Assessing exercise performance after heart transplantation Fatigue and exercise intolerance are the chief complaints of patients with congestive heart failure. Exercise performance improves after heart transplantation, but recipients still attain only 50–70% of normal values for exercise capacity. The main goal of therapy is to enable heart transplant recipients to return to a func- tional lifestyle with a good long-term quality of life (1–3). Reduced exercise tolerance in heart recipients can result from deconditioning, graft rejection, cardiac denervation, or treatment with high-dose immunosuppressive therapy (4, 5). However, no clinical research adequately explains the factors affecting exercise performance in heart transplantation recipients during the postopera- tive period. This study was designed to reveal the factors affecting exercise performance in those individuals. Ulubay G, Ulasli SS, Sezgin A, Haberal M. Assessing exercise performance after heart transplantation. Clin Transplant 2007: 21: 398–404. ª Blackwell Munksgaard, 2007 Abstract: Objective: Heart transplantation improves the survival rate and quality of life in patients with severe symptoms of congestive heart failure and an ejection fraction of 20% or less. Despite marked symptomatic and clinical improvement in those who undergo heart transplantation, exercise capacity often remains reduced, and the factors limiting exercise perform- ance during the post-transplantation period remain unclear. This study was performed to investigate the factors affecting exercise capacity in heart transplantation recipients. Patients and methods: Fourteen patients with cardiomyopathy were enrolled in this study. We measured peak exercise oxygen uptake (peak VO 2 ) in seven patients (age range: 42 ± 14 yr) 10–28 months after transplantation, in seven patients (age range: 33 ± 18 yr) with dilated cardiomyopathy before heart transplantation, and in 14 healthy control subjects (age range: 44 ± 12 yr). The left ventricular ejection fraction, Beck Depression Inventory score, Medical Outcome Health Survey Short Form-36 Ques- tionnaire (SF-36) results, and immunosuppressive therapy administered were recorded in all patient groups. Results: All patients in the post-transplantation group terminated exercise testing before the anaerobic threshold because of general fatigue. All heart transplantation recipients exhibited a left ventricular ejection fraction within the normal range (mean ± SD ¼ 57% ± 2%). The peak VO 2 mean values were significantly different among the three groups (p ¼ 0.001). There were statistically significant correlations between the peak VO 2 values and the Beck Depression Inventory scores (r ¼ )0.637, p ¼ 0.01), between the peak VO 2 values and bodily pain (r ¼ 0.717, p ¼ 0.006), between the peak VO 2 values and general health perceptions (r ¼ 0.706, p ¼ 0.007), and between peak VO 2 values and postoperative duration (r ¼ 0.843, p ¼ 0.03) in all patient groups. Conclusion: In the long-term treatment of heart transplant recipients, exercise training should be considered an important therapeutic tool that enables patients to achieve a good quality of life. Gaye Ulubay a , Sevinc Sarınc Ulaslı a , Atilla Sezgin b and Mehmet Haberal c Departments of a Pulmonary Diseases, b Cardiovascular Surgery and c General Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey Key words: beck depression inventory – exercise capacity – exercise rehabilitation – heart transplantation – peak exercise oxygen consumption – Short Form-36 Questionnaire Corresponding author: Gaye Ulubay, Depart- ment of Pulmonary Diseases, Faculty of Medi- cine, Baskent University, Ankara, Turkey. e-mail: gulubay66@yahoo.com Accepted for publication 29 December 2006 Clin Transplant 2007: 21: 398–404 DOI: 10.1111/j.1399-0012.2007.00658.x Copyright ª Blackwell Munksgaard 2007 398