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Sakkas GK, Giannaki CD, Wilund KR, Karatzaferi C. How to cultivate sustainable physical health and wellness in transplant recipients: the emerging and enduring role of exercise scientists. Curr Opin Organ Transplant 2024; 29:294-298. [PMID: 38841870 DOI: 10.1097/mot.0000000000001160] [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 The aim of the current review is to highlight the importance of exercise training as an important section of transplant recipient rehabilitation process and explain the role of the exercise scientist in the development, implementation, and assessment of the exercise regime. RECENT FINDINGS Transplant patients face a unique set of challenges in their recovery and rehabilitation process, often requiring a multifaceted approach to address the physical, emotional, and psychological aspects of their condition. Exercise training has emerged as a crucial component in the care of these patients, providing a means to improve functional capacity, enhance quality of life, and mitigate the adverse effects of transplant-related complications. Exercise scientists who are trained to assess patient's physical limitations, develop and deliver personalized exercise programs, and monitor their progress are uniquely positioned to play a crucial role in the treatment of patients with chronic conditions that require exercise training as a mean of improving and maintaining health and quality of life. SUMMARY Exercise scientists are the appropriate professionals for providing transplant recipients with the recommended exercise training for maintaining and improving their health status as part of the overall plan of long-term care and support.
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Affiliation(s)
- Giorgos K Sakkas
- Department of PA and Sports Sciences, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Christoforos D Giannaki
- Department of Life Sciences, School of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Kenneth R Wilund
- Department of Leadership, School of Nutritional Sciences and Wellness, University of Arizona, Tucson, USA
| | - Christina Karatzaferi
- Department of PA and Sports Sciences, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
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Gitto S, Golfieri L, Gabrielli F, Falcini M, Sofi F, Tamè MR, De Maria N, Marzi L, Mega A, Valente G, Borghi A, Forte P, Cescon M, Di Benedetto F, Andreone P, Petranelli M, Morelli MC, De Simone P, Lau C, Stefani L, Vizzutti F, Chiesi F, Marra F. Physical activity in liver transplant recipients: a large multicenter study. Intern Emerg Med 2024; 19:343-352. [PMID: 37985618 PMCID: PMC10954936 DOI: 10.1007/s11739-023-03474-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023]
Abstract
AIM Healthy lifestyle and appropriate diet are of critical importance after liver transplant (LT). We provided an analysis of the main patterns of physical activity and found factors associated with physical activity itself. METHODS Clinically stable LT recipients were enrolled between June and September 2021. Patients completed a composite questionnaire about physical activity, adherence to Mediterranean Diet (MD), quality of life (QoL), and employment. Correlations were analysed using the Pearson coefficients while different subgroups were compared by t-test for independent samples or ANOVAs. Multivariable logistic regression analysis was conducted to find predictors of inactivity. RESULTS We enrolled 511 subjects (71% males, mean age 63 ± 10.8 years). One hundred and ninety-three patients reported high level of physical activity, 197 a minimal activity and 121 declared insufficient activity. Among these latter, 29 subjects were totally inactive. Considering the 482 LT recipients performing some kind of physical activity, almost all reported a low-quality, non-structured activity. At multivariate analysis, time from LT (odds ratio 0.94, 95% CI 0.89-0.99, p = 0.017), sedentary lifestyle (odds ratio 0.99, 95% CI 0.19-0.81, p = 0.012), low adherence to MD (odds ratio 1.22, 95% CI 1.01-1.48, p = 0.049), and low level of QoL (physical dimension) (odds ratio 1.13, 95% CI 1.08-1.17, p < 0.001), were independently associated with total inactivity. CONCLUSION A large portion of LT recipients report an insufficient level of physical activity or are wholly inactive. Inactivity increases with time from LT and was strongly associated with suboptimal diet and low QoL.
