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Critical Reviews™ in Physical and Rehabilitation Medicine
How Important Is Exercise-Centered Rehabilitation Following Cardiac Transplantation?
Roy J. Shephard
Faculty of Physical Education and Health, and Faculty of Medicine, University of Toronto, Health Studies Program, Brock University, St. Catharines, Ontario
Orthotopic cardiac transplantation is now a widely applied surgical procedure and is well justified in cost/effectiveness terms when applied to appropriately selected patients. The present review considers the respective contributions of spontaneous recovery and exercise-centered rehabilitation to the recovery of function following surgery. There remains a need for well-controlled randomized trials of rehabilitation. Many studies show substantial gains without rehabilitation, particularly in the first few months following operation. There is also mounting evidence of autonomic nerve regeneration. Nevertheless, there remains a need for exercise-centered cardiac rehabilitation to optimize functional gains and counter major complications such as hypertension, accelerated atherosclerosis, and osteoporosis. Muscle weakness is responsible for a substantial part of the initial functional disturbance, and rehabilitation programs should include resistance exercise and weight-bearing activities as well as traditional aerobic modules.
MOTS CLÉS: autonomic regeneration, central cardiac denervation, complications, cost/effectiveness, muscle function, peripheral limitations, prognosis, spontaneous recovery.
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