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Spence CM, Foshaug R, Rowland S, Krysler A, Conway J, Urschel S, West L, Stickland M, Boulanger P, Spence JC, Khoury M. Evaluating a Telemedicine Video Game-Linked High-Intensity Interval Training Exercise Programme in Paediatric Heart Transplant Recipients. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:198-205. [PMID: 37969861 PMCID: PMC10642108 DOI: 10.1016/j.cjcpc.2023.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/04/2023] [Indexed: 11/17/2023]
Abstract
Paediatric heart transplant recipients (HTRs) have reduced exercise capacity, physical activity (PA), health-related quality of life (HRQoL), and self-efficacy towards PA. Exercise interventions have demonstrated improvements in exercise capacity and functional status in adult HTRs, with a specific emerging interest in the role of high-intensity interval training (HIIT). Studies of exercise interventions in paediatric HTRs have been limited and nonrandomized to date. HIIT has not yet been evaluated in paediatric HTRs. We thus seek to evaluate the safety and feasibility of a randomized crossover trial of a 12-week, home-based, video game-linked HIIT intervention using a cycle ergometer with telemedicine and remote physiological monitoring capabilities (MedBIKE) in paediatric HTRs. The secondary objective is to evaluate the impact of the intervention on (1) exercise capacity, (2) PA, (3) HRQoL and self-efficacy towards PA, and (4) sustained changes in secondary outcomes at 6 and 12 months after intervention. After a baseline assessment of the secondary outcomes, participants will be randomized to receive the MedBIKE intervention (12 weeks, 36 sessions) or usual care. After the intervention and a repeated assessment, all participants will cross over. Follow-up assessments will be administered at 6 and 12 months after the MedBIKE intervention. We anticipate that the MedBIKE intervention will be feasible and safely yield sustained improvements in exercise capacity, PA, HRQoL, and self-efficacy towards PA in paediatric HTRs. This study will serve as the foundation for a larger, multicentre randomized crossover trial and will help inform exercise rehabilitation programmes for paediatric HTRs.
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Affiliation(s)
- Christopher M. Spence
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Rae Foshaug
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Samira Rowland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Krysler
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Urschel
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Lori West
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Pierre Boulanger
- Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - John C. Spence
- Sedentary Living Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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Peterson S, Su JA, Szmuszkovicz JR, Johnson R, Sargent B. Exercise capacity following pediatric heart transplantation: A systematic review. Pediatr Transplant 2017; 21. [PMID: 28419703 DOI: 10.1111/petr.12922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 12/23/2022]
Abstract
Pediatric HTs account for 13% of all HTs with >60% of recipients surviving at least 10 years post-HT. The purpose of this systematic review is to synthesize the literature on exercise capacity of pediatric HT recipients to improve understanding of the mechanisms that may explain the decreased exercise capacity. Six databases were searched for studies that compared the exercise capacity of HT recipients ≤21 years old with a control group or normative data. Sixteen studies were included. Pediatric HT recipients, as compared to controls or normative data, exhibit significantly higher resting HR, and at peak exercise exhibit significantly decreased HR, VO2 , power, work, minute ventilation, and exercise duration. Peak VO2 appears to improve within the first 2.5 years post-HT; peak work remains constant; and there is inconclusive evidence that peak HR, HR recovery, and HR reserve improve with time since HT. These results are discussed in the context of the mechanisms that may explain the impaired exercise capacity of pediatric HT recipients, including chronotropic incompetence, graft dysfunction, side effects of immunosuppression therapy, and deconditioning. In addition, the limited literature on rehabilitation after pediatric HT is summarized.
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Affiliation(s)
- Sara Peterson
- Division of Pediatric Rehabilitation Medicine, Physical Therapy, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Division of Biokinesiology & Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Jennifer A Su
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jacqueline R Szmuszkovicz
- Division of Cardiology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Robert Johnson
- Norris Medical Library, University of Southern California, Los Angeles, CA, USA
| | - Barbara Sargent
- Division of Biokinesiology & Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
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Feldman AG, Neighbors K, Mukherjee S, Rak M, Varni JW, Alonso EM. Impaired physical function following pediatric LT. Liver Transpl 2016; 22:495-504. [PMID: 26850789 PMCID: PMC5129748 DOI: 10.1002/lt.24406] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/14/2016] [Accepted: 01/19/2016] [Indexed: 01/13/2023]
Abstract
The purpose of this article is to investigate the spectrum of physical function of pediatric liver transplantation (LT) recipients 12-24 months after LT. Review data were collected through the functional outcomes group, an ancillary study of the Studies of Pediatric Liver Transplantation registry. Patients were eligible if they had survived LT by 12-24 months. Children ≥ 8 years and parents completed the Pediatric Quality of Life Inventory™ 4.0 generic core scales, which includes 8 questions assessing physical function. Scores were compared to a matched healthy child population (n = 1658) and between survivors with optimal versus nonoptimal health. A total of 263 patients were included. Median age at transplant and survey was 4.8 years (interquartile range [IQR], 1.3-11.4 years) and 5.9 years (IQR, 2.6-13.1 years), respectively. The mean physical functioning score on child and parent reports were 81.2 ± 17.3 and 77.1 ± 23.7, respectively. Compared to a matched healthy population, transplant survivors and their parents reported lower physical function scores (P < 0.001); 32.9% of patients and 35.0% of parents reported a physical function score <75, which is > 1 standard deviation below the mean of a healthy population. Physical functioning scores were significantly higher in survivors with optimal health than those with nonoptimal health (P < 0.01). There was a significant relationship between emotional functioning and physical functioning scores for LT recipients (r = 0.69; P < 0.001). In multivariate analysis, primary disease, height z score < -1.64 at longterm follow-up (LTF) visit, > 4 days of hospitalization since LTF visit, and not being listed as status 1 were predictors of poor physical function. In conclusion, pediatric LT recipients 1-2 years after LT and their parents report lower physical function than a healthy population. Findings suggest practitioners need to routinely assess physical function, and the development of rehabilitation programs may be important.