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Affiliation(s)
- Stefano Gitto
- Internal Medicine and Liver Unit, University Hospital Careggi, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Lucia Golfieri
- Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino-metaboliche, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Filippo Gabrielli
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Margherita Falcini
- Internal Medicine and Liver Unit, University Hospital Careggi, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Sofi
- Unit of Clinical Nutrition, Careggi University Hospital, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Rosa Tamè
- Gastroenterology Division, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino-metaboliche, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Nicola De Maria
- Department of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Marzi
- Division of Gastroenterology, Bolzano Regional Hospital, Bolzano, Italy
| | - Andrea Mega
- Division of Gastroenterology, Bolzano Regional Hospital, Bolzano, Italy
| | - Giovanna Valente
- Liver Unit for Transplant Management - SATTE, Department of Medical Sciences, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | | | - Paolo Forte
- Gastroenterology Unit, University Hospital Careggi, Florence, Italy
| | - Matteo Cescon
- General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Andreone
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Petranelli
- Contract Lecturer, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Cristina Morelli
- Internal Medicine Unit for the Treatment of Severe Organ Failure, Dipartimento Medico chirurgico delle malattie digestive, epatiche ed endocrino-metaboliche, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Pisa, Italy
| | - Chloe Lau
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Laura Stefani
- Sports Medicine Center Clinical and Experimental Medicine Department, University of Florence, Florence, Italy
| | - Francesco Vizzutti
- Internal Medicine and Liver Unit, University Hospital Careggi, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesca Chiesi
- Department of Neuroscience, Psychology, Drug, and Child's Health (NEUROFARBA), Section of Psychology, University of Florence, Florence, Italy
| | - Fabio Marra
- Internal Medicine and Liver Unit, University Hospital Careggi, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Gabrielli F, Golfieri L, Nascimbeni F, Andreone P, Gitto S. Metabolic Disorders in Liver Transplant Recipients: The State of the Art. J Clin Med 2024; 13:1014. [PMID: 38398327 PMCID: PMC10889804 DOI: 10.3390/jcm13041014] [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: 01/25/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Liver transplantation represents a chief therapeutic approach for acute liver failure, end-stage liver disease and hepatocellular carcinoma. Despite witnessing advancements in short- and medium-term survival over recent decades, attributed to refinements in surgical techniques and immunosuppressive protocols, long-term mortality remains impervious to modification. Notably, cardiovascular disease emerges as a predominant cause of mortality among liver transplant recipients. This trend is accentuated by the increasing prominence of non-alcoholic steatohepatitis-related cirrhosis as an indication for liver transplantation. Moreover, the administration of immunosuppressive agents is intricately linked to the degradation of the metabolic profile in liver transplant recipients, thereby contributing to the initiation or exacerbation of cardiovascular risk factors, such as hypertension, diabetes, and dyslipidaemia. In addition, the post-liver transplantation period is marked by a decline in lifestyle quality and a failure to acknowledge the psychological distress experienced by patients throughout the transplant process. These factors can precipitate a deterioration in the patient's metabolic profile, exacerbated by suboptimal therapeutic compliance. This narrative review aims to comprehensively address the principal metabolic disorders intricately associated with liver transplantation.
