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Crepaldi A, Piva G, Lamberti N, Felisatti M, Pomidori L, Battaglia Y, Manfredini F, Storari A, López-Soto PJ. Supervised vs home-based exercise program in kidney transplant recipients: A pilot pragmatic non-randomized study. World J Transplant 2024; 14:96244. [DOI: 10.5500/wjt.v14.i4.96244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/03/2024] [Accepted: 06/25/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Although the benefits of exercise for kidney transplant recipients (KTRs) have been widely demonstrated, these patients experience several barriers in undertaking a structured exercise program in hospital and non-hospital facilities.
AIM To compare the effects of a supervised moderate-intensity gym-based intervention with a home-based low-intensity walking program on exercise capacity in KTRs.
METHODS KTRs were asked to choose between two six-month programs. The first group performed a low-intensity interval walking intervention at home-based exercise intervention (HBex). The second group performed a supervised training program at an adapted physical activity gym (Sgym), including aerobic and resistance training. The outcomes, collected at baseline and at the end of the programs, included the 6-minute walking test, the peak oxygen consumption (VO2peak) during a treadmill test, the 5-time sit-to-stand test, and blood pressure.
RESULTS Seventeen patients agreed to participate and self-selected into the HBex (n = 9) and Sgym (n = 8) groups. Two patients in the Sgym group dropped out because of familial problems. At baseline, patients in the HBex group were significantly older and had lower walking distance, VO2peak, and lower limb strength. Primary outcome changes were significantly greater in the HBex group than in the Sgym group (52 ± 23 m vs 8 ± 34; P = 0.005). No other significant differences between groups were observed. Both groups improved most of the outcomes in the within-group comparisons, with significant variations in VO2 peak.
CONCLUSION Six-month moderate-intensity supervised or low-intensity home-based training programs effectively improved exercise capacity in KTRs. Gym-based programs combine aerobic and resistance training; however, in-home walking may be proposed for frail KTRs.
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Affiliation(s)
- Anna Crepaldi
- Unit of Nephrology, University Hospital of Ferrara, Ferrara 44121, Emilia-Romagna, Italy
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córdoba, Cordoba 14004, Andalusia, Spain
| | - Giovanni Piva
- Unit of Nephrology, University Hospital of Ferrara, Ferrara 44121, Emilia-Romagna, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara 44121, Emilia-Romagna, Italy
| | - Michele Felisatti
- Esercizio Vita Medical Fitness, Ferrara 44124, Emilia-Romagna, Italy
| | - Luca Pomidori
- Esercizio Vita Medical Fitness, Ferrara 44124, Emilia-Romagna, Italy
| | - Yuri Battaglia
- Department of Medicine, University of Verona, Verona 37100, Veneto, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara 44121, Emilia-Romagna, Italy
| | - Alda Storari
- Unit of Nephrology, University Hospital of Ferrara, Ferrara 44121, Emilia-Romagna, Italy
| | - Pablo Jesús López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba, University of Cordoba, Reina Sofía University Hospital, Cordoba 14004, Andalusia, Spain
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Bourgeois N, Tansey CM, Janaudis-Ferreira T. Exercise training in solid organ transplant candidates and recipients. Curr Opin Organ Transplant 2024; 29:277-283. [PMID: 38841863 DOI: 10.1097/mot.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Exercise training programs are an integral part of the management of solid organ transplantation (SOT) candidates and recipients. Despite this, they are not widely available and specific guidelines on exercise parameters for each type of organ are not currently provided. A review of this topic could help clinicians to prescribe appropriate exercise regimens for their patients. RECENT FINDINGS In this narrative review, we discuss the physical impairments of SOT candidates and recipients and how these affect their physical function and transplant outcomes. We examine recent systematic reviews, statements, and randomized controlled trials on exercise training in SOT candidates and recipients and present the current available evidence while providing some practical recommendations for clinicians based on the frequency, intensity, time, and type principle. SUMMARY While randomized controlled trials of better methodology quality are needed to strengthen the evidence for the effects of exercise training and for the optimal training characteristics, the available evidence points to beneficial effects of many different types of exercise. The current evidence can provide some guidance for clinicians on the prescription of exercise training for transplant candidates and recipients.
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Affiliation(s)
- Nicholas Bourgeois
- Lung Transplant Program, Centre Hospitalier de l'Université de Montréal
- School of Physical and Occupational Therapy, McGill University
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Catherine M Tansey
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec
| | - Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
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De Beir J, De Baets S, Vandecruys M, Renier M, De Smet S, Van Craenenbroeck AH, Van Biesen W, Nagler EV, Verbeke F, Calders P, Vanden Wyngaert K. Challenges in posttransplantation care for kidney transplant recipients: A qualitative study highlighting gaps in psychological, social and exercise support. J Ren Care 2024. [PMID: 39049568 DOI: 10.1111/jorc.12507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Kidney transplantation offers meaningful health improvements compared to dialysis, yet the quality of life and life expectancy of kidney transplant recipients still lag behind those of their healthy peers. Physical inactivity and poor physical fitness are prevalent among kidney transplant recipients, affecting overall life participation. OBJECTIVES To explore challenges hindering life participation for kidney transplant recipients and reveal facilitators and barriers to integrating rehabilitation into their daily lives. DESIGN An explorative study using a qualitative method. PARTICIPANTS Fourteen purposively selected kidney transplant recipients. APPROACH Semistructured, individual interviews were conducted posttransplantation. The following topics were covered: living with chronic kidney disease, pretransplantation challenges, posttransplantation recovery, engagement in various activities, including physical activity, and the need for supervised exercise rehabilitation programmes. Interviews were recorded and transcribed verbatim, and an inductive thematic analysis approach was used. FINDINGS Data saturation occurred after analysing 12 interviews, revealing two main themes: the impact on life participation and the impact on physical and mental functioning. Participants expressed the need for comprehensive posttransplant care, including mental health support, family education and guidance on returning to work. Structured support in managing physical fitness, tailored to individual preferences, was also recognised as important. CONCLUSIONS The study underscores the necessity for a biopsychosocial approach to posttransplant care that addresses the multifaceted challenges faced by kidney transplant recipients. A multidisciplinary approach, tailored support, education and individualised exercise programmes are crucial for enhancing their overall well-being and integrating rehabilitation into their daily lives, considering both physical and psychosocial aspects.
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Affiliation(s)
- Jasmine De Beir
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Stijn De Baets
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Frailty in Ageing Research Group, Department of Gerontology and Mental Health and Wellbeing Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marieke Vandecruys
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marie Renier
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stefan De Smet
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
- Exercise Physiology Research Group, Department of Movement Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Evi V Nagler
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Francis Verbeke
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Karsten Vanden Wyngaert
- Center for Nursing Excellence, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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