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Affiliation(s)
- Amy G. Feldman
- University of Colorado School of Medicine, and Digestive Health Institute, Children’s Hospital Colorado, Aurora, CO, USA; Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics
| | - Katie Neighbors
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA; Pediatrics
| | - Shubra Mukherjee
- Rehabilitation Institute of Chicago, Chicago, IL, USA; Pediatric and Adolescent Rehabilitation
| | - Melanie Rak
- Rehabilitation Institute of Chicago, Chicago, IL, USA; Pediatric and Adolescent Rehabilitation
| | - James W. Varni
- Texas A&M University, College Station, TX, USA; Pediatrics
| | - Estella M. Alonso
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA; Pediatrics
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4
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Deliva RD, Patterson C, So S, Pellow V, Miske S, McLister C, Manlhiot C, Pollock-BarZiv S, Drabble A, Dipchand AI. The World Transplant Games: an incentive to improve physical fitness and habitual activity in pediatric solid organ transplant recipients. Pediatr Transplant 2014; 18:889-95. [PMID: 25307141 DOI: 10.1111/petr.12370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2014] [Indexed: 12/18/2022]
Abstract
This prospective, interventional study examined the impact of training for the WTG on levels of health-related physical fitness and habitual activity in a cohort of pediatric SOT recipients. Physical fitness (FitnessGram(®) ) and habitual activity (HAES) measures were performed on participants (n = 19) in the WTG and compared to non-participant controls (n = 14) prior to and following the WTG. Pre-WTG exercise training was provided to participants. Participants demonstrated a statistically significant improvement in their habitual weekday (6.1 ± 1.7 to 8.5 ± 1.9 h; p = 0.002) and weekend (6.3 ± 2.6 to 8.4 ± 2.5 h; p = 0.01) activity over the training period, while controls improved weekday activity only (6.3 ± 2.0 to 8.3 ± 2.1 h; p = 0.05. Weekend activity: 7.7 ± 2.7 to 8.3 ± 2.3 h; p = 0.68). Participants demonstrated a non-statistical improvement in select physical fitness parameters; however, a greater number of participants achieved healthy criterion standards for cardiovascular fitness (2 vs. 1), abdominal strength (5 vs. 3), and upper body strength (7 vs. 3) following training and participating in the WTG. The WTG can provide a positive incentive for greater levels of physical activity and promote improvements in physical fitness levels. Further study is needed to examine long-term impact on lifestyle changes and health outcomes.
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Affiliation(s)
- Robin D Deliva
- Division of Physiotherapy, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; SickKids Transplant Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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5
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Maria da Silva R, Brunow de Carvalho W, Johnston C, Borba de Castro M, Manta Ferreira I, Patti CL, Anthero de Azevedo R, Miziara Gonzalez A, Moura Linhares M, Augusto Salzedas-Netto A. Functional capacity after pediatric liver transplantation: a pilot study. Pediatr Transplant 2014; 18:586-93. [PMID: 25039300 DOI: 10.1111/petr.12318] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 11/30/2022]
Abstract
The prospective cross-sectional study investigated the 6MWT performance in pediatric group of liver transplant recipients (6-17 yr, median post-transplantation time of 22 months) and compared to the normal values obtained in healthy children as well as evaluated the reproducibility of the 6MWT. We analyzed the relationship between walked distance and the 6MWw, distance walked × body weight) with the anthropometric, clinical, and pulmonary functions. In post-transplanted group, the average walked distance was significantly shorter compared with control (687 ± 80 m vs. 511 ± 72 m, p < 0.001). The calculated ICC coefficient confirmed the reproducibility among tests. The Pearson correlation revealed that only walked distance in the 6MWT was moderately correlated with tidal volume. Conversely, the 6MWw was significantly correlated with age, weight, height, BMI, FVC, PEF rate, and volume expiratory. According to multiple regression analysis, age, VE and FVC factors explained 80% of the variance in the 6MWw. In conclusion, the pediatric liver transplant recipients' performance in the 6MWT is significantly lower than the values for healthy children of the same age. Notably, the 6MWw may provide relevant information, constituting an additional parameter in the determination of functional capacity.
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Brosig C, Pai A, Fairey E, Krempien J, McBride M, Lefkowitz DS. Child and family adjustment following pediatric solid organ transplantation: factors to consider during the early years post-transplant. Pediatr Transplant 2014; 18:559-67. [PMID: 24923434 DOI: 10.1111/petr.12286] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 11/29/2022]
Abstract
Adjusting to life after transplant can be challenging to pediatric solid organ transplant recipients and their families. In this review, we discuss a number of important factors to consider during the first 2-3 yr after transplant (defined as the "early years"), including transitioning from hospital to home, returning to physical activity, feeding and nutrition, school reentry, potential cognitive effects of transplant, family functioning, and QOL. We highlight steps that providers can take to optimize child and family adjustment during this period.
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Affiliation(s)
- Cheryl Brosig
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA; Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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7
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Abstract
Organ transplantation is one of the medical miracles or the 20th century. It has the capacity to substantially improve exercise performance and quality of life in patients who are severely limited with chronic organ failure. We focus on the most commonly performed solid-organ transplants and describe peak exercise performance following recovery from transplantation. Across all of the common transplants, evaluated significant reduction in VO2peak is seen (typically renal and liver 65%-80% with heart and/or lung 50%-60% of predicted). Those with the lowest VO2peak pretransplant have the lowest VO2peak posttransplant. Overall very few patients have a VO2peak in the normal range. Investigation of the cause of the reduction of VO2peak has identified many factors pre- and posttransplant that may contribute. These include organ-specific factors in the otherwise well-functioning allograft (e.g., chronotropic incompetence in heart transplantation) as well as allograft dysfunction itself (e.g., chronic lung allograft dysfunction). However, looking across all transplants, a pattern emerges. A low muscle mass with qualitative change in large exercising skeletal muscle groups is seen pretransplant. Many factor posttransplant aggravate these changes or prevent them recovering, especially calcineurin antagonist drugs which are key immunosuppressing agents. This results in the reduction of VO2peak despite restoration of near normal function of the initially failing organ system. As such organ transplantation has provided an experiment of nature that has focused our attention on an important confounder of chronic organ failure-skeletal muscle dysfunction.
