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Pérez-Sáez MJ, Pascual J. Unmet Questions About Frailty in Kidney Transplant Candidates. Transplantation 2024:00007890-990000000-00795. [PMID: 38886883 DOI: 10.1097/tp.0000000000005093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Frailty occurs frequently among patients with advanced chronic kidney disease, especially among women. Assessing frailty in kidney transplant (KT) candidates is crucial for informing them about associated risks. However, there is poor agreement between frailty scales and research on their correlation with transplant outcomes. Being prefrail significantly impacts both graft and patient survival, often beginning with just 1 Fried criterion. Rather than viewing frailty as a categorical state, it should be regarded as a spectrum ranging from 1 to 5 criteria, with the risk of adverse outcomes escalating as frailty worsens. Frailty status fluctuates during the waiting period for KT; hence, a 1-time frailty evaluation is insufficient to determine risks and implement strategies for improving functional status. Further research should investigate the components of frailty that most frequently change during this waiting period and establish strategies to prevent or reverse frailty. Although careful evaluation of frail KT candidates is necessary to prevent early complications and mortality, exclusion based solely on a frailty score is unwarranted. Instead, efforts should focus on timely interventions to enhance their condition before transplantation. Although evidence is limited, exercise programs appear feasible and yield positive results. A pretransplant clinical framework encompassing multimodal prehabilitation-comprising physical therapy, nutritional measures, and psychological support-during the waiting list period may help alleviate the effects of frailty and poor fitness after KT, ultimately improving key outcomes. Despite logistical challenges, there is a pressing need for interventional trials in this area.
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Affiliation(s)
- María José Pérez-Sáez
- Nephrology Department, Hospital del Mar, Barcelona, Spain
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
| | - Julio Pascual
- Nephropathies Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Institute for Research i+12, Madrid, Spain
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Tache-Codreanu DL, David I, Popp CG, Bobocea L, Trăistaru MR. Successfully physical therapy program for functional respiratory rehabilitation after lung transplant surgery - case report. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2024; 65:331-340. [PMID: 39020549 PMCID: PMC11384042 DOI: 10.47162/rjme.65.2.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
The first lung transplant (LT) was made in Romania in 2018 at a 36-year-old male patient with chronic obstructive pulmonary disease (COPD). The study follows the first LT rehabilitation by describing the physical therapy program (PTP), the measurements of body mass and appendicular skeletal muscle mass (ASM) by bio-impedancemetry analysis (BIA) and the functional capacity assessment realized by the six-minute walk test (6MWT) and by the functional respiratory tests (FRTs) in order to evaluate the effectiveness of functional respiratory rehabilitation in this case during a period of one year. In parallel, repeated transbronchial biopsies were performed after six weeks, three months, six months and one year since the transplant. Only the first biopsies showed injuries suggesting an acute rejection, all the rest revealing mild, unspecific lesions. The patient followed 15 sessions of respiratory exercises, joints mobilizations and progressive global muscle strength started one month after LT surgery and was also instructed to perform the exercises at home, using a tablet given at discharge and under monthly guidance through telemedicine. All the measurements were performed before and after the rehabilitation cure, and it was repeated at three different evaluations for one year. The results showed that at the end of follow-up, the 6MWT was significantly increased from 59% of predicted distance at the intake in post-acute hospitalization to 166% at one year after LT, without desaturation that represent a very good evolution; the FRTs increased to normal, and the body weight increased with 18 kg (from severe underweight to normal weight) with constant increasement of skeletal muscle mass. The use of PTP after LT surgery significantly improves functional capacity and increases body mass and skeletal muscle mass.