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Affiliation(s)
- Filippo Gabrielli
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
- Department of Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Lucia Golfieri
- Clinical Psychology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Fabio Nascimbeni
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Pietro Andreone
- Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU di Modena, University of Modena and Reggio Emilia, 41126 Modena, Italy
- Postgraduate School of Allergology and Clinical Immunology, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Tranchita E, Cafiero G, Giordano U, Guzzo I, Labbadia R, Palermi S, Cerulli C, Candusso M, Spada M, Ravà L, Gentili F, Drago F, Turchetta A. Preliminary Evaluation of Sedentary Lifestyle in Italian Children after Solid Transplant: What Role Could Physical Activity Play in Health? It Is Time to Move. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:990. [PMID: 36673745 PMCID: PMC9859408 DOI: 10.3390/ijerph20020990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Eliana Tranchita
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Division of Sports Medicine, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Giulia Cafiero
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Division of Sports Medicine, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Ugo Giordano
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Division of Sports Medicine, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Isabella Guzzo
- Kidney Transplant Follow-Up Unit, Division of Nephrology, Department of Pediatrics, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Raffaella Labbadia
- Kidney Transplant Follow-Up Unit, Division of Nephrology, Department of Pediatrics, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Claudia Cerulli
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, 00135 Rome, Italy
| | - Manila Candusso
- Hepatology, Gastroenterology, Nutrition and Liver transplantation Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Marco Spada
- Division of Abdominal Transplantation and Hepato-Bilio-Pancreatic Surgery, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Lucilla Ravà
- Clinical Epidemiology Unit, Bambino Gesù Children’s Hospital IRCCS, 00165, Rome, Italy
| | - Federica Gentili
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Division of Sports Medicine, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Attilio Turchetta
- Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Division of Sports Medicine, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
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Wiltshire G, Clarke NJ, Phoenix C, Bescoby C. Organ Transplant Recipients' Experiences of Physical Activity: Health, Self-Care, and Transliminality. QUALITATIVE HEALTH RESEARCH 2021; 31:385-398. [PMID: 33124516 PMCID: PMC7750649 DOI: 10.1177/1049732320967915] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Physical activity (PA) is an important lifestyle component of long-term health management for organ transplant recipients, yet little is known about recipients' experiences of PA. The purpose of this study was to shed light on this experience and to investigate the possible implications of PA in the context of what is a complex patient journey. Phenomenological analysis was used to examine interviews with 13 organ transplant recipients who had taken part in sporting opportunities posttransplantation. Findings illuminate how participants' experiences of PA were commonly shaped by the transliminal nature of being an organ transplant recipient as well as a sense of duty to enact health, self-care, and donor-directed gratitude. This analysis underlines the potential role of PA in supporting organ transplant recipients' attempts to live well following transplantation and makes novel connections between PA and our existing knowledge about challenges related to identity, survivorship, obligation, and patient empowerment.
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Affiliation(s)
- Gareth Wiltshire
- Loughborough University,
Loughborough, United Kingdom
- Gareth Wiltshire, School of Sport
Exercise and Health Sciences, Loughborough University, John Beckwith
Building, Epinal Way, Loughborough LE11 3TU, UK.
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6
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Sport and Exercise in Improving Outcomes After Solid Organ Transplantation: Overview From a UK Meeting. Transplantation 2020; 103:S1-S11. [PMID: 31259878 DOI: 10.1097/tp.0000000000002710] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Outcomes after solid organ transplantation continue to improve, but premature loss of life remains a major concern, with death from cerebrovascular disease and cardiovascular disease accounting for around 20% late deaths. There are multiple contributory factors including preexisting, and the posttransplant development of, cardiometabolic conditions (such as hypertension, diabetes mellitus, hyperlipidemia, and obesity). There is accumulating evidence that the regular engagement in exercise is an important factor affecting outcomes before, during, and after transplantation; yet most waitlist candidates and recipients have reduced levels of physical activity. The mechanisms whereby physical activity is associated with better outcomes and a reduction in risk factors for cardiovascular disease are incompletely understood. Attempts to increase physical activity in the transplant population, as in the general population, have had limited success. Use of concepts from Nudge theory provides an evidence-based approach that may help increase physical activity and so reduce premature mortality. Both National and International Transplant Games provide a vehicle for increasing physical activity in this population and may also help to reduce premature death by providing a forum for mutual support for recipients and their families as well as an excellent forum for highlighting the success and impact of organ donation.