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Affiliation(s)
- Trevor J Williams
- Department of Allergy, Immunology, and Respiratory Medicine Alfred Hospital and Monash University, Melbourne, Australia.
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Altamirano-Diaz LA, Nelson MD, West LJ, Khoo NS, Rebeyka IM, Haykowsky MJ. Left ventricular distensibility does not explain impaired exercise capacity in pediatric heart transplant recipients. J Heart Lung Transplant 2013; 32:63-9. [DOI: 10.1016/j.healun.2012.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 09/18/2012] [Accepted: 09/19/2012] [Indexed: 11/26/2022] Open
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9
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Deliva RD, Hassall A, Manlhiot C, Solomon M, McCrindle BW, Dipchand AI. Effects of an acute, outpatient physiotherapy exercise program following pediatric heart or lung transplantation. Pediatr Transplant 2012; 16:879-86. [PMID: 23050737 DOI: 10.1111/petr.12003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2012] [Indexed: 12/11/2022]
Abstract
This prospective interventional study investigated the impact of a three-month, ambulatory HA or HB, semi-individualized, PT-prescribed exercise program following pediatric HTx or LTx. SMW distance, strength, and flexibility were assessed at start and completion of the program and one yr after enrollment. Subjects received either an HB or HA exercise program three times per week. The cohort demonstrated clinically and statistically significant improvements in SMW distances at three months (425.7 ± 109.4-500.6 ± 93.6 m, p < 0.001) and at one yr (528.5 ± 66.6 m, p = 0.001), although there was no difference between the two groups at any time. Similar improvements were also observed in strength and flexibility measures. Correlates with higher SMW distance at three months and one yr included older age, male gender, and underlying diagnosis other than CHD. Male gender and diagnosis other than CHD were associated with a slower improvement in the SMW distance. This is the first report of institutionally based, outpatient exercise rehabilitation in the recovery following pediatric thoracic transplantation. We found similar improvements to HB interventions up to one yr after surgery. Further study of the role of exercise rehabilitation and long-term fitness outcomes is needed.
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Affiliation(s)
- R D Deliva
- Division of Physiotherapy, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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10
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Trojetto T, Elliott RJ, Rashid S, Wong S, Dlugosz K, Helm D, Wickerson L, Brooks D. Availability, characteristics, and barriers of rehabilitation programs in organ transplant populations across Canada. Clin Transplant 2011; 25:E571-8. [PMID: 21955056 DOI: 10.1111/j.1399-0012.2011.01501.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Rehabilitation is receiving increasingly more attention from the medical community in the management of individuals' pre- and post-organ transplantation. A cross-sectional descriptive survey was administered to all known transplant programs across Canada to explore the availability, characteristics, and barriers of rehabilitation programs pre- and post-heart, lung, kidney, and liver transplantation. Of the 58 programs surveyed, 35 agreed to participate (nine heart, six lung, 13 kidney, seven liver), and six refused for a response rate of 71%. Twelve transplant programs that offered rehabilitation were identified (six heart, five lung, one liver). All rehabilitation programs identified included aerobic exercises, strength training, and education and involved a multidisciplinary team. The Six Minute Walk Test and the Medical Outcomes Short Form-36 questionnaire were the most commonly used outcome measures. In kidney and liver transplant programs, over 50% of respondents from these programs cited lack of funding, shortage of health care personnel, and a low volume of patients in a centralized region as barriers to providing rehabilitation programs. Rehabilitation can play an integral role in pre- and post-transplantation management, and barriers to access and provision of rehabilitation for organ transplant populations should be examined further.
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Affiliation(s)
- T Trojetto
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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11
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Estenne M, Fessler HE, DeCamp MM. Lung transplantation and lung volume reduction surgery. Compr Physiol 2011; 1:1437-71. [PMID: 23733648 DOI: 10.1002/cphy.c100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Since the publication of the last edition of the Handbook of Physiology, lung transplantation has become widely available, via specialized centers, for a variety of end-stage lung diseases. Lung volume reduction surgery, a procedure for emphysema first conceptualized in the 1950s, electrified the pulmonary medicine community when it was rediscovered in the 1990s. In parallel with their technical and clinical refinement, extensive investigation has explored the unique physiology of these procedures. In the case of lung transplantation, relevant issues include the discrepant mechanical function of the donor lungs and recipient thorax, the effects of surgical denervation, acute and chronic rejection, respiratory, chest wall, and limb muscle function, and response to exercise. For lung volume reduction surgery, there have been new insights into the counterintuitive observation that lung function in severe emphysema can be improved by resecting the most diseased portions of the lungs. For both procedures, insights from physiology have fed back to clinicians to refine patient selection and to scientists to design clinical trials. This section will first provide an overview of the clinical aspects of these procedures, including patient selection, surgical techniques, complications, and outcomes. It then reviews the extensive data on lung and muscle function following transplantation and its complications. Finally, it reviews the insights from the last 15 years on the mechanisms whereby removal of lung from an emphysema patient can improve the function of the lung left behind.
