Page 15 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

immunosuppressants is associated with muscle myopathy,
inhibitors has been shown to a
Physical activity in recipients of solid organ transplantation
Box 1.
Guidelines on physical activity to promote or maintain health in adults:
30 minutes or more of moderate-intensity physical activity on at least
week).
adults,

is is also referred to as the Dutch Norm for Health-enhancing Physical Activity. For
(18-55) physical activity is moderate-intense when a metabolic equivalent task (MET)
between 4.0 and 6.5 MET is reached (think of brisk walking [5 km/h] or cycling at a pace of 16
km/h). For the elderly (>55 years),
activities between 3.0 and 5.0 MET (walking 4km/h, cycling 10
km/h) are indicted as moderate-intense. Activities should be performed in bouts of at least ten
20 minutes or more of vigorous-intensity exercise on at least three days a week (75 min./week).

is
a combination of moderate-intensity and vigorous-intensity physical activity to meet this criteria.
Muscle strengthening activities
muscle strength and endurance activities of major muscle groups are recommended on two or more
non-consecutive days per week. It is recommended to perform eight to ten exercises with eight to 12
repetitions for each exercise.

ve days a week (150 min./
Aerobic activities -
minutes. - OR
is also referred to as the Fitnorm. Performed in bouts of at least ten minutes. - OR
AND
-
As indicated, reduced exercise capacity is determined across organ transplantation
groups despite restoration of a nearly normal organ function of the initially failing organ
after transplantation.4
the pre-transplantation phase by the direct e
Functional recovery, therefore, lags behind that which would be
expected for the organ function. Exercise capacity in this population is already a
limitations in end-stage lung disease) and secondary e
ect of the failing organ (i.e., cardiopulmonary

ected in

ects of the disease (i.e., anemia in
chronic kidney disease).4

ese exercise limitations are aggravated by disuse and nutritional
depletion in the end-stage disease phase leading to a catabolic state with deconditioning
and muscle weakness. After transplantation, the recipients exercise tolerance is further
in

uenced by the extended hospital and intensive care stay, prolonged sedentary time,
episodes of rejection, and the use of immunosuppressive medication.
43,44

e use of

18,45,46
ect mitochondrial respiration and muscle degeneration.
and the use of calcineurin
sirolimus can lead to bone-marrow suppression causing anemia and fatigue.
48
A study in
47
Furthermore, corticosteroids can induce weight gain and osteoporosis which can
subsequently limit exercise performance. Mycophenolate mofetil, azathioprine, and
lung transplant recipients indicated that the occurrence of an early and pathologic lactate
threshold and peripheral muscle weakness contributed to the limitation of maximal
exercise capacity.
As a result of the higher sedentary time and periods of immobilization,
transplantation. A shift occurs from Type I (oxidative, fatigue resistant) to Type II

bers
49
a muscle

ber type change is seen after transplantation, especially after lung
13.
1