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Calogero A, Sagnelli C, Peluso G, Sica A, Candida M, Campanile S, Minieri G, Incollingo P, Creta M, Pelosio L, Tammaro V, Scotti A, Jamshidi A, Caggiano M, Sagnelli E, Dodaro CA, Carlomagno N, Santangelo M. Physical activity in elderly kidney transplant patients with multiple renal arteries. Minerva Med 2020; 113:119-127. [PMID: 32338484 DOI: 10.23736/s0026-4806.20.06573-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Kidney transplantation (KT) is the gold standard for treatment of patients with end- stage-renal disease. To expand the donor reserve, it is necessary to use marginal/suboptimal kidneys. METHODS We retrospectively evaluated the short/long-term outcome of 34 KT elderly patients who received allografts with vascular abnormalities (MRA group), in comparison with 34 KT patients who received a kidney with a single renal artery (SRA group) pair-matched by age, length of time on dialysis, comorbidity and donor age. RESULTS All participants completed the International Physical Activity Questionnaire at KT, and then 4, 8, and 12 weeks after transplantation. Our data indicate that kidney with vascular anatomical variants may be successfully transplanted, since the overall rate of surgical complications was 20.6% in the SRA group and 17.6% in the MRA group and that the 5-year survival rate after KT was 100% in both groups. CONCLUSIONS The data also underline that individualized physical activity programs induced similar excellent results in both groups, improving physical capacities, arterial pressure, lipid metabolism, insulin sensitivity, quality of life and physical and mental status.
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Affiliation(s)
- Armando Calogero
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.,Department of Nephrology, Urology, General Surgery and Kidney Transplants, Anesthesiology and Intensive Care, University Federico II, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Gaia Peluso
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maria Candida
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Silvia Campanile
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Gianluca Minieri
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Paola Incollingo
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Massimiliano Creta
- Department of Nephrology, Urology, General Surgery and Kidney Transplants, Anesthesiology and Intensive Care, University Federico II, Naples, Italy
| | - Luigi Pelosio
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenzo Tammaro
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandro Scotti
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Akbar Jamshidi
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Marcello Caggiano
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Evangelista Sagnelli
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy -
| | - Concetta A Dodaro
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.,Department of Nephrology, Urology, General Surgery and Kidney Transplants, Anesthesiology and Intensive Care, University Federico II, Naples, Italy
| | - Nicola Carlomagno
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Michele Santangelo
- General Surgery and Transplant Unit, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.,Department of Nephrology, Urology, General Surgery and Kidney Transplants, Anesthesiology and Intensive Care, University Federico II, Naples, Italy
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8
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Totti V, Campione T, Mosconi G, Tamè M, Todeschini P, Sella G, Roi GS, Spazzoli A, Angelini ML, Sangiorgi G, Giannini A, Bellis L, Nanni Costa A. Promotion of Pre- and Post-Transplant Physical Exercise in the Emilia-Romagna Region: The Network of the Program "Transplantation, Physical Activity, and Sport". Transplant Proc 2019; 51:2902-2905. [PMID: 31606183 DOI: 10.1016/j.transproceed.2019.02.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/17/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Following the positive experience of the national project "A transplant...and now it's time for sport," the Transplant Reference Center of the Emilia-Romagna Region has pursued the promotion of pre- and post-transplant physical exercise by developing a network. METHODS The path involved the transplant centers and operative units (UU.OO) who wanted to target transplant and waiting list patients, who are clinically stable, to perform personalized exercise through a program (supervised or not) prescribed by a specialist in sports medicine. With the collaboration of the Collective Prevention and Public Health Service, the network was established, consisting of the sports medicine centers and the gyms that promote health for adapted physical activity (PS-AMA). To implement the network, training courses for all the professionals involved (doctors, nurses, exercise specialists) and operational meetings in the transplant centers-nephrology units with patients' associations have been organized. RESULTS To date, there are 14 transplant centers and UU.OO, 9 sports medicine centers, and 45 PS-AMA involved in this network. Seven training courses were organized with the participation of 193 health professionals. Since January 2016, there have been 65 transplanted patients and 5 patients on the waiting list who practice the prescribed exercise. Of these, 45 carry out supervised exercise in PS-AMA; 25 perform autonomous exercise. Each patient is monitored every 6 months. No problems related to the exercise performance were recorded. CONCLUSIONS The development of a network of professionals and associations is the key element to raise awareness of physical activity among transplanted and waiting-for-transplant patients, reducing the pathologies associated with a sedentary lifestyle.