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Affiliation(s)
- Marc Estenne
- Chest Service and Thoracic Transplantation Unit, Erasme University Hospital, Brussels, Belgium
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12
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Yeung JP, Human DG, Sandor GGS, De Souza AM, Potts JE. Serial measurements of exercise performance in pediatric heart transplant patients using stress echocardiography. Pediatr Transplant 2011; 15:265-71. [PMID: 21492351 DOI: 10.1111/j.1399-3046.2010.01467.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Heart transplantation is an increasingly acceptable therapeutic option for children with end-stage and complex congenital heart disease. With advances in surgery, immunosuppression, and follow-up care, functional outcomes need to be evaluated. We report the results of serial exercise testing performed using stress echocardiography in a cohort of pediatric HTP. HTP (n = 7) exercised on a semi-recumbent ergometer to volitional fatigue. Echocardiography-Doppler measurements, HR, and blood pressure were taken at rest and during staged exercise. Results were compared with healthy CON (n = 12). HTP did significantly less work during exercise (940 vs. 1218 J/kg, p < 0.03). Their SVI (33 vs. 49 mL/m(2), p < 0.003), CI (5.16 vs. 9.25 L/min/m(2), p < 0.0005), and HR (162 vs. 185 bpm, p < 0.02) were lower at peak exercise. HTP had a lower SF at peak exercise (48% vs. 52%, p < 0.03) and an abnormal relationship between the MVCFc and σPS. During follow-up, hemodynamics and left ventricular function remained relatively constant in HTP. HTP are able to exercise safely; however, their exercise tolerance is reduced, and hemodynamics and contractility are diminished. Over time, their hemodynamics and left ventricular function have remained relatively constant.
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Affiliation(s)
- Joanne P Yeung
- Department of Pediatrics, BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada
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13
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Exercise Capacity Improves With Time in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2009; 28:585-90. [DOI: 10.1016/j.healun.2009.01.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 01/12/2009] [Accepted: 01/21/2009] [Indexed: 11/20/2022] Open
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Gruber W, Orenstein DM, Braumann KM, Hüls G. Health-related fitness and trainability in children with cystic fibrosis. Pediatr Pulmonol 2008; 43:953-64. [PMID: 18781654 DOI: 10.1002/ppul.20881] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The objective of this study was to examine the effects of a supervised exercise training program performed during an in patient rehabilitation course on various attributes of health-related fitness, e.g., flexibility, balance and coordination. 286 patients with CF, age range 6-18 years (11.8 +/- 3.4 years), mean forced expiratory volume in 1 sec (FEV1 82.7 +/- 22.3% predicted) were included. Patients performed the modified Munich fitness test (mMFT) to assess flexibility, balance, strength and coordination. To assess aerobic capacity a 6-min walk-test (6MWT) was performed. In addition, some of the patients performed an incremental exercise test on a bicycle ergometer using the Godfrey protocol before and after the exercise training program. The supervised training program consisted of 4-6 weeks of different sports activities 5 times per week. After training, pulmonary function showed a significant (P < 0.05) increase. All test items of the mMFT improved significantly (P < 0.05). Compared to healthy children test scores achieved from children with CF in the mMFT were lower but within a normal range. Our children with CF had a lower walk distance in 6MWT (P < 0.05) compared to healthy. Our findings clearly demonstrated benefits of a systematic exercise training program on components of physical fitness in patients with CF, with improvements of test-tasks to predicted normal in some cases. The results from our study suggested that an exercise training program in CF should be focused on several aspects of physical fitness including all components of physical fitness, e.g. aerobic endurance, flexibility, balance and motor skills.
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Affiliation(s)
- W Gruber
- Clinic Sattelduene for Children and Adolescents, Amrum, Germany.
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Patterson JA, Pitetti KH, Young KC, Goodman WF, Farhoud H. Case Report on PWC of a Competitive Cyclist before and after Heart Transplant. Med Sci Sports Exerc 2007; 39:1447-51. [PMID: 17805072 DOI: 10.1249/mss.0b013e318074d3d7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION It has been well documented that for heart transplant recipients (HTR), posttransplantation physical work capacity (PWC) normally does not exceed 60% of the value for healthy age-matched controls. Few, if any, studies have undertaken posttransplantation PWC measurements of well-conditioned individuals (i.e., PWC>300 W). CASE SUMMARY A 37-yr-old professionally trained male cyclist suffered an acute myocardial infarction (AMI) immediately after a road race and received a heart transplant (HT) 4 months after the AMI. The participant resumed training 1 month after surgery and underwent a maximal exercise test 6 months after surgery. Peak PWC (33.8 mL.kg(-1).min(-1), 250 W) was 92% of the age-predicted maximum, and peak heart rate (165 bpm) was 96% of his known maximum. These results were similar to the participants in a study who had been training regularly for 36+/-24 months before testing, and PWC evaluations occurred 43+/-12 months after HT. CONCLUSION Results suggest that 1) lifestyle before HT may positively affect posttransplantation PWC, 2) exercise capacity was not limited by chronotropic incompetence, and 3) a more aggressive approach to HT recovery could be applied to HTR with similar activity histories.
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Affiliation(s)
- Jeremy A Patterson
- Department of Kinesiology and Sports Studies, Wichita State University, and Cyprus Heart, Wichita, KS 67260-0016, USA.
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Sagiv M, Goldhammer E, Ben-Sira D, Amir R. What Maintains the Metabolic Cost at Maximal Exercise in Heart Transplant Recipients and Coronary Artery Disease Patients? J Heart Lung Transplant 2007; 26:617-21. [PMID: 17543786 DOI: 10.1016/j.healun.2007.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 01/02/2007] [Accepted: 02/03/2007] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In this study we assess the influence of disease status on hemodynamic and cardiac output values, as measured by oxygen utilization at peak aerobic exercise, in heart transplant recipients (HTRs) and coronary artery disease patients (CAD). METHODS Fifteen CAD patients and 13 HTRs (40.2 +/- 12.6 and 41.7 +/- 11.7 years, respectively) underwent a peak cardiopulmonary exercise test on bicycle ergometry. Arterial oxygen was defined on the basis of echocardiography and venous oxygen content. RESULTS At rest, except for cardiac output, oxygen uptake and lactate levels, all variables were significantly (p < 0.01) different between groups. At peak exercise, compared with HTRs, CAD patients had significantly (p < 0.0001) higher values for cardiac output (12.4 +/- 0.8 and 20.2 +/- 1.7 liters/min, respectively), stroke volume (87.3 +/- 5.4 and 129.3 +/- 9.7 ml, respectively) and oxygen uptake (22.7 +/- 3.6 and 29.7 +/- 2.7 ml/kg/min, respectively) (p < 0.01), whereas (a - v)O2 was significantly lower (127.0 +/- 4.3 and 141.9 +/- 6.4 O2 ml/liter, respectively; p < 0.0001). CONCLUSIONS The differences in oxygen utilization at peak exercise may be attributed to differences in energy metabolism, namely higher oxygen extraction in HTRs, compensating for the dramatically reduced oxygen delivery. It is further suggested that CAD patients and HTRs respond to a greater extent to maximal aerobic testing by reducing their left ventricular systolic function despite increased after-load.
