Page 159 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

Physical activity in recipients of solid organ transplantation In the systematic review on exercise training in recipients of solid organ
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transplantation, it was also demonstrated that, for the described interventions, there was a
substantial variation in the length of time between the transplantation and the initiation of
the exercise program.
For recipients of a heart transplantation, it was indicated that
exercise training that began within one year after transplantation was associated with
signi

cant improvements in the overall maximal oxygen uptake compared to standard care
whereas those who started the exercise program 12 months after transplantation exhibited
no signi

cant improvement in functional capacity.
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Based on several observations in
clinical practice and from the described research

ndings, we hypothesize that starting
rehabilitation between three and nine months after transplantation would be optimal. First,
it is expected that natural recovery will occur in the period after discharge from the
hospital. Being at home and becoming familiar with functioning of the new organ will
likely provide su

cient stimulation to resume activities of daily life and generate an initial
increase in the level of physical activity compared to the pre-transplantation phase. Second,
the results of our study as described in Chapter 3 and another study on the longitudinal
recovery after transplantation showed that there is an initial steep increase in recovery in
the half

rst six months after transplantation, but this recovery does not continue in the second ng to
of the rst year.2,45 ird, to be able to perform su cient maximal exercise testi be used in establishing an adequate training schedule, participants should be able to
perform a maximal exercise test of a duration between eight and 12 minutes.
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supervised rehabilitation programs, therefore, should be developed.
is
combination of factors makes us believe that intervening between three to nine months
after the transplant would be optimal.

e geographical distribution of recipients of a solid organ transplantation is wide
and, therefore, centralized outpatient rehabilitation programs are di
time and the burden it places on recipients is likely to be detrimental to the expected pro

cult to realize. Travel
t
of exercise training. Alternatives to full hospital or rehabilitation center based and
As indicated in several studies in this thesis, there are no overt di
transplantation groups in physical activity level, sedentary time, and its associated factors,
e
rences between
therefore, we would propose that rehabilitation programs are designed generically to
include all types of recipients of organ transplantation. Based on the

ndings of this thesis,
a rehabilitation program designed as an assessment week after transplantation was
proposed. In this proposition, we have assumed that an expert center will take the lead in
the program and be in charge of assessment and setting up the rehabilitation program. In
that program, the physical component is the primary element, but a broader lifestyle
assessment is also performed [Box 1]. Currently, the proposed program is being performed
in a pilot setting to generate experience and preliminary results in order to investigate
whether the program can be broadly applied or should be adapted.
157.
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