Page 155 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

Physical activity in recipients of solid organ transplantation necessary in order to develop the prerequisite functions to develop and maintain a healthy
and active lifestyle with a su
cient amount of physical activity. Increasing physical activity
levels in daily life (usually on a light to moderate intense level) is potentially not enough to
regain a normal exercise capacity and, therefore, training or exercise on a higher intensity
level seems mandatory.

e use of immunosuppressive medication after transplantation and the associated
risks of this medication on the development of cardiovascular diseases might also positively
support guidelines that are more elaborate for transplant recipients to prevent the
development of secondary diseases, however, further studies are needed. Considering the
amount of physical activity in the general population, it was stated by Powell et al. in 2011
that ‘some activity is better than none, and more is better than some’.
28
However, it is
unclear if this is also the case for cardiovascular risk reduction in the transplant population;
potentially complying with the guidelines is necessary to achieve positive e

ects.
Future
studies should provide more insight into the amount and intensity of physical activity that
is required to generate cardiovascular health bene

ts. As is already known, aerobic exercise
enhances endothelial-dependent vasodilatation in healthy adults, patients with
hypertension, and patients with coronary artery disease and chronic heart failure.
36,37
Moderate-intensity physical activity has been shown to augment endothelial-dependent
vasodilatation through increased production of nitric oxide where high intensity aerobic
exercise potentially leads to oxidative stress.
activity for generating the maximal positive e
unknown.

e optimal frequency and intensity of physical
ect in recipients of organ transplantation is
also not speci
Related to the guidelines not being speci
tasks to determine the intensity of activities.
physical e
38

is one MET unit is speci

c, reference values that are available are

c for the transplant population. As an example, the SQUASH questionnaire
that is used in Chapter 6 provides information on the amount and intensity of physical
activities performed in daily life and utilizes a compendium of metabolic equivalents of

e metabolic equivalent of tasks (MET) is a
unit of measurement within physiology that expresses the amount of energy that a certain

ort requires when compared to the amount of energy required at rest. One
MET corresponds to the resting metabolic rate, the amount of energy consumed during
sitting or lying supine.

ed at 3.5 milliliters of oxygen per
kilogram body weight per minute. Complying with the physical activity guidelines would
lead to 150 MET minutes of physical activity per week in which moderate to vigorous
physical activities are de

ned as activities of at least 4.0 MET (adult population). To
calculate the intensity of indicated activities, a compendium of physical activities is used.
is broadly employed compendium, however, is based on the energy expenditure of the
average American population when performing speci

c tasks or sports. It is questionable if
these values are one to one transferable to a European population and even more
questionable if persons with a chronic disease or condition have the same metabolic rate
and movement e

ciency. Furthermore, the transformation of absolute data to a relative
39
intensity of an activity can only be performed accurately if a subject’s maximal oxygen
intake is known and, therefore, questionnaire data will always result in a gross estimation.
153.
24
8