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Bourgeois N, Lands LC, Prévost K, Poirier C, Janaudis-Ferreira T. Virtual Physical Prehabilitation in Lung Transplant Candidates: A Proof-of-Concept Study. Transpl Int 2024; 37:12355. [PMID: 38433973 PMCID: PMC10904465 DOI: 10.3389/ti.2024.12355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
This study aimed to preliminary test the effectiveness of 12-week virtual physical prehabilitation program followed by a maintenance phase. The main objective was to estimate the extent to which it affects exercise capacity, frailty, lower limb strength and health-related quality of life (HRQOL) in lung transplant candidates. The program offered supervised strengthening exercises, independent aerobic exercises and weekly phone calls (maintenance phase). Primary outcome was the six-minute walk distance (6MWD). Secondary outcomes: the Short Physical Performance Battery (SPPB), five-times sit-to-stand test (5STS), the St George's Respiratory Questionnaire (SGRQ) for HRQOL. Twenty patients were included (mean age 57.9; 6 women/14 men); fourteen completed the prehabilitation program and 5 completed the maintenance phase. There was no statistically significant improvement in 6MWD, SPPB or SGRQ after the 12-week program. Most patients either maintained or improved the 6MWT and SPPB scores. There was a significant improvement in the 5STS. After the maintenance phase, most patients either improved or maintained their scores in all outcomes except for the sub-score of symptoms in the SGRQ. A 12-week virtual physical prehabilitation program with a 12-week maintenance phase can help lung transplant candidates improve or maintain their physical function while waiting for transplantation.
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Affiliation(s)
- Nicholas Bourgeois
- Lung Transplant Program, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Larry C. Lands
- Lung Transplant Program, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Department of Pediatrics, Montreal Children’s Hospital-McGill University Health Centre, Montreal, QC, Canada
| | - Karina Prévost
- Lung Transplant Program, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Charles Poirier
- Lung Transplant Program, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Stylemans D, Vandecruys M, Leunis S, Engelborghs S, Gargioli D, Monbaliu D, Cornelissen V, Van Craenenbroeck AH, De Smet S. Physical Exercise After Solid Organ Transplantation: A Cautionary Tale. Transpl Int 2024; 37:12448. [PMID: 38414660 PMCID: PMC10898592 DOI: 10.3389/ti.2024.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 02/29/2024]
Abstract
An increasing body of randomized controlled trials suggests the safety of engaging in moderate to vigorous intensity exercise training following solid organ transplantation. Fueled by emerging sport events designed for transplant recipients and the ever-growing body of research highlighting the diverse health benefits of physical activity, transplant recipients are now increasingly participating in strenuous and occasionally competitive physical endeavors that largely surpass those evaluated in controlled research settings. This viewpoint article adopts a cautionary stance to counterbalance the prevalent one-sided optimistic perspective regarding posttransplant physical activity. While discussing methodological limitations, we explore plausible adverse impacts on the cardiovascular, immunological, and musculoskeletal systems. We also examine the physiological consequences of exercising in the heat, at high altitude, and in areas with high air pollution. Risks associated with employing performance-enhancing strategies and the conceivable psychological implications regarding physical activity as a tribute to the 'gift of life' are discussed. With a deliberate focus on the potential adverse outcomes of strenuous posttransplant physical activity, this viewpoint aims to restore a balanced dialogue on our comprehension of both beneficial and potentially detrimental outcomes of physical activity that ultimately underscores the imperative of well-informed decision-making and tailored exercise regimens in the realm of posttransplant care.
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Affiliation(s)
- Dimitri Stylemans
- Department of Respiratory Diseases, Pulmonary Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Marieke Vandecruys
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Sofie Leunis
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Sofie Engelborghs
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Davide Gargioli
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
- Transplantoux Foundation, Leuven, Belgium
| | - Véronique Cornelissen
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Amaryllis H. Van Craenenbroeck
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Nephrology and Kidney Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Stefan De Smet
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
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Keating SE, Sabag A, Hallsworth K, Hickman IJ, Macdonald GA, Stine JG, George J, Johnson NA. Exercise in the Management of Metabolic-Associated Fatty Liver Disease (MAFLD) in Adults: A Position Statement from Exercise and Sport Science Australia. Sports Med 2023; 53:2347-2371. [PMID: 37695493 PMCID: PMC10687186 DOI: 10.1007/s40279-023-01918-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
Metabolic-associated fatty liver disease (MAFLD) is the most prevalent chronic liver disease worldwide, affecting 25% of people globally and up to 80% of people with obesity. MAFLD is characterised by fat accumulation in the liver (hepatic steatosis) with varying degrees of inflammation and fibrosis. MAFLD is strongly linked with cardiometabolic disease and lifestyle-related cancers, in addition to heightened liver-related morbidity and mortality. This position statement examines evidence for exercise in the management of MAFLD and describes the role of the exercise professional in the context of the multi-disciplinary care team. The purpose of these guidelines is to equip the exercise professional with a broad understanding of the pathophysiological underpinnings of MAFLD, how it is diagnosed and managed in clinical practice, and to provide evidence- and consensus-based recommendations for exercise therapy in MAFLD management. The majority of research evidence indicates that 150-240 min per week of at least moderate-intensity aerobic exercise can reduce hepatic steatosis by ~ 2-4% (absolute reduction), but as little as 135 min/week has been shown to be effective. While emerging evidence shows that high-intensity interval training (HIIT) approaches may provide comparable benefit on hepatic steatosis, there does not appear to be an intensity-dependent benefit, as long as the recommended exercise volume is achieved. This dose of exercise is likely to also reduce central adiposity, increase cardiorespiratory fitness and improve cardiometabolic health, irrespective of weight loss. Resistance training should be considered in addition to, and not instead of, aerobic exercise targets. The information in this statement is relevant and appropriate for people living with the condition historically termed non-alcoholic fatty liver disease (NAFLD), regardless of terminology.
