Early Post-TAVI Physical Activity After Eccentric Training Compared to Standard Practice - Results of a Feasibility Study.

Background: Physical activity after transcatheter aortic valve implantation (TAVI) can improve cardiovascular outcomes and health-related quality of life. The aim of the study was to evaluate the functional status before and shortly after TAVI and to test the feasibility of an eccentric training program and its effect on functional mobility compared to standard care. Methods: In this interventional controlled feasibility trial, elective TAVI patients without severe mobility limitations were enrolled. The center of pressure (CoP) measurements in standing position, the Timed Up & Go test (TUG) to assess functional mobility and the Chair-Rising test (CRT) for functional lower extremity muscle strength were assessed before and within five days after TAVI; the SF-12 test and the EuroQol-5 Dimension test was calculated. The intervention group performed daily 10-minute guided eccentric training starting earliest on day two after TAVI; controls received standard care (no structured or supervised exercise program). Results: Of 357 screened patients, 99 met inclusion criteria; 45% declined to participate; 54 patients participated (median age 81 [78-83], 53.7% female). Orthopedic disorders were common (51.9%), as was chronic joint disease (18.5%). Before TAVI, most patients in both groups completed CoP testing. Fewer patients in the eccentric group required handrail support for the two-leg CoP test than controls (4.2% vs 31.0%, p=0.015). After TAVI, similar proportions in both groups completed the single-leg COP test (44% vs 51.7, p=0.389), all needing assistance. After day three, the intervention could be started in 72% of patients. None of those patients were able to complete all four exercises within 10 minutes No group differences were observed for TUG and CRT results (all p>0.15). The physical SF-12 score improved more in controls (+8.9 points [25.-75. percentiles -2.7-14.9], p=0.022) compared to patients receiving eccentric training (+1.6 [-4.9-9.5], p=0.463). Conclusion: Elderly TAVI patients showed limited functional mobility pre- and early post-procedure. Initiating eccentric training within the first few postoperative days was feasible but associated with considerable barriers and might not provide short-term functional benefit compared with standard care. Early activity after TAVI remains challenging within fast-track recovery pathways.