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Affiliation(s)
- Moran Sagiv
- Sports Medicine and Rehabilitation Division, Zinman College of Physical Education and Sport Sciences, Wingate Institute, Netanya, Israel
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Abstract
During the past two decades, several advances have resulted in marked improvement in medium-term survival for infants and children undergoing heart transplantation. Unfortunately, progress has been less dramatic in the field of lung and heart-lung transplantation, where there is little evidence of improved outcomes. The procedures remain palliative and all transplant recipients are at risk for the adverse effects of non-specific immunosuppression, including infections, lymphoproliferative disorders, and non-lymphoid malignancies. In addition, current immunosuppressive agents have narrow therapeutic windows and exhibit a wide array of organ toxicities, posing special challenges for the young patient who must endure life-long immunosuppression. New immunosuppressive regimens have lowered the rates of acute rejection but appear to have had relatively little impact on the incidence of chronic rejection, the principal cause of late graft loss. The ultimate goal is to induce a state of donor-specific tolerance, wherein the recipient will accept the allograft indefinitely without the need for long-term immunosuppression. This quest is currently being realised in animal models of solid organ transplantation, and offers great hope for children undergoing heart and lung transplantation in the future.
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Affiliation(s)
- Steven A Webber
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Abstract
The study of patient healthcare outcomes after cardiothoracic transplantation has increased substantially over the last 2 decades. Physical function after heart, lung, and heart-lung transplantation has been studied using both subjective and objective measures. The majority of reports in the literature on physical function after cardiothoracic transplantation are descriptive and observational. The purposes of the article are to review and critique the existing literature on cardiothoracic recipients' subjective and objective physical function, including respiratory function for heart-lung and lung transplant recipients. In addition, the literature on sexual function in cardiothoracic recipients is examined, the gaps in the literature are identified, and recommendations are given for future research.
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Affiliation(s)
- Kathleen L Grady
- Center for Heart Failure, and Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, 201 E. Huron Street, Chicago, IL 60611, USA.
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Sagiv M, Ben-Sira D, Goldhammer E. Prescription of exercise to heart transplantation recipients: The role of respiratory rate. J Heart Lung Transplant 2005; 24:506-7. [PMID: 15797760 DOI: 10.1016/j.healun.2004.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hirshfeld AB, Kahle AL, Clark BJ, Bridges ND. Parent-reported health status after pediatric thoracic organ transplant. J Heart Lung Transplant 2005; 23:1111-8. [PMID: 15454179 DOI: 10.1016/j.healun.2003.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2003] [Revised: 08/14/2003] [Accepted: 08/14/2003] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Thoracic organ transplantation is a life-changing event for a child and family from both a physical and a psychosocial perspective. Accurate pre-transplantation counseling and effective post-transplantation follow-up depend on a good understanding of post-transplantation health status, especially as perceived by families. METHODS The Child Health Questionnaire-Parent Form 50 (CHQ-P50), an instrument that assesses parent-reported health status of pediatric patients, was administered to 47 pediatric thoracic organ transplant recipients (41 heart, 6 lung) 5 to 18 years of age. RESULTS Transplant recipients scored lower on the Physical Health Summary (PhS) score than the general population, as evidenced by a lower median score (50.6 vs 55.1, p < 0.0001) and a difference in the distribution of quartiles (p = 0.001), skewed toward the lower quartiles of the general population. The distribution of PhS scores in transplant recipients was comparable to scores of 3 groups of pediatric patients with other chronic health conditions (juvenile rheumatoid arthritis, epilepsy and asthma). The distribution of the Psychosocial Health Summary (PsS) scores was similar to that of the general population, but the median score was lower (51.5 vs 53.2, p = 0.02). Transplant patients clearly scored lower than the general population on 4 of 12 sub-scales, including those assessing general health, physical functioning, family activities and parental emotional impact. No difference was found in sub-scales reflecting self-esteem, mental health, behavior, pain, peer interactions, family cohesion or parental time demands. CONCLUSIONS Thoracic organ transplantation in children ages 5 to 18 years is associated with an ongoing deficit in parent-perceived physical health status.
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Affiliation(s)
- Amy B Hirshfeld
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Abstract
This article discusses exercise physiology and its application in the pediatric population. This article discusses exercise physiology and its application in the pediatric population. The authors briefly review the normal physiologic response to exercise. They then discuss populations in which exercise testing is most useful, the indications and contraindications for graded exercise, and the usual parameters that are measured during testing. Finally, the authors review some of the recent data on exercise performance in specific pediatric populations.