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Affiliation(s)
- Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Room 534, Bd 26B, St Lucia, Brisbane, QLD, 4067, Australia.
| | - Angelo Sabag
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Kate Hallsworth
- NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, PA-Southside Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Graeme A Macdonald
- Faculty of Medicine, PA-Southside Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jonathan G Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University- College of Medicine, Hershey, PA, USA
- Liver Center, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
- Cancer Institute, The Pennsylvania State University- Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Nathan A Johnson
- Faculty of Medicine and Health, Discipline of Exercise and Sport Science, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
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Annema C, De Smet S, Castle EM, Overloop Y, Klaase JM, Janaudis-Ferreira T, Mathur S, Kouidi E, Perez Saez MJ, Matthys C, Dobbels F, Ferrari P, Gołębiewska J, Mrzljak A, Girman P, Perch M, Lopez-Lopez V, White C, Koval D, Greenwood S, Monbaliu D. European Society of Organ Transplantation (ESOT) Consensus Statement on Prehabilitation for Solid Organ Transplantation Candidates. Transpl Int 2023; 36:11564. [PMID: 37547750 PMCID: PMC10401602 DOI: 10.3389/ti.2023.11564] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023]
Abstract
There is increasingly growing evidence and awareness that prehabilitation in waitlisted solid organ transplant candidates may benefit clinical transplant outcomes and improve the patient's overall health and quality of life. Lifestyle changes, consisting of physical training, dietary management, and psychosocial interventions, aim to optimize the patient's physical and mental health before undergoing surgery, so as to enhance their ability to overcome procedure-associated stress, reduce complications, and accelerate post-operative recovery. Clinical data are promising but few, and evidence-based recommendations are scarce. To address the need for clinical guidelines, The European Society of Organ Transplantation (ESOT) convened a dedicated Working Group "Prehabilitation in Solid Organ Transplant Candidates," comprising experts in physical exercise, nutrition and psychosocial interventions, to review the literature on prehabilitation in this population, and develop recommendations. These were discussed and voted upon during the Consensus Conference in Prague, 13-15 November 2022. A high degree of consensus existed amongst all stakeholders including transplant recipients and their representatives. Ten recommendations were formulated that are a balanced representation of current published evidence and real-world practice. The findings and recommendations of the Working Group on Prehabilitation for solid organ transplant candidates are presented in this article.
