With Exercise Prescription- by Taylor Garman

* “Bob” * 47 yr old male * 5’7’’, 160 lbs * BP 119/72 * Cholesterol 175 mg/Dl * Has just received a cardiac transplant and wants to start an exercise presecription

* Would be low risk but due to cardiac transplant, high risk * Medical exam recommended before exercise * Exercise test recommended before exercise * MD supervision of exercise test recommended * * above are guidelines from ACSM * According to the World Transplant journal, he should avoid vigorous exercise in general due to the transplant

* when a patient receives a new heart from donor who is brain dead but still on life support * they try to match tissue types as close as possible to avoid the new heart being rejected

* Sometimes, doctors leave the old heart in and just place the new one on top of it. * This is called a heterotopic transplant

* Cardiac Transplants are used for patients who have severe angina, heart failure, severe heart defects, life threatening fibrillations * - improves life expectancy but can reduce exercise capacity and health related quality of life, could be from reduced cardiac output from a reduced stroke volume. Reduced muscle strength and oxidative capacity could also be affected from vasodilatory problems or capillary density.

* Studies show that steady state training with moderate intensity yields positive but small results * Begin with a thorough warm-up period, which should be followed by steady-state (Steady- state training refers to no rapid changes in intensity or exercising with an even HR) aerobic exercise

* Following all clearances with doctors and at least six months after the procedure, Bob may start a light exercise program. * If at any time Bob experiences difficulty breathing, angina, heart palpitations, or heart pain, he is advised to stop IMMEDIATELY and seek medical help

* Start off with a frequency of 3 days a week * Light to moderate intensity 40%-60% of VO2 max * For the first couple weeks Bob should only exercise for 30 minute sessions. He can increase mins as he progresses through the program. * It should mainly consist of aerobic activity

* Warm up with dynamic stretches * Walk 30 minutes * Static stretch

* Warm up with dynamic stretches * 10 mins of plyometric exercises (jump rope, jumping jacks) * Walk 20 mins * Static stretching

* Dynamic warm up stretches * 15 min walking/jogging * 15 mins of core exercises, sit ups, Russian twists, crunches * Static stretching- major muscle groups

* The walking and jogging will put him in a moderate intensity steady aerobic state * This will allow Bob’s new heart to ease into exercise rather than fluctuating at high intervals from high intensity training or from exercises using the first two metabolic pathways.

* After a few weeks Bob can incorporate some very light weight training for muscular endurance but should not overdo it * He should also avoid the Valsalva maneuver at all costs

* Nytoen, K. (2013, December 24). Exercise after Heart transplantation- an Overview. Retrieved November 8, * Ahmari, S. (2006, January 25). Prevalence, pathophysiology, and clinical significance of post-heart transplant atrial fibrillation and atrial flutte. Retrieved November 8, * Cooper, M. (2013, June 6). Heart Transplant. Retrieved November 8, 2015.