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Affiliation(s)
- Paul Stephens
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Abarbanell G, Mulla N, Chinnock R, Larsen R. Exercise assessment in infants after cardiac transplantation. J Heart Lung Transplant 2004; 23:1334-8. [PMID: 15607660 DOI: 10.1016/j.healun.2003.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2003] [Revised: 09/02/2003] [Accepted: 09/05/2003] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Few data describe exercise performance after cardiac transplantation during infancy. The aim of this study was to compare the cardiorespiratory response to exercise in healthy subjects with that of subjects who had undergone heart transplantation during infancy to treat hypoplastic left heart syndrome. METHODS Subjects (24 heart transplant recipients and 25 healthy controls) exercised on a treadmill using pediatric ramp protocols. We measured heart rate (HR), blood pressure, and metabolic data. Median age at transplantation was 20 days (range, 4 to 97 days). Age of recipients at exercise testing was 9.7 +/- 2.3 years and in healthy subjects was 10.5 +/- 1.4 years (p=not significant [NS]). RESULTS Exercise duration was similar in both groups (10.3 +/- 2.0 minutes in recipients vs 11.1 +/- 1.5 minutes in healthy subjects, (p=NS). Heart rate at rest was greater in recipients (94 +/- 15 beats per minute [bpm] vs 85 +/- 11 bpm, p=0.02). Peak HR also was less in the recipient group (158 +/- 15 bpm vs 189 +/- 12 bpm, p <0.001). Peak oxygen consumption was 14% less in the recipients (32.3 +/- 5.6 ml/kg/min vs 36.8 +/- 5.5 ml/kg/min, p <0.01). Ventilatory anaerobic threshold was decreased in recipients, 27.6 +/- 9.6 vs 32.8 +/- 6.0, p <0.05. Respiratory exchange ratio at peak exercise was equal in both groups (1.06 +/- 0.06 vs 1.06 +/- 0.08). Oxygen pulse index did not differ significantly, 5.5 +/- 1.1 ml/beat/m2 in recipients and 6.1 +/- 1.7 ml/beat/m2 in healthy subjects (p=NS). CONCLUSIONS Overall, children who undergo cardiac transplantation in infancy have exercise capacities within the normal range. These recipients have a decreased heart rate reserve that may account for the differences in peak oxygen consumption when compared with healthy subjects.
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Affiliation(s)
- Ginnie Abarbanell
- Department of Pediatrics, Loma Linda Children's Hospital, Loma Linda University, Loma Linda, California 92354, USA
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24
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Abstract
Heart transplant is an effective therapy for children with end-stage heart disease. Success of this treatment depends on coordination and careful communication among the family, primary care physician, and transplant team. Primary care physicians play an essential role in the monitoring and management of the medical, nutritional, developmental, and psychosocial issues of pediatric heart transplant patients and their families (Box 3). Ongoing assessment of the child and parent's progress in adapting to transplant is crucial in order for appropriate referrals to occur. Relationships with the primary care team can improve medical outcomes for this complex group of patients and provide a framework for improved adherence to care.
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Affiliation(s)
- Elizabeth D Blume
- Department of Cardiology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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25
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Abstract
Exercise intolerance in heart transplant recipients (HTR) has a multifactorial origin, involving complex interactions among cardiac, neurohormonal, vascular, skeletal muscle and pulmonary abnormalities. However, the role of these abnormalities may differ as a function of time after transplantation and of many other variables. The present review is aimed at evaluating the role of cardiac, pulmonary and muscular factors in limiting maximal aerobic performance of HTR, and the benefits of chronic exercise. Whereas pulmonary function does not seem to affect gas exchange until a critical value of diffusing lung capacity is attained, cardiac and skeletal muscle function deterioration may represent relevant factors limiting maximal and submaximal aerobic performance. Cardiac function is mainly limited by chronotropic incompetence and diastolic dysfunction, whereas muscle activity seems to be limited by impaired oxygen supply as a consequence of the reduced capillary network. The latter may be due to either immunosuppressive regimen or deconditioning. Endurance and strength training may greatly improve muscle function and maximal aerobic performance of HTR, and may also reduce side effects of immunosuppressive therapy and control risk factors for cardiac allograft vasculopathy. For the above reasons exercise should be considered an important therapeutic tool in the long-term treatment of heart transplant recipients.
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Affiliation(s)
- Claudio Marconi
- Muscle Physiology and Proteome Section, IBFM-Consiglio Nazionale delle Ricerche, LITA, v Flli Cervi 93, Segrate, 20090 Milan, Italy.
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26
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Abstract
During the last two decades, several advances have resulted in marked improvement in medium-term survival, with excellent quality of life, in children undergoing cardiac transplantation. Improved outcomes reflect better selection of donors and recipients, increased surgical experience in transplantation for complex congenital heart disease, development of effective surveillance for rejection, and wider choice of immunosuppressive medications. Despite all of these advances, recipients continue to suffer from the adverse effects of non-specific immunosupression, including infections, induction of lymphoproliferative disorders and other malignancies, renal dysfunction, and other important end-organ toxicities. Furthermore, newer immunosuppressive regimes, thus far, appear to have had relatively little impact on the incidence of chronic rejection. Progress in our understanding of the immunologic mechanisms of rejection and graft acceptance should lead to more targeted immunosuppressive therapy and avoidance of non-specific immunosupression. The ultimate goal is to induce a state of tolerance, wherein the recipient will accept the allograft indefinitely, without the need for long-term immunusupression, and yet remain immuno-competent to all non-donor antigens. This quest is currently being realized in many animal models of solid organ transplantation, and offers great hope for the future.
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Affiliation(s)
- Steven A Webber
- Division of Pediatric Cardiology, Department of Pediatrics, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh, PA 15213, USA.
