Clinical Implementation of Different Strategies for Exercise-Based Rehabilitation in Kidney and Liver Transplant Recipients: A Pilot Study

Supervised vs home-based exercise program in kidney transplant recipients: A pilot pragmatic non-randomized study

BACKGROUND

Although the benefits of exercise for kidney transplant recipients (KTRs) have been widely demonstrated, these patients experience several barriers in undertaking a structured exercise program in hospital and non-hospital facilities.

AIM

To compare the effects of a supervised moderate-intensity gym-based intervention with a home-based low-intensity walking program on exercise capacity in KTRs.

METHODS

KTRs were asked to choose between two six-month programs. The first group performed a low-intensity interval walking intervention at home-based exercise intervention (HBex). The second group performed a supervised training program at an adapted physical activity gym (Sgym), including aerobic and resistance training. The outcomes, collected at baseline and at the end of the programs, included the 6-minute walking test, the peak oxygen consumption (VO2peak) during a treadmill test, the 5-time sit-to-stand test, and blood pressure.

RESULTS

Seventeen patients agreed to participate and self-selected into the HBex (n = 9) and Sgym (n = 8) groups. Two patients in the Sgym group dropped out because of familial problems. At baseline, patients in the HBex group were significantly older and had lower walking distance, VO2peak, and lower limb strength. Primary outcome changes were significantly greater in the HBex group than in the Sgym group (52 ± 23 m vs 8 ± 34; P = 0.005). No other significant differences between groups were observed. Both groups improved most of the outcomes in the within-group comparisons, with significant variations in VO2 peak.

CONCLUSION

Six-month moderate-intensity supervised or low-intensity home-based training programs effectively improved exercise capacity in KTRs. Gym-based programs combine aerobic and resistance training; however, in-home walking may be proposed for frail KTRs.

Age-specific determinants of reduced exercise capacity in youth after heart transplant: A longitudinal cohort study

Background

Although prior studies show that children have impaired exercise capacity after heart transplant, the age-specific determinants of this phenomenon are not well understood. We examine exercise capacity and its associations in school-age and adolescent youth post-heart transplant.

Methods

This retrospective cohort study of heart transplant patients who completed a cardiopulmonary exercise test between 1999 and 2018 includes 332 tests on 104 patients younger than 18 years. Tests were stratified into those by school-aged children (5-11 years old) and adolescents (12-17). The primary outcome was peak oxygen consumption; secondary outcomes were anaerobic threshold and peak power production. Potential determinants included age at transplant, diagnosis, and laboratory and invasive hemodynamic measurements.

Results

All exercise capacity outcomes for patients post-transplant regardless of age were significantly reduced compared to the predicted performance of age and sex-matched controls. Percent predicted median peak oxygen consumption (62.63, 95% confidence interval (CI) 59.18, 66.07), anaerobic threshold (66.52, 95%CI 62.24, 70.81), and peak power production (54.00, 95%CI 50.56, 57.44) were reduced. Younger age at transplant and a higher peak heart rate were independently associated with increased peak oxygen consumption across age groups. Elevated wedge pressure and brain natriuretic peptide predicted decreased exercise capacity in adolescents.

Conclusions

Youth after heart transplant have significantly reduced exercise capacity. Younger age at transplant and higher peak heart rate predict increased exercise capacity throughout childhood. Indicators of congestion predict decreased exercise capacity in adolescents. These findings should encourage deeper attention to the relationship between exercise physiology and the social context of children after transplant.

Getting your transplant center ready for prime time: Health care system obstacles to prehabilitation

1_i4s1nhjfKaltura.