Multimodal Prehabilitation in Patients Listed for Heart Transplantation: A Pilot Study

Purpose To assess the effect of multimodal prehabilitation in patients listed for heart transplantation (HT) Prehabilitation programs that combine physical training, nutritional support and emotional reinforcement have been effective in increasing functional capacity and preventing postoperative complications in selected high risk surgical populations Methods Adult patients listed for HT were included. Exclusion criteria were hospitalized/unstable patients and lack of availability for going to the hospital for 2 times a week. Patients were evaluated before and after completing 8 weeks of prehab program. The intervention consisted on exercise training, nutritional counseling and protein supplementation, respiratory physiotherapy and mindfulness therapy. The exercise training consisted in 2 1-hour sessions/week of personalized monitored and supervised moderate-intensity interval training and endurance strength training at the hospital outpatient gym facility during 8 weeks. After 8 weeks, and until HT, patients followed a mixed maintenance program (1 session/week of supervised training) and were encouraged to keep their physical activity. Results 14 patients were included from July 2017 to October 2018 (12M/2F, Age 53±10yr-old). One patient was transplanted before the program was started. 7 patients completed the 8wks-intensive phase program and were re-assessed and 2 patients are still in the intensive phase. The 4 remaining ones received transplantation before completing the program. 5 patients enrolled in the program were successfully transplanted (median time of intubation=16h (6-19); median hospital stay=15 days (14-17). The median duration of the program was 72 days (range 14-452). One patient asked to opt out from the HT waiting list since symptomatology improved. No cardiac events occurred during the program. Conclusion Multimodal prehabilitation program in patients awaiting HT seems feasible, safe and might increase exercise tolerance, functional capacity and quality of life.