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27
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Ficker FJ. Should physical activity and/or competitive sports be curtailed in pediatric heart transplant recipients? Pediatr Transplant 2002; 6:267-9. [PMID: 12234265 DOI: 10.1034/j.1399-3046.2002.2e014.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pastore E, Turchetta A, Attias L, Calzolari A, Giordano U, Squitieri C, Parisi F. Cardiorespiratory functional assessment after pediatric heart transplantation. Pediatr Transplant 2001; 5:425-9. [PMID: 11737767 DOI: 10.1034/j.1399-3046.2001.t01-2-00032.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Limited data are available on the exercise capacity of young heart transplant recipients. The aim of this study was therefore to assess cardiorespiratory responses to exercise in this group of patients. Fourteen consecutive heart transplant recipients (six girls and eight boys, age-range 5-15 yr) and 14 healthy matched controls underwent a Bruce treadmill test to determine: duration of test; resting and maximum heart rates; maximum systolic blood pressure; peak oxygen consumption (VO2 peak); and cardiac output. Duration of test and heart rate increase were then compared with: time since transplantation, rejections per year, and immunosuppressive drugs received. The recipients also underwent the following lung function tests: forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). When compared with healthy controls, transplant recipients had tachycardia at rest (126 +/- 3.7 beats/min; p < 0.001); significantly reduced tolerance (9.3 +/- 0.4 min; p < 0.001), a maximum heart rate of 169 +/- 5.4 beats/min (p < 0.05); a cardiac output of 5.65 +/- 0.6 L/min (p < 0.05); and a lower heart-rate increase from rest to peak exercise (p < 0.001) but a similar VO2 peak. The heart-rate increase correlated significantly with time post-transplant (r = 0.55; p < 0.05), number of rejection episodes per year (r = - 0.63; p < 0.05), and number of immunosuppressive drugs (r = - 0.60; p < 0.05). The recipients had normal FVC and FEV1 values. After surgery, few heart transplant recipients undertake physical activity, possibly owing to over-protective parents and teachers and to a lack of suitable supervised facilities. The authors stress the importance of a cardiorespiratory functional evaluation for assessment of health status and to encourage recipients, if possible, to undertake regular physical activity.
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Affiliation(s)
- E Pastore
- Department of Sport Medicine, Bambino Gesù Children's Hospital, Rome, Italy, Italian National Health Istitute, Rome, Italy
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Unnithan VB, Veehof SH, Rosenthal P, Mudge C, O'Brien TH, Painter P. Fitness testing of pediatric liver transplant recipients. Liver Transpl 2001; 7:206-12. [PMID: 11244161 DOI: 10.1053/jlts.2001.22324] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Liver transplantation is accepted as the standard management for end-stage liver disease in children. Pediatric heart and heart-lung transplant recipients have shown significantly diminished exercise capacities compared with age-matched, able-bodied, control subjects. The primary aim of this study is to compare the fitness levels of a group of pediatric liver transplant (LT) recipients (LT group, 20 boys, 9 girls; age, 8.9 +/- 4.8 years; 56 +/- 35 months posttransplantation) with a group of able-bodied control subjects (22 boys, 12 girls; age, 8.4 +/- 3.8 years). The secondary aim is to compare the performance of the LT group against the Fitnessgram criterion standards. We assessed muscular endurance by means of a partial curl-up, flexibility by means of the back-saver sit and reach, and cardiorespiratory fitness by means of the progressive aerobic cardiovascular endurance run (PACER). The only significant (P <.05) difference between the 2 groups was the number of shuttles run in the PACER (control, 16.8 +/- 9.8 v LT, 11.5 +/- 8.4 shuttles). Other differences between the 2 groups were not significant. With regard to satisfying the Fitnessgram criterion standards, only 35% of the LT group achieved the standards for the partial curl-up, 88% of the LT group achieved the criterion standards for flexibility, and 0% achieved the standards for the PACER. These results indicate that the LT group has diminished exercise capacity. The origins of exercise limitations deserve further investigation.
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Affiliation(s)
- V B Unnithan
- Exercise and Sport Science, University of San Francisco, 1230 Fulton St., San Francisco, CA 94117-1080, USA.
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Pahl E, Sundararaghavan S, Strasburger JF, Mitchell BM, Rodgers S, Crowley D, Gidding SS. Impaired exercise parameters in pediatric heart transplant recipients: comparison of biatrial and bicaval techniques. Pediatr Transplant 2000; 4:268-72. [PMID: 11079265 DOI: 10.1034/j.1399-3046.2000.00122.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The exercise performance of pediatric heart transplant recipients and the effects of bicaval anastomosis were studied in 19 children using a Bruce protocol. Although all children had decreased exercise capacity and heart rates when compared with normals, the bicaval anastomosis patients had similar endurance and peak heart rates as the standard biatrial group.
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Affiliation(s)
- E Pahl
- Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois, USA.
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31
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Abstract
Increasing numbers of individuals leading normal lives have transplanted organs. They may appear in any hospital for treatment of trauma or general diseases. Common anaesthesia methods can be used for these patients, but safe conduct of anaesthesia requires knowledge of the immunosuppression, risk factors, and altered physiology or drug actions. This article reviews the anaesthesia-related literature on patients with transplanted organs.
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Affiliation(s)
- H J Toivonen
- Department of Anaesthesia, University of Helsinki, Finland.
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Fink G, Lebzelter J, Blau C, Klainman E, Aravot D, Kramer MR. The sky is the limit: exercise capacity 10 years post-heart-lung transplantation. Transplant Proc 2000; 32:733-4. [PMID: 10856563 DOI: 10.1016/s0041-1345(00)00961-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- G Fink
- Pulmonology Institute, Rabin Medical Center, Petach-Tikva, Israel
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Starnes VA, Woo MS, MacLaughlin EF, Horn MV, Wong PC, Rowland JM, Durst CL, Wells WJ, Barr ML. Comparison of outcomes between living donor and cadaveric lung transplantation in children. Ann Thorac Surg 1999; 68:2279-83; discussion 2283-4. [PMID: 10617017 DOI: 10.1016/s0003-4975(99)01155-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term survival in lung transplant is limited by bronchiolitis obliterans (BOS). We compared outcomes in pediatric living donor bilateral lobar (LL) vs cadaveric lung transplant (CL). METHODS Children were studied who had LL or CL with at least 1 year follow-up. Data collected included acute rejection episodes, pulmonary function tests (PFT), BOS, and survival. Mean age was 13.36+/-3.16 years in LL and 12.00+/-4.19 years in CL patients (p = 0.37, ns). RESULTS There was no difference in rejection (p = 0.41, ns). CL had rejection earlier (2.48+/-3.84 months) than LL (13.60+/-10.74 months; p = 0.02). There was no difference in 12 month PFT. But at 24 months, LL had greater forced expiratory volume in 1 second (FEV1) (p = 0.001) and FEF25-71% (p = 0.01) than CL. BOS was found in 0/14 LL vs 9/11 (82%) CL after 1 year (p = 0.04). After 2 years, 0/8 LL and 6/7 (86%) CL had BOS (p < 0.05). LL had 85% survival vs 79% for CL at 12 months. At 24 months, LL survival was 77% vs 67% for CL. CONCLUSIONS Pediatric LL had less BOS and better pulmonary function than CL. As BOS is a determinant of long-term outcome, we believe LL is the preferred lung transplant method for children.
