Page 154 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

Chapter 8
known barriers for an extensive application. However, as maximal exercise capacity is a
strong and independent predictor of cardiovascular disease and mortality
would be of substantial value. It would generate strong (intermediate) outcome
most daily physical activities do not require maximal e
test can be bene

cial while strength testing or other functional tests can provide insight

ort, a submaximal test or endurance
investing
in the testing of maximal exercise capacity in recipients of solid organ transplantation
measurements with relative ease and provides information to be used in adequate activity
or training advice.
In addition to laboratory testing,

eld tests are often used which, depending on the
aim of the test, focus on the morphological component (body mass index, waist to hip
ratio), muscular component (handgrip, sit-up and stand), motor component (balance
testing), or cardiovascular component (submaximal exercise testing).
Although outcomes
are usually surrogates of strong outcome measures such as organ function, graft survival,
and mortality, results can be bene
into limiting factors of physical activity in recipients of solid organ transplantation. Field
tests are usually easy to perform, do not need supervision of a medical doctor, and are low
in cost.

erefore, these tests are useful in cohort studies as well as in the evaluation of
intervention studies. However, as stated,
Physical activity guidelines and reference values

cial in an assessment of functional capacity. Because

eld tests are utilized preferably in addition to
e leading recommendation on the amount and type of physical activity to promote or
25
maximal exercise testing in order to also generate strong outcome measures.
maintain health is composed by the American College of Sports Medicine (ACSM) and
the American Heart Association (AHA).

e ACSM/AHA guidelines recommend adults
to accumulate at least 30 minutes of moderate to vigorous intensity physical activity at least

ve days per week.
32,33

is guideline corresponds to the guideline adopted as the Dutch
norm for health enhancing physical activity.

e adult population with a clinically
signi

cant chronic condition or physical limitation is advised to comply with the general
recommendations for healthy adults to the extent that their abilities and conditions allow.
32,33,35

e formulation of the general guideline and the speci

c advice for persons with a
chronic condition a
o
34
rds ample opportunity for interpretation. How is moderate to
vigorous intensity de
ned and measured, and how is the ‘extent of a person’s abilities and
conditions’ determined? Furthermore, thus far, no studies have been performed that
speci

cally investigate the appropriateness of applying the general guidelines to
populations with a chronic disease or chronic condition and, therefore, it is not known
whether the general physical activity guidelines also apply for recipients of solid organ
transplantation.
Possibly ful

lling the general physical activity guidelines is a goal that is set too
high for recipients of solid organ transplantation. However, it is also possible that ‘just’
ful

lling the general guidelines is not enough to increase physical activity levels in the early
stages after transplantation. Due to usually prolonged periods of inactivity in the end-stage
disease phase, a higher frequency, duration, and/ or intensity of activities may possibly be
152.
25,30,31,