BACKGROUND: Approximately 5-6% of older individuals ≥75 years of age will develop aortic stenosis and require aortic valve replacement via transcatheter aortic valve replacement (TAVR). Due to most patients not surviving ≥5 years post-TAVR the reduction of morality risk and maximization of quality of life (QoL) in the post-procedural setting are crucial. As high as 70% of TAVR patients may develop low muscle mass which will remain post-TAVR and can increase mortality risk and reduce QoL. The combination of resistance training (RT) with protein supplementation is an effective modality for maintaining and gaining muscle mass. However, their effectiveness is unexplored in TAVR patients. PURPOSE: To determine the effects of a 12-week home-based digitally supervised progressive RT program combined with protein supplementation (RT+PRO) vs. protein supplementation only (PRO) on body composition, inflammation, strength, physical function, and QoL measures in post-operative TAVR patients. METHODS: Twenty-two TAVR patients participated in study (75.7±6.5 years). Measurements included anthropometrics, body composition via hand-foot bioelectrical impedance analysis, blood draws to measure serum levels of tumor necrosis factor alpha (TNF-α) and C-reactive protein (CRP), muscular strength assessments via handgrip dynamometer, leg dynamometer, 30-second chair stand, and 5-repetition chair stand, and physical function via short physical performance battery (SPPB), 8-foot Up-and-Go, 2-minute step test, and 30-second arm curl, and subjective QoL. After completion of testing participants were stratified by gender and arm curl performance into one of two groups: digitally supervised home-based RT+PRO (n=11) or PRO (n=11) for 12 weeks. Participants in RT+PRO completed a whole-body RT program of 12 exercises, 2x/week of 8 to 15 repetitions for up to 3 sets and both groups consumed an additional 75g (37.5 g twice a day) of whey protein per day. All baseline tests were immediately repeated at the conclusion of 12 weeks. A two-way repeated measures analysis of variance (ANOVA) was used to evaluate differences in variables between groups. In the case of significance, a post hoc one-way ANOVA was used to identify significant differences. Significance was accepted at p≤0.05. RESULTS: Participants in PRO (Height: 1.69±0.13 m, Weight: 92.2±21.6 kg, 74±6 years of age) had significantly lower diastolic blood pressure at baseline compared to RT+PRO (Height: 1.70±0.09 m, Weight: 86.4±15.4 kg, 77±7 years of age; 68±6 vs. 73±7 mmHg). No other significant differences were observed at baseline. All participants in RT+PRO completed all RT sessions (24 session per participant) and adherence to PRO consumption was 91% for RT+PRO and 95% for PRO. Compared to PRO, participants in RT+PRO experienced a significantly greater improvements in 30-second chair stand repetitions (RT+PRO Pre: 11±3 vs. Post: 13±3; PRO Pre: 12±2 vs. Post: 12±3 repetitions;), time to complete 5 sit-to-stands in a chair (RT+PRO Pre: 12.3±3.8 vs. Post: 9.6±2.7; PRO Pre: 11.2±2.4 vs Post: 10.9±2.9 seconds), SarQoL score (RT+PRO Pre: 63.7±12.9 vs. Post: 74.0±14.6; PRO Pre: 69.7±13.6 vs. Post: 69.2±16.1 points), and serum levels of CRP (RT+PRO Pre: 3.1±2.1 vs. Post: 2.0±1.5; PRO: Pre: 2.5±2.1 vs. Post: 2.2±2.0 mg/L). RT+PRO (9.5±2.3 vs. 9.5±2.0 kg/m2) and PRO (9.3±2.3 vs. 9.1±2.3 kg/m2) maintained SMI from baseline to follow-up. CONCLUSION: Digitally supervised home-based RT+PRO significantly improved measures of strength, inflammation, and QoL in TAVR patients over 12 weeks. The convenient nature of home-based RT should be pursued as a method for cardiac rehabilitation to increase both patient participation and benefits from exercise. Protein supplementation should be taken in unison with RT to ensure retention of muscle mass. High protein consumption for periods of >6 months may elicit a benefit for the retention of muscle mass.