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Affiliation(s)
- Coby Annema
- Section of Nursing Science, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stefan De Smet
- Group Rehabilitation for Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Nephrology and Renal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Ellen M. Castle
- Physiotherapy, Department of Health Sciences, College of Health, Medicine and Life Sciences, Brunel University London, London, United Kingdom
| | - Yasna Overloop
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Joost M. Klaase
- Section of Hepatobiliary Surgery & Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tania Janaudis-Ferreira
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Christophe Matthys
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Pisana Ferrari
- Associazione Italiana Ipertensione Polmonare (AIPI), Bologna, Italy
| | - Justyna Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Mrzljak
- Liver Transplant Center, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Peter Girman
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Michael Perch
- Section of Lung Transplantation, Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Victor Lopez-Lopez
- Department of General, Visceral and Transplant Surgery, Hospital Clínico y Universitario Virgen de La Arrixaca, Murcia, Spain
| | - Colin White
- Representative of the European Kidney Patients’ Federation, Dublin, Ireland
| | - Dmytro Koval
- Ukrainian Transplant Coordination Center, Specialized State Institution, Kiev, Ukraine
| | - Sharlene Greenwood
- Renal Medicine and Therapies, King’s College Hospital NHS Trust, London, United Kingdom
- Centre for Nephrology, Urology and Transplantation, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Diethard Monbaliu
- Laboratory of Abdominal Transplantation, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Transplantoux Foundation, Leuven, Belgium
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Smith KM, Massey BJ, Young JL, Rhon DI. What are the unsupervised exercise adherence rates in clinical trials for knee osteoarthritis? A systematic review. Braz J Phys Ther 2023; 27:100533. [PMID: 37597491 PMCID: PMC10462806 DOI: 10.1016/j.bjpt.2023.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/11/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Exercise is an effective intervention for knee osteoarthritis (OA), and unsupervised exercise programs should be a common adjunct to most treatments. However, it is unknown if current clinical trials are capturing information regarding adherence. OBJECTIVE To summarize the extent and quality of reporting of unsupervised exercise adherence in clinical trials for knee OA. METHODS Reviewers searched five databases (PubMed, CINAHL, Medline (OVID), EMBASE and Cochrane). Randomized controlled trials where participants with knee OA engaged in an unsupervised exercise program were included. The extent to which exercise adherence was monitored and reported was assessed and findings were subgrouped according to method for tracking adherence. The types of adherence measurement categories were synthesized. A quality assessment was completed using the Physiotherapy Evidence Database (PEDro) scores. RESULTS Of 3622 abstracts screened, 176 studies met criteria for inclusion. PEDro scores for study quality ranged from two to ten (mean=6.3). Exercise adherence data was reported in 72 (40.9%) studies. Twenty-six (14.8%) studies only mentioned collection of adherence. Adherence rates ranged from 3.7 to 100% in trials that reported adherence. For 18 studies (10.2%) that tracked acceptable adherence, there was no clear superiority in treatment effect based on adherence rates. CONCLUSIONS Clinical trials for knee OA do not consistently collect or report adherence with unsupervised exercise programs. Slightly more than half of the studies reported collecting adherence data while only 40.9% reported findings with substantial heterogeneity in tracking methodology. The clinical relevance of these programs cannot be properly contextualized without this information.
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Affiliation(s)
- Kristin M Smith
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA.
| | - B James Massey
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA; Department of Physical Therapy, Wingate University, Wingate, NC, USA
| | - Jodi L Young
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA
| | - Daniel I Rhon
- Science Program in Physical Therapy, Bellin College, Green Bay, WI, USA; Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Lv H, Zheng H, Liu J, Cai Q, Ren Y, Yi H, Yang Y, Hu X, Chen G. Expert consensus on liver transplantation perioperative evaluation and rehabilitation for acute-on-chronic liver failure. LIVER RESEARCH 2022. [DOI: 10.1016/j.livres.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Collado-Mateo D, Lavín-Pérez AM, Peñacoba C, Del Coso J, Leyton-Román M, Luque-Casado A, Gasque P, Fernández-del-Olmo MÁ, Amado-Alonso D. Key Factors Associated with Adherence to Physical Exercise in Patients with Chronic Diseases and Older Adults: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2023. [PMID: 33669679 PMCID: PMC7922504 DOI: 10.3390/ijerph18042023] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 12/18/2022]
Abstract
Physical inactivity is a major concern and poor adherence to exercise programs is often reported. The aim of this paper was to systematically review published reviews on the study of adherence to physical exercise in chronic patients and older adults and to identify those adherence-related key factors more frequently suggested by reviews for that population. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results were classified considering the target population and participants' characteristics to identify the most repeated factors obtained for each condition. Fifty-five articles were finally included. Fourteen key factors were identified as relevant to increase adherence to physical exercise by at least ten reviews: (a) characteristics of the exercise program, (b) involvement of professionals from different disciplines, (c) supervision, (d) technology, (e) initial exploration of participant's characteristics, barriers, and facilitators, (f) participants education, adequate expectations and knowledge about risks and benefits, (g) enjoyment and absence of unpleasant experiences, (h) integration in daily living, (i) social support and relatedness, (j) communication and feedback, (k) available progress information and monitoring, (l) self-efficacy and competence, (m) participant's active role and (n) goal setting. Therefore, adherence to physical exercise is affected by several variables that can be controlled and modified by researchers and professionals.
