Importance of physical capacity and the effects of exercise in heart transplant recipients

Table 1 A simplified illustration of the ANOVA results: The response in markers of inflammation and angiogenesis during high-intensity interval training and moderate intensity continuous training sessions

	MICT	HIT
General inflammation
CRP	→	→
sTNFr-1	↑	↑
Vascular inflammation
vWFd	↓	↑
VCAM	→	→
Blood platelets
PDGF	↑	↑
sCD40L	↑	↑
DKK-1	↑	↑
Angiogenesis
VEGF-1	↑	↑↑
Ang2	↑	↑↑
Tie-2	→	→
Endostatin	→	→
Cardiokine/myokine
GDF-15	↑	↓1
ST2	→	→
SPARC	↑	↑

¹The decrease is found in the recovery period (0-2 h) after the exercise-session. Horizontal arrows illustrate non-significant response during exercise. Arrows pointing up illustrate a significant increase with exercise, regardless of intensity, and two arrows illustrate a significant increase by increasing intensity (HIT). An arrow pointing down, illustrates a significant decrease in response during exercise. HIT: High-intensity interval training; MICT: Moderate intensity continuous training.

Table 2 What is known and unknown in this field?

What is known in this field

A proper rehabilitation program including exercise training is recommended in all HTx patients

Good physical fitness is associated with improved outcome in HTx patients

The effect of HIT is superior to the effect of moderate training in general as well as for patients with coronary heart disease and heart failure

Accumulating evidence has shown that this is true also for HTx recipients 1-8 yr after HTx

Gaps in knowledge

There is no consensus on how, when and at which intensity exercise should be performed and organized after HTx

Because newly transplanted patients are totally denervated (without functional nerve supply resulting in impaired heart rate response), the effect of HIT has never been evaluated in this population, and the effect of HIT in de-novo HTx patients’ needs to be investigated

The effect of HIT on late complications after HTx as CAV, diabetes mellitus, gout, renal function and graft survival needs to be explored

Data on whether a HIT intervention should be carried out decentralized or in cooperation with the primary health care services as well as the safety and cost-effectiveness are scarce

How to optimize ways to maintain exercise training during long-term follow up needs to be investigated

HIT: High-intensity interval training; HTx: Heart transplantation; CAV: Coronary allograft vasculopathy.