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Affiliation(s)
- Valentina Totti
- Department of Biomedical & Neuromotor Sciences, University of Bologna, Italy; Associazione Nazionale Emodializzati, Dialisi e Trapianto, Milano, Italy
| | - Tiziana Campione
- Transplants Reference Center of the Emilia-Romagna Region, Bologna, Italy
| | - Giovanni Mosconi
- Nephrology and Dialysis, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Mariarosa Tamè
- Department of Gastrointestinal Diseases, Gastroenterology Division, Sant'Orsola-Malpighi University-Hospital, Bologna, Italy
| | - Paola Todeschini
- Department of Nephrology and Dialysis, Sant'Orsola-Malpighi University-Hospital, Bologna, Italy
| | | | - Giulio Sergio Roi
- Isokinetic Medical Group, Education and Research Department, Bologna, Italy
| | | | | | - Gabriela Sangiorgi
- Transplants Reference Center of the Emilia-Romagna Region, Bologna, Italy
| | - Adriana Giannini
- Collective Prevention and Public Health Service of Emilia-Romagna Region, Bologna, Italy
| | - Lia Bellis
- Italian National Transplant Center, Rome, Italy
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9
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Calella P, Hernández-Sánchez S, Garofalo C, Ruiz JR, Carrero JJ, Bellizzi V. Exercise training in kidney transplant recipients: a systematic review. J Nephrol 2019; 32:567-579. [DOI: 10.1007/s40620-019-00583-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 01/04/2019] [Indexed: 12/20/2022]
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10
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Roi GS, Mosconi G, Totti V, Angelini ML, Brugin E, Sarto P, Merlo L, Sgarzi S, Stancari M, Todeschini P, La Manna G, Ermolao A, Tripi F, Andreoli L, Sella G, Anedda A, Stefani L, Galanti G, Di Michele R, Merni F, Trerotola M, Storani D, Nanni Costa A. Renal function and physical fitness after 12-mo supervised training in kidney transplant recipients. World J Transplant 2018; 8:13-22. [PMID: 29507858 PMCID: PMC5829451 DOI: 10.5500/wjt.v8.i1.13] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.
METHODS Ninety-nine kidney transplant recipients (KTRs) were assigned to interventional exercise (Group A; n = 52) and a usual care cohort (Group B; n = 47). Blood and urine chemistry, exercise capacity, muscular strength, anthropometric measures and health-related quality of life (HRQoL) were assessed at baseline, and after 6 and 12 mo. Group A underwent a supervised training three times per week for 12 mo. Group B received only general recommendations about home-based physical activities.
RESULTS Eighty-five KTRs completed the study (Group A, n = 44; Group B, n = 41). After 12 mo, renal function remained stable in both groups. Group A significantly increased maximum workload (+13 W, P = 0.0003), V’O2 peak (+3.1 mL/kg per minute, P = 0.0099), muscular strength in plantar flexor (+12 kg, P = 0.0368), height in the countermovement jump (+1.9 cm, P = 0.0293) and decreased in Body Mass Index (-0.5 kg/m2, P = 0.0013). HRQoL significantly improved in physical function (P = 0.0019), physical-role limitations (P = 0.0321) and social functioning scales (P = 0.0346). No improvements were found in Group B.
CONCLUSION Twelve-month of supervised aerobic and resistance training improves the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Recommendations alone are not sufficient to induce changes in exercise capacity of KTRs. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities.