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Affiliation(s)
- Daniel Collado-Mateo
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
| | - Ana Myriam Lavín-Pérez
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
- GO fitLAB, Ingesport, 28003 Madrid, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Alcorcón, 28922 Madrid, Spain;
| | - Juan Del Coso
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
| | - Marta Leyton-Román
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
| | - Antonio Luque-Casado
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
| | - Pablo Gasque
- Department of Physical Education, Sport and Human Motricity, Autónoma Univesity, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain;
| | - Miguel Ángel Fernández-del-Olmo
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
| | - Diana Amado-Alonso
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (D.C.-M.); (J.D.C.); (M.L.-R.); (A.L.-C.); (M.Á.F.-d.-O.); (D.A.-A.)
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10
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Rupnik E, Skerget M, Sever M, Zupan IP, Ogrinec M, Ursic B, Kos N, Cernelc P, Zver S. Feasibility and safety of exercise training and nutritional support prior to haematopoietic stem cell transplantation in patients with haematologic malignancies. BMC Cancer 2020; 20:1142. [PMID: 33234112 PMCID: PMC7687740 DOI: 10.1186/s12885-020-07637-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 11/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Prehabilitation with regular exercise and nutritional care for patients undergoing surgeries for malignant disease was recently introduced to increase physiologic reserve prior to the procedure, accelerate recovery and improve outcomes. This study aimed to investigate the feasibility and safety of combined exercise training and nutritional support in patients with haematologic malignancies prior to haematopoietic stem cell transplantation (HSCT). Methods In this single-arm pilot study, 34 HSCT candidates were enrolled at least two weeks before admission for the procedure. Patients performed aerobic exercises at least 4 days per week for 20–30 min and strength exercises 3 days per week for 10–20 min. They received daily supplements of whey protein (0.3–0.4 g/kg body weight) and oral nutritional supplements if needed. The primary endpoints were feasibility (acceptability > 75%, attrition < 20%, adherence > 66%) and safety. The secondary endpoints were fat-free mass (FFM), muscle strength, physical performance and health-related quality of life (HRQoL) at HSCT. Results The rate of acceptability, attrition and adherence to aerobic exercise, strength exercise and protein supplement consumption was 82.4, 17.8, 71, 78 and 80%, respectively. No severe adverse events were reported. Twenty-eight patients participated in the study for a median of 6.0 weeks (range, 2–14). They performed aerobic exercises 4.5 days per week for 132 min per week and strength exercises 3.0 times per week. Patients consumed 20.7 g of extra protein daily. At the end of the programme, we recorded increases of 1.1 kg in FFM (p = 0.011), 50 m in walking distance in the 6-min walking test (6MWT) (p < 0.001), 3.3 repetitions in the 30-s chair-stand test (30sCST) score (p < 0.001) and 2.6 kg in handgrip strength (p = 0.006). The EORTC QLQ-C30 scores improved by 8.6 (p < 0.006) for global health status, 8.3 (p = 0.009) for emotional functioning, and 12.1 (p = 0.014) for social functioning. There was less fatigue, nausea and insomnia (p < 0.05). Conclusions Our study shows that a multimodal intervention programme with partially supervised exercise training combined with nutritional support prior to HSCT is feasible and safe. Patients showed improvements in FFM, physical performance and HRQoL. Additional research is needed to assess the possible positive effects of such interventions.
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Affiliation(s)
- Erik Rupnik
- Department of Hematology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia.
