Physical exercise and myocardial reinnervation in post-heart transplantation: systematic review
Abstract
Heart transplantation is considered the gold standard procedure for the treatment of refractory heart failure (HF). The surgical procedure demands a complete autonomic denervation of the heart, consequently impairing quick changes in heart rate, which is maintained, however slightly elevated, in these patients. Physical exercise has been shown to be a positive alternative for treating these patients, leading to an improved functional capacity, as expressed by an increase in maximum oxygen consumption (VO2) and tolerance to physical efforts. Despite this evidence, the impact of exercise on the cardiac autonomic reinnervation process is still not well elucidated. Therefore, the aim of this study is to evaluate whether the regular practice of physical exercise influences the post-transplant cardiac reinnervation process. A systematic review was performed using the descriptors: Physical Exercise, Cardiac Autonomic Control and Heart Transplantation in the SciELO and PubMed databases. Four articles published between 1996 and 2014 were selected for the preparation of this review. The regular practice of exercise does not seem to impact the process of cardiac autonomic reinnervation that occurs in a partial and physiological way. Based on this literature, the gains related to physical training as measured by increased VO2 peak, reduced blood pressure and increased tolerance to physical exersion, are predominantly peripheral regulated and easily lost if the patient fails to continue its practice. Thus, exercise is beneficial for heart transplanted patients, however, does not appear to influence cardiac autonomic reinnervation.
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