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Affiliation(s)
- Giulio Sergio Roi
- Department of Education and Research, Isokinetic Medical Group, Bologna 40123, Italy
| | - Giovanni Mosconi
- Department of Nephrology and Dialysis, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
| | - Valentina Totti
- Department of Biomedical & Neuromotor Sciences, University of Bologna, Bologna 40121, Italy
- Associazione Nazionale Emodializzati, Dialisi e Trapianto, Milano 20121, Italy
| | - Maria Laura Angelini
- Department of Nephrology and Dialysis, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
| | - Erica Brugin
- Department of Cardiovascular, Sports Medicine, Noale 30033, Italy
| | | | - Laura Merlo
- Sports Medicine, ULSS Company 9, Treviso 31100, Italy
| | - Sergio Sgarzi
- Sports Medicine, Regional Hospital of Bologna, Bologna 40121, Italy
| | - Michele Stancari
- Sports Medicine, Regional Hospital of Bologna, Bologna 40121, Italy
| | - Paola Todeschini
- Department of Nephrology and Dialysis, S. Orsola Hospital, Bologna 40121, Italy
| | - Gaetano La Manna
- Department of Nephrology and Dialysis, S. Orsola Hospital, Bologna 40121, Italy
| | - Andrea Ermolao
- Sports Medicine Unit DIMED, Department of Medicine, University of Padua, Padua 35100, Italy
| | - Ferdinando Tripi
- Sports Medicine, Regional Hospital of Modena, Modena 41100, Italy
| | - Lucia Andreoli
- Sports Medicine, Regional Hospital of Modena, Modena 41100, Italy
| | - Gianluigi Sella
- Sports Medicine, Regional Hospital of Ravenna, Ravenna 48121, Italy
| | - Alberto Anedda
- Sports Medicine, Regional Hospital of Parma, Parma 43121, Italy
| | - Laura Stefani
- Department of Experimental and Clinical Medicine, School of Sports Medicine, University of Florence, Sports Medicine Centre, Florence 50100, Italy
| | - Giorgio Galanti
- Department of Experimental and Clinical Medicine, School of Sports Medicine, University of Florence, Sports Medicine Centre, Florence 50100, Italy
| | - Rocco Di Michele
- Department of Biomedical & Neuromotor Sciences, University of Bologna, Bologna 40121, Italy
| | - Franco Merni
- Department of Biomedical & Neuromotor Sciences, University of Bologna, Bologna 40121, Italy
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11
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Sundaram V, Lim J, Tholey DM, Iriana S, Kim I, Manne V, Nissen NN, Klein AS, Tran TT, Ayoub WS, Schlansky B. The Braden Scale, A standard tool for assessing pressure ulcer risk, predicts early outcomes after liver transplantation. Liver Transpl 2017; 23:1153-1160. [PMID: 28512923 DOI: 10.1002/lt.24789] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/29/2017] [Accepted: 05/07/2017] [Indexed: 12/13/2022]
Abstract
The Braden Scale is a standardized tool to assess pressure ulcer risk that is reported for all hospitalized patients in the United States per requirements of the Center for Medicare and Medicaid Services. Previous data have shown the Braden Scale can predict both frailty and mortality risk in patients with decompensated cirrhosis. Our aim was to evaluate the association of the Braden Scale score with short-term outcomes after liver transplantation (LT). We performed a retrospective cohort study of deceased donor LT recipients at 2 centers and categorized them according to the Braden Scale at hospital admission as low (>18), moderate (16-18), or high risk (<16) for pressure ulcer. We created logistic and Poisson multiple regression models to evaluate the association of Braden Scale category with in-hospital and 90-day mortality, length of stay (LOS), nonambulatory status at discharge, and discharge to a rehabilitation facility. Of 341 patients studied, 213 (62.5%) were low risk, 59 (17.3%) were moderate risk, and 69 (20.2%) were high risk. Moderate- and high-risk patients had a greater likelihood for prolonged LOS, nonambulatory status, and discharge to a rehabilitation facility, as compared with low-risk patients. High-risk patients additionally had increased risk for in-hospital and 90-day mortality after LT. Multiple regression modeling demonstrated that high-risk Braden Scale score was associated with prolonged LOS (IRR, 1.56; 95% confidence interval [CI], 1.47-1.65), nonambulatory status at discharge (odds ratio [OR], 4.15; 95% CI, 1.77-9.71), and discharge to a rehabilitation facility (OR, 5.51; 95% CI, 2.57-11.80). In conclusion, the Braden Scale, which is currently assessed in all hospitalized patients in the United States, independently predicted early disability-related outcomes and greater LOS after LT. Liver Transplantation 23 1153-1160 2017 AASLD.
