Small effort, high impact: Focus on physical activity improves oxygen uptake (VO2peak ), quality of life, and mental health after pediatric renal transplantation

Preliminary Evaluation of Sedentary Lifestyle in Italian Children after Solid Transplant: What Role Could Physical Activity Play in Health? It Is Time to Move

BACKGROUND

Advances in the medical-surgical field have significantly increased survival after solid organ transplantation in the pediatric population. However, these patients are predisposed to the development of long-term complications (e.g., cardiovascular disease). The therapeutic role of physical activity (PA) to counteract these complications is well known. The purpose of the study was to investigate the level of PA in a pediatric population after solid organ transplantation.

METHODS

In the first 4 weeks at the beginning of the school year, the Physical Activity Questionnaire for Older Children and Adolescents was administered to young patients who had previously undergone solid transplants at our institute.

RESULTS

Questionnaires of 49 patients (57.1% female, mean age 13.2 ± 3.5 years) were analyzed and 32.7% of subjects did not perform any exercise during school physical education classes. Only 24% practiced a moderate quantity of exercise in the previous week (2-3 times/week) and 72% engaged in sedentary behaviors during weekends.

CONCLUSIONS

Preliminary data confirmed that young recipients are still far from meeting the minimum indications of the World Health Organization on PA and sedentary behavior. It will be necessary to increase their involvement in PA programs in order not only to increase their life expectancy but also to improve their quality of life.

The Associations between 24-Hour Movement Behaviours and Quality of Life in Preschoolers: A Compositional Analysis of Cross-Sectional Data from 2018-2021

Studies show that the quality of life (QoL) of preschoolers is closely related to physical activity (PA), sedentary behaviour (SB), and sleep (SL). Yet many researchers looked at these 24-h movement behaviours as behaviours that are independent of one another when examining the association of QoL with these behaviours. The main purpose of the present study was to describe the temporal trends in PA, SB, and SL in preschoolers and the concomitant association with QoL of children. Annual cross-sectional data on QoL and 24-h movement behaviours of 8045 Singaporean preschoolers were collected from 2018 to 2021. Compositional analysis, linear regression, and isotemporal replacement approaches were used to examine changes in PA, SB, and SL from 2018-2021 and how these changes were associated with QoL. Temporal trends in movement behaviours showed that PA and SL decreased after 2020. During 2018-2021, the association of PA and QoL in preschoolers was characterised by a 'U' curve (βPA-2018 = 3.06, p < 0.001; βPA-2019 = 1.43, p < 0.05; βPA-2020 = -0.43, p > 0.05; βPA-2021 = 2.82, p < 0.001), while SL and QoL were characterised by an inverted 'U' curve (βSL-2018 = -2.39, p < 0.001; βSL-2019 = -0.27, p > 0.05; βSL-2020 = 2.00, p < 0.01; βSL-2021 = -0.21, p > 0.05). SB was significantly and negatively associated with QoL after 2020, with 2020 identified as the inflection point for the change in SB (βSB-2018 = 0.67, p > 0.05; βSB-2019 = -1.16, p > 0.05; βSB-2020 = -1.56, p < 0.01; βSB-2021 = -2.61, p < 0.01). Using a time re-allocation technique to treat the 2021 data, reallocating time from SB to PA or to SL predicted improvements in QoL of preschoolers (Pall < 0.05). The study provided useful information on the temporal trends in PA, SB, SL, and QoL of preschoolers over four years. Additionally, these data provided insights into how changes in QoL are predicted by changes in duration in the 24-h movement behaviours.

Physical performance capacity after pediatric kidney transplant and clinical parameters associated with physical performance capacity

BACKGROUND

History of chronic kidney disease and kidney transplantation is known to influence physical performance capacity. The aim of this study was to compare the physical performance of pediatric kidney transplant recipients to healthy controls and to find possible correlations between clinical parameters and physical performance capacity.

METHODS

Twenty-four pediatric kidney transplant recipients (62.5% boys) were tested at a median age of 10.8 years. Physical performance capacity was tested with a test set including six different components assessing muscle endurance, strength, speed, and flexibility. The control group consisted of 273 healthy age-matched schoolchildren. Clinical parameters were collected as part of routine follow-up protocol. The majority of patients (62.5%) had congenital nephrotic syndrome of Finnish type (CNS) as primary diagnosis, and therefore, the results of CNS recipients were compared to the other disease groups.

