By Serena Agusto-Cox | News & Views
Prolonged illness before a heart or lung transplant can reduce a patient’s physical capacity, which can be further diminished by lengthy periods of immobility after surgery causing disuse and muscle deconditioning. One way to optimize recovery in transplant recipients is to get them moving as early as possible. In a 39th AACVPR Annual Meeting session, titled “Exercise and (P)Rehabilitation for Heart or Lung Transplant Candidates and Recipients: Current Practice and Future Directions,” Mayo Clinic’s Bryan J. Taylor, PhD, FACSM, and other presenters outlined current exercise and rehabilitation practices and explored future directions for heart- and lung-transplant patient care.
According to Taylor, one of the best ways to improve a transplant patient’s physical function and enhance their overall health-related quality of life is to leverage exercise-based cardiac or pulmonary rehabilitation (CR/PR) as soon as a patient is capable. “Rehabilitation is important because as the transplant patients move forward, it can help them return to normality, work, and a more active lifestyle,” he says. “Additionally, it can enhance and expedite recovery, reduce complications, and promote cardiovascular health and improved lung function.”
In the session, Taylor and the other panelists shared the key elements of CR/PR, the roles and responsibilities of each member in the CR/PR multidisciplinary team, and the importance of specialists and practical considerations when treating transplant patients. Additionally, they shared data on how CR/PR can reduce hospitalizations and mortality risks for transplant patients.
Taylor explains that it is also important to have a clear message for transplant patients pre- and post-surgery. The benefits of CR/PR can be relayed from the top down, with not only the transplant providers and advanced practitioners sharing the benefits of CR/PR, but also the care coordinators and the CR/PR team. “We have found that a universal message that stresses the importance of CR/PR not only helps patient engagement but also helps alleviate a lot of patients’ concerns and anxieties before they begin rehab,” he says.
Key Elements of CR/PR for Transplant Patients
- Universal message about the benefits of CR/PR
- Multidisciplinary teams
- Individualized training programs and care coordination
- Medical monitoring and management of transplant patients
Multidisciplinary CR/PR teams depend on the expertise of each specialty: exercise physiologist, physical therapist, dietician and nutritionist, respiratory therapist, psychologist, nurses, and pharmacists. According to Taylor, a key benefit of such multidisciplinary teams is that “they have the expertise necessary to identify emerging issues with transplant patients and address them before they become a significant concern.” He adds, “Some patients waiting for a heart transplant, for example, may have a left ventricular assist device – the team supporting these patients need to understand the complexity of these devices, as well as the patients themselves, to optimize CR.”
Each CR/PR team’s goal is to ensure patients are on the right recovery road for their own long-term health. Taylor says that with transplant patients, many post-operative complications can occur, including steroid-induced muscle problems, diabetes mellitus, high blood pressure, and osteoporosis risk. That means CR/PR programs must consider the whole patient, making sure that such complications are addressed as part of rehabilitation and that the mental and emotional health of each patient is taken into account because transplant surgery is a traumatic experience.
A recorded version of the session will be available after November 1 via AACVPR's On-Demand Access Pass, providing an opportunity for those who missed it to learn about what specific needs transplant patients have and what complications can arise during CR/PR. With an emphasis on the importance of multidisciplinary teams, viewers will be able to take away practical tips for overcoming patient anxieties and executing successful CR/PR with transplant patients. Experience shared by boots-on-the-ground CR/PR staff will provide insights into current CR/PR strategies and how teams can improve their patient care and outcomes in the future.
Wendy K. Cawley, BSN, RN, CCRP; Tathagat Narula, MBBS, MD, FACP; Brandyn M. Rader, MS, CEP; and Bryan J. Taylor, PhD, FACSM, presented their session, "Exercise and (P)Rehabilitation for Heart or Lung Transplant Candidates and Recipients: Current Practice and Future Directions," at the 39th AACVPR Annual Meeting, September 25-27 in Anaheim, California.