjects. A one-way ANOVA with repeated measures was utilized for comparisons of retest, groups, and interaction. As a result of the exercise program, significant changes (P less than 0.005) in absolute (VO2max, 1 X min-1) and relative (VO2max, ml X min-1 X kg-1) aerobic capacities were realized within each training group while initial and post-training VO2max were not significantly different between the two groups. Similar changes were documented by a reduction in heart rate at submaximal exercise intensities and during recovery. It was concluded that exercising at LI (30-45% HRR) is an adequate training stimulus in older individuals and produces changes in VO2max that are comparable to those elicited by HI (60-75% HRR) training.