# The left ventricular assist device ‘skeleton man’: case report—simple tools for skeletal muscle evaluation and very early aerobic/resistance/inspiratory training in cardiac cachexia

## TL;DR

This case report shows how skeletal muscle evaluation and early exercise training can improve outcomes in a weak heart failure patient receiving a left ventricular assist device.

## Contribution

The study introduces simple tools for skeletal muscle evaluation and demonstrates the effectiveness of early aerobic/resistance/inspiratory training in cardiac cachexia.

## Key findings

- Skeletal muscle evaluation using simple tools was feasible in a very weak LVAD patient.
- An 8-week ARIS training program significantly improved muscle mass, strength, and functional capacity.
- Early exercise training is safe and effective even in frail, post-LVAD patients.

## Abstract

Skeletal muscle wasting (SMW) is highly prevalent in patients with heart failure (HF) at left ventricular assist device (LVAD) implantation and is associated with morbidity and mortality. At the same time, SMW is clinically under-recognized, while exercise training (ET) studies in weak LVAD patients are lacking.

A 60-year-old man with advanced HF, SMW, cardiac cachexia, and frailty was confined in bed for 6 months initially supported with intravenous inotropes and subsequently with an intra-aortic balloon pump. His frailty was recognized as an LVAD-responsive frailty, and patient was successfully implanted with a HeartWare (Medtronic). Post-surgery, patient was very weak, unable even to move in bed without assistance. We evaluated skeletal muscle using simple tools such as the Oxford scale, mid-thigh circumference, hand-held dynamometry, and maximum inspiratory pressure. Physical performance was assessed with the sit to stand test, gait speed test, pedal bike timing, and the 6 min walk test. On top of routine physiotherapy, patient underwent an 8-week modified aerobic/resistance/inspiratory (ARIS) ET programme at moderate intensity and showed significant improvements in skeletal muscle mass and strength and physical and functional capacity.

We want to emphasize the importance of skeletal muscle evaluation at LVAD implantation and the feasibility and effectiveness of early ARIS training in very weak patients.