RESULTS

The physical performance capacity in pediatric kidney transplant recipients was lower compared to healthy controls. Surprisingly, no statistically significant correlation was found between graft function and physical performance capacity. The CNS patients scored worse than patients with other diagnoses in all test domains except for sit-and-reach and shuttle run, but the differences did not reach statistical significance.

CONCLUSION

The physical performance of pediatric kidney transplant recipients is reduced, especially in those with congenital nephrotic syndrome. Clinical parameters, including graft function, did not predict physical performance capacity, suggesting that the reduced physical performance seems to be of multivariable cause. A higher resolution version of the Graphical abstract is available as Supplementary information.

Cardiovascular Risk Factors are Inversely Associated With Omega-3 Polyunsaturated Fatty Acid Plasma Levels in Pediatric Kidney Transplant Recipients

OBJECTIVES

High plasma levels of the omega-3 fatty acids eicosapentaenoic acid (EPA), docosahexaenoic acid, and docosapentaenoic acid associates with positive outcomes in adult renal transplant recipients. However, data from pediatric populations are scarce. The aim of the study was to assess the fatty acid profile in a pediatric renal transplantation cohort and to examine the associations between plasma omega-3 fatty acids and cardiovascular disease (CVD) risk factors.

METHODS

In this cross-sectional study comprising 53 children (median age, 12.2 years; 32 boys) with a renal transplant, we assessed the prevalence of CVD risk factors as well as markers of end organ damage: carotid intima-media thickness (cIMT) and left ventricular mass index. The associations between plasma omega-3 fatty acids and CVD risk factors were assessed.

RESULTS

Twenty-five (47%) patients were preemptively transplanted. Seventy-six percent had dyslipidemia and 51% had hypertension. The mean left ventricular mass index was 40.4 ± 14.3 g/m^2.7, and 14% had left ventricular hypertrophy. The mean cIMT was 0.41 ± 0.04 mm. In a multivariate linear regression, EPA levels were inversely associated to blood pressure (β coeff. = -0.37, P = .007), triglycerides (β coeff. = -0.44, P = .01), and high-density lipoprotein cholesterol (β coeff. = -0.41, P = .01).

CONCLUSION

EPA levels are inversely associated with components of the metabolic syndrome, which may provide support for specific dietary advice or supplementation in this patient population. cIMT is less pronounced in our cohort than in comparable cohorts with lower rate of preemptive transplantations. Our results need replication in prospective cohorts.

Physical fitness and health-related quality of life in pediatric renal transplant recipients: An interventional trial with active video gaming

BACKGROUND

Pediatric renal transplant recipients are at increased risk for cardiovascular diseases, one contributing factor is reduced cardiorespiratory fitness. The purpose was to evaluate cardiorespiratory fitness, motor coordination, muscle strength, daily physical activity, and health-related quality of life and to find out, if active video gaming is effective for improving these items in this patient population.

METHODS

Twenty renal transplant recipients (13.5 ± 3.4 years) and 33 matched healthy controls (13.1 ± 3.2 years) performed a spiroergometry, a motor coordination test, and a maximal handgrip strength test. Quality of life was determined with a validated questionnaire, and daily physical activity was recorded with a physical activity monitor. Thirteen patients (12.9 ± 3.4 years) participated in a 6-week home-based exergaming intervention (3×/week for 30 minutes) and repeated all tests after that.

RESULTS

The renal transplant recipients exhibited a substantial impairment compared with the controls in peak oxygen consumption (-31%, P < .001), motor competence (-44%, P < .001), daily physical activity (-33%, P = .001), and quality of life (-12%, P = .017). Handgrip strength was similar in both groups. Despite of low compliance in the intervention group, steps per hour were significantly increased after 6 weeks of exergaming (+31%, P = .043); however, all other measures remained unchanged.

CONCLUSION

Cardiorespiratory fitness, motor competence, and quality of life are reduced in pediatric renal transplant recipients. Home-based exergaming is not appropriate to improve these items, probably due to a substantially impaired motor competence. However, it provided a stimulus for an increased daily physical activity.