Early post-TAVI physical activity compared to standard practice - results of a real-life study

Background
Physical activity has been shown to have positive effects on cardiovascular endpoints and health-related quality of life after transcatheter aortic valve implantation (TAVI).

Objective
The aim of the pilot study was to evaluate the functional status of elderly patients undergoing TAVI before and after the procedure and to test the feasibility of an eccentric focused activation program early after TAVI and its effect on functional mobility compared to standard practice.

Methods
Inclusion criteria comprised patients undergoing elective TAVI. The “postural control while standing” test, the “Timed Up & Go” test (TUG) to assess functional mobility skills in elderlies,
the “Chair-Rising test” (CRT) for functional lower extremity muscle strength, the SF-12 test (physical and mental domain) as well as the visual scale of the EQ5D test were assessed before
and five days after TAVI. The intervention consisted of 10-minute guided training sessions once a day, starting on day two after surgery, with a focus on eccentric activity of large muscle
groups. Patients in the control group received standard practice.

Results
A total of 357 TAVI patients were screened. 99 patients met the inclusion criteria; of those, 45% declined to participate. The most common exclusion criterion was diseases that preclude
physical activity. Therefore, data from 54 patients (median age 81 [78-83], 53.7% female) was analyzed. Overall, 51.9% (28/54) of the patients had orthopedic disorders and 18.5% (10/54)
chronic joint disease. The median length of hospital stay was 9 days (7-9.5). Before TAVI, most patient were able to perform the postural control test with both legs and with one leg,
however, frequently needed a handrail for support (Table 1). SF-12 physical scale improved after TAVI 43.0 points (30.1-51.8) compared to before TAVI 36.3 points (30.4-45.0), p=0.017.
Five days after TAVI, approximately 50% of patients were able to perform the postural control test, the TUG- and CRT, with one-third of them still needing assistance. The duration of the
TUG test was longer after TAVI (15.0 sec [14.0-20.5] compared to before TAVI (13.0 sec [11.0-16.2], p=0.032). Also, in patients who were able to perform the CRT after TAVI (25/54, 46.3%),
test duration increased compared to before TAVI (23.5 sec vs. 17.0 sec, p=0.033). After TAVI, there were no differences in all tests assessed comparing patients with early physical activity
compared to standard practice, Table 2.

Conclusion
Given the increasing discussion about fast-track TAVI and same-day or next day discharge policies, patients investigated in our study had a low level of functional mobility before TAVI,
which did not reach baseline levels even days after the procedure. Ambitious exercise programs in this cohort should consider both the physical abilities of the patients and their motivation for exercise. Further studies may investigate to what extent physically healthier and “fitter” subgroups could benefit.