From the Guidelines
Evidence-based exercise programs post-mitral valve surgery should include a multidisciplinary rehabilitation program with a gradual progression in intensity, starting with low-intensity activities such as walking and breathing exercises, and eventually incorporating moderate-intensity aerobic exercise and resistance training. According to the European Heart Journal study 1, a multidisciplinary rehabilitation programme should be available for all patients undergoing valve surgery, particularly those with a complicated post-operative course. The study recommends that patients should undergo a submaximal exercise test about 2 weeks after surgery to guide detailed exercise recommendations.
Some key components of these exercise programs include:
- Walking, starting with 5-10 minutes daily and increasing to 30-60 minutes over several weeks
- Breathing exercises and gentle range-of-motion movements for the upper body in the early recovery phase
- Moderate-intensity aerobic exercise like stationary cycling, swimming, or elliptical training, aiming for 150 minutes per week spread across multiple sessions
- Resistance training with light weights (1-5 pounds) starting 6-8 weeks post-surgery, focusing on major muscle groups with 10-15 repetitions per exercise
- Monitoring heart rate to maintain it at 50-75% of maximum capacity and watching for warning signs like chest pain, dizziness, or unusual shortness of breath
The European Heart Journal study 1 also notes that good candidates for exercise training include patients with aortic valve replacement (AVR) and normal left ventricular (LV) function, as well as those who have undergone successful mitral valve repair with preserved LV function. Exercise tolerance after mitral valve replacement (MVR) is much lower than that after AVR, particularly if there is residual pulmonary hypertension, and therefore, exercise programs should be tailored to the individual patient's needs and abilities.
From the Research
Evidence-Based Exercise Programs
- Early exercise training after mitral valve repair is feasible and efficient, with improvements in peak oxygen consumption and anaerobic threshold 2
- Moderate exercise training after aortic and/or mitral valve surgery can increase oxygen uptake, with no significant differences between experimental and control groups 3
- Participation in sports after mitral valve repair does not seem to be related to worse outcomes, with no correlation between sports participation and MVR failure 4
Comparison of Prostheses
- Mechanical prostheses are associated with better hemodynamic performance and functional capacity compared to biological prostheses in patients with ischemic mitral regurgitation 5
- Cardiac rehabilitation can improve physical capacity and psychological well-being in patients following mitral valve and aortic valve procedures, with similar improvements in 6-min walk test distance and exercise minutes per week 6
Key Findings
- Exercise training can improve exercise tolerance and functional capacity in patients after mitral valve surgery 2, 3
- The type of prosthesis used in mitral valve replacement can affect exercise hemodynamics and functional capacity 5
- Cardiac rehabilitation can improve physical and psychological well-being in patients after mitral valve and aortic valve procedures 6