The therapeutic role of exercise in patients with orthotopic heart transplant.

January 1995 marked the 27th anniversary of the performance of the first human cardiac transplant in the United States. This followed nearly a decade of laboratory work developing and validating the technique involved. During the past 26 yr, cardiac transplantation has evolved from what was initially considered a radical and experimental form of therapy to one that is currently viewed in most of the world as a valid form of advanced therapy for end-stage heart disease. Today, many patients go home to medical personnel who may not be familiar with all the medical parameters associated with a patient's condition after cardiac transplantation. If patients with a heart transplant are to live in the community and work and enjoy themselves, their ability to lead healthy and active lives needs to be recognized and facilitated by professionals in the field of cardiac rehabilitation. The purpose of this article is to review the clinical considerations related to the physiology of the transplanted human heart. A review of studies conducted to investigate the acute and chronic responses to exercise in the transplanted human heart is presented. Recommendations for exercise testing, exercise prescription, and exercise programming for this patient population based on current data are presented.