| | - Matevz Skerget
- Department of Hematology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia
| | - Matjaz Sever
- Department of Hematology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Irena Preloznik Zupan
- Department of Hematology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Maja Ogrinec
- Institute for Medical Rehabilitation, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia
| | - Barbara Ursic
- Institute for Medical Rehabilitation, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia
| | - Natasa Kos
- Institute for Medical Rehabilitation, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia
| | - Peter Cernelc
- Department of Hematology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Samo Zver
- Department of Hematology, University Medical Centre Ljubljana, Zaloska cesta 7, 1000, Ljubljana, Slovenia.,Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
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11
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Pesce de Souza F, Massierer D, Anand Raje U, Tansey CM, Boruff J, Janaudis-Ferreira T. Exercise interventions in solid organ transplant candidates: A systematic review. Clin Transplant 2020; 34:e13900. [PMID: 32391965 DOI: 10.1111/ctr.13900] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Exercise training may be recommended to solid organ transplant (SOT) candidates to improve fitness and tolerance before surgery. We aimed to determine the acceptance, safety, and effectiveness of exercise interventions in SOT candidates. METHODS Online databases were searched. Studies of any design were included. Outcomes of interest were acceptance, safety, exercise capacity, and health-related quality of life. RESULTS Twenty-three articles were included. Acceptance ranged from 16% to 100%. In the fifteen studies that assessed adverse events, none mentioned any adverse events occurring during the study. Five out of seven studies reported an increase in maximal exercise capacity post-exercise in the intervention group (range of mean change: 0.45 to 2.9 mL/kg). Eight out of fourteen studies reported an increase in 6-minute walking distance in the intervention group after the training period (range of mean change: 40-105 m). Two articles showed an improvement in the mental composite scores as well as in the physical composite scores post-exercise in the intervention group. CONCLUSION There was a lack of significant findings among most randomized controlled trials. Exercise training is acceptable and safe for selective SOT candidates. The effects of exercise training on exercise capacity and quality of life in SOT candidates are unclear.
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Affiliation(s)
| | - Daniela Massierer
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Health Outcomes Research (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Uma Anand Raje
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Catherine M Tansey
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Health Outcomes Research (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center Montreal, QC, Canada
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12
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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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13
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Hallsworth K, Adams LA. Lifestyle modification in NAFLD/NASH: Facts and figures. JHEP Rep 2019; 1:468-479. [PMID: 32039399 PMCID: PMC7005657 DOI: 10.1016/j.jhepr.2019.10.008] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 12/16/2022] Open
Abstract
The development of non-alcoholic fatty liver disease is closely linked to lifestyle factors, namely excessive caloric intake coupled with reduced physical activity and exercise. This review aims to examine the evidence behind lifestyle change as a tool to improve hepatic steatosis and liver histology in patients with non-alcoholic fatty liver disease/non-alcoholic steatohepatitis. Furthermore, potential barriers to adopting lifestyle changes and strategies to overcome these barriers in the clinical setting are discussed.
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Affiliation(s)
- Kate Hallsworth
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Liver Unit, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Upon Tyne, UK
- Corresponding author. Address: 4th Floor William Leech Building, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK. Tel.: +44 191 208 8882; fax: +44 191 208 5685.
| | - Leon A. Adams
- Medical School, The University of Western Australia, Perth, WA, Australia
- Department of Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
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14
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Williams FR, Berzigotti A, Lord JM, Lai JC, Armstrong MJ. Review article: impact of exercise on physical frailty in patients with chronic liver disease. Aliment Pharmacol Ther 2019; 50:988-1000. [PMID: 31502264 DOI: 10.1111/apt.15491] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/24/2019] [Accepted: 08/12/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Physical frailty is common in chronic liver disease and the setting of liver transplantation. It is associated with poor quality of life, increased hospitalisation and mortality. Despite this, the impact of exercise in these patients remains poorly understood. AIM To summarise the impact of physical exercise on physical frailty in patients with chronic liver disease until after liver transplantation. METHODS A MEDLINE and PubMed search was undertaken using the terms; "physical activity", "functional capacity", "exercise", "prehabilitation", "frailty", "liver cirrhosis", "liver failure", "liver transplantation" "chronic liver disease" and "end-stage liver disease" from January 1990 to June 2019. RESULTS Eleven studies (five randomised controlled, five observational, one case study) demonstrated that exercise improves VO2 peak, anaerobic threshold, 6-minute walk distance, muscle mass/function and quality of life in patients with compensated and decompensated cirrhosis. Improvements were most significant with a combination of aerobic and resistance exercises at moderate-high intensity. The studies were small (n = 1-50) and mainly focused on supervised, hospital-based exercises, excluding patients with significant liver failure (MELD > 12). Seven studies (four randomised controlled and three observational) demonstrated that predominantly supervised (only one home-based) aerobic exercise after liver transplantation improves aerobic capacity, muscle mass/strength and quality of life. There was marked heterogeneity in timing, intensity and type of exercises. CONCLUSION Exercise improves key components of physical frailty (functional/aerobic capacity, sarcopenia) and quality of life in chronic liver disease and after liver transplantation. Understanding the type, compliance, intensity and duration of exercise and its impact on hard clinical outcomes should be the focus of future large controlled clinical trials.