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Affiliation(s)
- Vinay Sundaram
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jane Lim
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA
| | - Danielle M Tholey
- Department of Medicine, Division of Gastroenterology, Oregon Health and Science University, Portland, OR
| | - Sentia Iriana
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA
| | - Irene Kim
- Department of Surgery, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Vignan Manne
- Department of Medicine, Akron General Hospital, Akron, OH
| | - Nicholas N Nissen
- Department of Surgery, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Andrew S Klein
- Department of Surgery, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Tram T Tran
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Walid S Ayoub
- Department of Medicine, Division of Gastroenterology, Los Angeles, CA.,Department of Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Barry Schlansky
- Department of Medicine, Division of Gastroenterology, Oregon Health and Science University, Portland, OR
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12
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Cappuccilli M, Mosconi G, Roi GS, De Fabritiis M, Totti V, Merni F, Trerotola M, Marchetti A, La Manna G, Nanni Costa A. Inflammatory and Adipose Response in Solid Organ Transplant Recipients After a Marathon Cycling Race. Transplant Proc 2017; 48:408-14. [PMID: 27109967 DOI: 10.1016/j.transproceed.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/19/2016] [Accepted: 02/02/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Organ transplant recipients frequently have chronic inflammation, with a weighty impact on cardiovascular risk. These patients can benefit from exercise, although the role of intense training is unclear. We evaluated the effect of a 130-km cycling race on inflammatory cytokines and adiponectin levels in transplant recipients. METHODS Circulating interleukin (IL)-6, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and adiponectin were assayed in 35 healthy subjects vs 19 transplant recipients (10 kidney, 8 liver, 1 heart), matched for sex, age, body mass index, and preparation workout. The determinations were performed before the race, at the end, and after 18 to 24 hours. Baseline values of 32 sedentary transplant recipients also were evaluated to explore the possible chronic impact of lifestyle. RESULTS All cyclists had 6- to 8-fold increased IL-6 levels after the race that decreased, without returning to baseline, the day after. Conversely, serum TNF-α and IFN-γ showed a progressive increase starting during physical performance and enduring for the next 18 to 24 hours in healthy subjects, whereas they were unchanged over time in cyclists with transplants. In transplant recipients who did not perform exercise, all of the analytes were significantly higher in comparison to basal levels of physically active subjects. CONCLUSIONS Our data suggest that clinically stable and properly trained transplant recipients can safely perform and progressively benefit from exercise, even at a competitive level. The changes in inflammation parameters were temporary and parallel with those of the healthy subjects. The comparison with sedentary transplant recipients revealed an overall amelioration of inflammatory indexes as a possible effect of regular physical activity on systemic inflammation.
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Affiliation(s)
- M Cappuccilli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Section of Nephrology, University of Bologna, Bologna, Italy
| | - G Mosconi
- Unit of Nephrology and Dialysis, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - G S Roi
- Isokinetic Medical Group, Bologna, Italy
| | - M De Fabritiis
- Unit of Nephrology and Dialysis, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - V Totti
- Emilia Romagna Transplant Reference Centre (CRT-ER), ANED Sport, S. Orsola-Malpighi University Hospital, Bologna, Italy; Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - F Merni
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - M Trerotola
- Italian National Transplant Centre, Rome, Italy
| | - A Marchetti
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Section of Nephrology, University of Bologna, Bologna, Italy
| | - G La Manna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Section of Nephrology, University of Bologna, Bologna, Italy
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13
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Rao S, Ghanta M, Moritz MJ, Constantinescu S. Long-Term Functional Recovery, Quality of Life, and Pregnancy After Solid Organ Transplantation. Med Clin North Am 2016; 100:613-29. [PMID: 27095649 DOI: 10.1016/j.mcna.2016.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the salient features of functional recovery, health-related quality of life (HR-QOL), and reproductive health, with special emphasis on pregnancy outcomes in kidney and liver recipients. Transplantation results in improved functional status and HR-QOL. Addressing factors that limit the optimal rehabilitation of transplant recipients can improve transplant outcomes. After successful transplantation, there is a rapid return of fertility, warranting counseling regarding contraception. Practitioners should be aware of the teratogenic potential of mycophenolic acid products. Posttransplant pregnancies are high risk, with increased incidences of hypertension, preeclampsia, and prematurity. Most pregnancies in kidney and liver recipients have successful maternal and newborn outcomes.