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Affiliation(s)
- V A Starnes
- Division of Cardiothoracic Surgery, Childrens Hospital Los Angeles, California 90027, USA.
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Abstract
Heart transplantation is now an accepted method for treatment of heart disease in children, but transplantation in pediatric recipients continues to present unique challenges. The differences in indications and the complexity of surgery for congenital heart disease are only two of those challenges. A successful means of mechanical support is not available, which puts children at special risk of dying while waiting for transplantation. In addition, physiologic differences produce issues about management after transplantation, including use of immunosuppressive agents, control of infection, identification of transplant coronary artery disease, and posttransplant lymphoproliferative disease. Because of the longer life expectancy desired from pediatric transplantation, measurement of quality of life must be more comprehensive. This broad range of special demands means that although the state of pediatric heart transplantation is positive, there are areas for continued improvement.
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Affiliation(s)
- E C Suddaby
- Inova Fairfax Hospital for Children, Falls Church, VA 22042, USA
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35
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36
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Montenegro LM, Ward A, McGowan FX, Davis PJ. New directions in perioperative management for pediatric solid organ transplantation. J Cardiothorac Vasc Anesth 1998; 12:457-72. [PMID: 9713740 DOI: 10.1016/s1053-0770(98)90205-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Advances in pediatric solid organ transplantation have furthered the understanding of end-organ failures and refined the strategies for perioperative management of these otherwise lethal diseases. As the donor pool expands, the number of transplantations increases and long-term survival continues to improve, more complete knowledge of the immunologic and pathologic processes will be gained. A thorough understanding of the principles of transplantation medicine remains essential for physicians to provide optimal perioperative care of pediatric organ transplant patients.
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Affiliation(s)
- L M Montenegro
- University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, PA 15213-2583, USA
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Sigfússon G, Fricker FJ, Bernstein D, Addonizio LJ, Baum D, Hsu DT, Chin C, Miller SA, Boyle GJ, Miller J, Lawrence KS, Douglas JF, Griffith BP, Reitz BA, Michler RE, Rose EA, Webber SA. Long-term survivors of pediatric heart transplantation: a multicenter report of sixty-eight children who have survived longer than five years. J Pediatr 1997; 130:862-71. [PMID: 9202606 DOI: 10.1016/s0022-3476(97)70270-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Short-term survival after pediatric heart transplantation is now excellent, but ultimately the efficacy of this procedure will depend on duration and quality of survival. We sought to evaluate the clinical course of long-term survivors of heart transplantation in childhood. METHODS Patients who had undergone heart transplantation at the university hospitals of Stanford, Columbia, and Pittsburgh between 1975 and 1989 and survived longer than 5 years from transplantation were identified and their clinical courses retrospectively reviewed. RESULTS Sixty eight children have survived more than 5 years from transplantation, and 60 (88%) are currently alive with a median follow-up of 6.8 years (5 to 17.9 years). Thirteen have survived more than 10 years from transplantation. Renal dysfunction caused by immunosuppressive agents was common, and two patients required late renal transplantation. Lymphoproliferative disease or other neoplasm occurred in 12 patients, but none resulted in death. Coronary artery disease was diagnosed in 13 patients (19%), leading to retransplantation in eight. Death after 5 years was related to acute or chronic rejection in 5 of 8 cases. Two of the deaths were directly related to noncompliance with immunosuppressive medication. All survivors are in New York Heart Association class 1. CONCLUSIONS Long-term survival with good quality of life can be achieved after heart transplantation in childhood, though complications of immunosuppression remain common. Posttransplantation coronary artery disease is emerging as the main factor limiting long term graft and patient survival.
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Affiliation(s)
- G Sigfússon
- Department of Pediatrics, University of Pittsburgh, Pennsylvania, USA
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Williams TJ, Snell GI. Early and long-term functional outcomes in unilateral, bilateral, and living-related transplant recipients. Clin Chest Med 1997; 18:245-57. [PMID: 9187819 DOI: 10.1016/s0272-5231(05)70376-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Lung transplantation offers the possibility of improved quality of life and survival in patients with severe pulmonary and pulmonary vascular disease. Since the first human lung allotransplantation in 1963, survival has moved from hours or days into the present era of long-term (years) survival in many recipients. Measurement of outcome has now extended to measurement of exercise capacity and quality of life. A substantial improvement in quality of life is seen; however, exercise capacity remains moderately impaired in spite of the return (in many) of near normal cardiopulmonary function, suggesting peripheral limitation to exercise. Recently, fiber type changes and abnormal oxidative metabolism have been shown in the skeletal muscle of stable lung transplant recipients. This suggests a persistence of a pretransplant skeletal muscle injury and/ or the effects of post-transplant immunosuppression (particularly Cyclosporin A and corticosteroids).
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Affiliation(s)
- T J Williams
- Lung Transplant Service (Medical), Alfred Hospital, Victoria, Australia
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Duitsman D. What health educators should know about pediatric heart transplant recipients. THE JOURNAL OF SCHOOL HEALTH 1996; 66:305-307. [PMID: 8899589 DOI: 10.1111/j.1746-1561.1996.tb03403.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- D Duitsman
- Southwest Missouri State University, Dept. of Health, Physical Education, and Recreation, Springfield 65804, USA
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