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Affiliation(s)
- Felicity R Williams
- NIHR Biomedical Research Centre, University of Birmingham, Birmingham, UK.,Liver Transplant Unit, Queen Elizabeth University Hospitals Birmingham, Birmingham, UK
| | - Annalisa Berzigotti
- Department for Visceral Surgery and Medicine, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Janet M Lord
- NIHR Biomedical Research Centre, University of Birmingham, Birmingham, UK.,MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Jennifer C Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Matthew J Armstrong
- NIHR Biomedical Research Centre, University of Birmingham, Birmingham, UK.,Liver Transplant Unit, Queen Elizabeth University Hospitals Birmingham, Birmingham, UK
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15
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Exercise for Solid Organ Transplant Candidates and Recipients: A Joint Position Statement of the Canadian Society of Transplantation and CAN-RESTORE. Transplantation 2019; 103:e220-e238. [DOI: 10.1097/tp.0000000000002806] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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16
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Exercise in cirrhosis: Translating evidence and experience to practice. J Hepatol 2018; 69:1164-1177. [PMID: 29964066 DOI: 10.1016/j.jhep.2018.06.017] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 02/06/2023]
Abstract
Physical inactivity, sarcopenia, and frailty are highly prevalent, independent predictors of morbidity and mortality in patients with cirrhosis. Across a range of chronic diseases, exercise training is a key recommendation supported by guidelines and, for some conditions, even by governmental funding of exercise programmes. Consistent with the broader chronic disease literature, the evidence for a benefit of exercise in cirrhosis is promising. Several small trials have reported significant improvements in muscle health (mass, strength, functional capacity), quality of life, fatigue, and reductions in the hepatic venous pressure gradient, without adverse events. With strong emerging evidence surrounding the substantial risks of sarcopenia/frailty and our first-hand experiences with liver pre-transplant exercise programmes, we contend that routine patient care in cirrhosis should include an exercise prescription. Some clinicians may lack the resources and necessary background to translate the existing evidence into a practicable intervention. Our team, comprised of physiotherapists, exercise physiologists, hepatologists, transplant specialists, and knowledge translation experts from six North American centres, has distilled the essential background information, tools, and practices into a set of information ready for immediate implementation into clinics ranging from a family practice setting to specialty cirrhosis clinics. Augmenting the rationale and evidence are supplementary materials including video and downloadable materials for both patients and the physician. Supporting the exercising patient is a section regarding information about nutrition, providing practical tips suitable for all patients with cirrhosis.
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17
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Knols RH, Fischer N, Kohlbrenner D, Manettas A, de Bruin ED. Replicability of Physical Exercise Interventions in Lung Transplant Recipients; A Systematic Review. Front Physiol 2018; 9:946. [PMID: 30079028 PMCID: PMC6062962 DOI: 10.3389/fphys.2018.00946] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction: This systematic review aimed to assess the replicability of physical exercise interventions in lung transplantation patients. For replicability we focused on (1) the description of training principles, (2) the description of FITT components and adherence to the interventions, (3) the amount of detailed information given on the physical exercise intervention, and (4) reporting the methodological quality of the included works. Methods: Relevant databases (Medline-Ovid, EMBASE, CINAHL, PsychInfo, Cochrane Library) were searched. Author dyads selected and systematically analyzed the included studies independent from each other. A purpose developed checklist was used to assess the details of the exercise interventions and their methodological quality. Results: From the seven included manuscripts, three described resistance training, one endurance, and three combined training approaches. All manuscripts reported specificity and initial values, six manuscripts mention progression and overload. The exercise principle reversibility was reported once and diminishing returns was not reported at all. All studies reported the type of exercise, three studies reported intensity and one study reported time for training. Not any study completely reported frequency or described adherence to the intervention. Lack of detailed reporting was identified as the cause for murky description of the interventions. The highest score for intervention description was 5 of possible 12 items. Conclusions: Replicability of many exercise interventions in LTX is not warranted due too poor descriptions of important items related to training. In particular there were insufficiently detailed reporting of training principles and FITT components in programs developed for LTX. Future interventions that aim to train LTX patients should spent effort in writing reports in which the intervention is detailed to such an extent that full replicability in clinical settings can be guaranteed.
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Affiliation(s)
- Ruud H Knols
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
| | - Nicolas Fischer
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Dario Kohlbrenner
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Anastasios Manettas
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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