Cardiovascular prevention and rehabilitation for patients with ventricular assist device from exercise therapy to long-term therapy. Part I: Exercise therapy.

In the present context of an aging population, limited donor heart availability, improved reliability of mechanical cardiac support and improved patient outcomes, ventricular assist device (VAD) options to support end-stage heart failure patients are rapidly expanding. In addition, both the smaller size and lighter weight of the pumps now produced and early evidence that these third generation devices may be associated with lower risk of infection and right ventricular failure will probably lead to greater physician and patient acceptability. This is the first of a two-part review on the role of cardiovascular prevention and rehabilitation in patients with VAD. In this first part, we will discuss the role of exercise therapy in VAD patients, while the second will focus on long-term management. One of the prerequisites for use of a VAD--whether permanent (as destination therapy) or semi-permanent (as an alternative to heart transplantation)--is that exercise capacity, although not normal, must be adequate for daily life activities. An intensive multidisciplinary rehabilitation program has the potential to increase exercise performance and improve the quality of life of VAD patients. Both early progressive mobilization and exercise training may improve the overall condition of VAD patients, and favorably impact their clinical course.