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Affiliation(s)
- Swati Rao
- Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA
| | - Mythili Ghanta
- Pancreas Transplant Program, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA
| | - Michael J Moritz
- Transplant Services, Lehigh Valley Health Network, Allentown, PA 18103, USA; Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA; National Transplantation Pregnancy Registry, Gift of Life Institute, 401 North 3rd Street, Philadelphia, PA 19123, USA
| | - Serban Constantinescu
- National Transplantation Pregnancy Registry, Gift of Life Institute, 401 North 3rd Street, Philadelphia, PA 19123, USA; Kidney Transplant Program, Section of Nephrology, Hypertension and Kidney Transplantation, Temple University School of Medicine, 3440 North Broad Street, Kresge West, Suite 100, Philadelphia, PA 19140, USA.
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14
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Mosconi G, Angelini M, Balzi W, Totti V, Roi G, Cappuccilli M, Tonioli M, Storani D, Trerotola M, Costa A. Can Solid-Organ–Transplanted Patients Perform a Cycling Marathon? Trends in Kidney Function Parameters in Comparison With Healthy Subjects. Transplant Proc 2016; 48:415-9. [DOI: 10.1016/j.transproceed.2015.12.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 01/14/2023]
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15
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Dungey M, Bishop NC, Young HML, Burton JO, Smith AC. The Impact of Exercising During Haemodialysis on Blood Pressure, Markers of Cardiac Injury and Systemic Inflammation--Preliminary Results of a Pilot Study. Kidney Blood Press Res 2015; 40:593-604. [PMID: 26619202 DOI: 10.1159/000368535] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Patients requiring haemodialysis have cardiovascular and immune dysfunction. Little is known about the acute effects of exercise during haemodialysis. Exercise has numerous health benefits but in other populations has a profound impact upon blood pressure, inflammation and immune function; therefore having the potential to exacerbate cardiovascular and immune dysfunction in this vulnerable population. METHODS Fifteen patients took part in a randomised-crossover study investigating the effect of a 30-min bout of exercise during haemodialysis compared to resting haemodialysis. We assessed blood pressure, plasma markers of cardiac injury and systemic inflammation and neutrophil degranulation. RESULTS Exercise increased blood pressure immediately post-exercise; however, 1 hour after exercise blood pressure was lower than resting levels (106±22 vs. 117±25 mm Hg). No differences in h-FABP, cTnI, myoglobin or CKMB were observed between trial arms. Exercise did not alter circulating concentrations of IL-6, TNF-α or IL-1ra nor clearly suppress neutrophil function. CONCLUSIONS This study demonstrates fluctuations in blood pressure during haemodialysis in response to exercise. However, since the fall in blood pressure occurred without evidence of cardiac injury, we regard it as a normal response to exercise superimposed onto the haemodynamic response to haemodialysis. Importantly, exercise did not exacerbate systemic inflammation or immune dysfunction; intradialytic exercise was well tolerated.
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Affiliation(s)
- Maurice Dungey
- Leicester Kidney Exercise Team, John Walls Renal Unit, University Hospitals of Leicester, Leicestershire, United Kingdom
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