Page 161 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

However, additional research is needed in this
up-to-date clinical information and re
Physical activity in recipients of solid organ transplantation
Directions in research
e results of this thesis contribute to the further development of interventions to increase
physical activity and reduce sedentary time in recipients of solid organ transplantation.
ectiveness of interventions and newly arising themes in the physical activity and
transplantation
eld.

eld in order to obtain more insight into the
e

- E ectiveness of rehabilitation and physical therapy interventions:
Clinical decisions and rehabilitation programs should be supported by accurate, timely, and

ect the best available evidence. Relying on
randomized controlled trials in this

eld of study will likely not be su

cient as the
population is small and diverse. Furthermore, with the use of randomized controlled trials
with a control group that receives no intervention, half of the study population is omitted
from an intervention that is very likely to have several positive e

ects.

erefore, it might
even be considered as unethical to exclude half of the population from the intervention as
there is strong evidence of the positive e

recommend an evaluation of the e
ects of higher levels of physical activity in the
general population and subgroups of the transplantation population. I would, therefore,

ectiveness of programs that are introduced in regular
care. Comparing results of a population that begins with an intervention with an historical
cohort of recipients would be more practical and time-e
will accumulate and disseminate new knowledge through innovation in local rehabilitation
settings will be required. It was recently recommended to form a small group of innovative
institutions or expert centers to join around a shared set of clinical questions to achieve this
knowledge and innovation in a timely manner.

is requires a common set of advanced
process and outcome measures in order to aggregate and analyze su
46

cient data that will
enable answering questions of interest. In achieving this goal, international collaborations
are recommended. Future studies should also focus on the e

cient. A pragmatic approach that

ects of targeting the indicated
and amendable aspects associated with the level of physical activity and sedentary time in
this population.
d
- Muscle wasting and frailty in the transplant population: 47
- Development of transplant speci c physical activity gu As indicated, the physical activity guidelines are not speci
reference values. A good starting point would be to investigate the di
i
elines and reference values:
c for recipients of solid organ
transplantation and further research is needed to specify them.

e same is valid for

erences in the resting
transplant population.

speci
is data could be used in the development of a transplantation

c table of metabolic equivalents of tasks values for activities.
metabolic rate and energy expenditure during regular activities when compared to the non-
Muscle wasting and frailty are concepts that are gaining attention in the transplant
population. Muscle wasting has been linked to negative pre- and post-transplant outcomes
when compared to recipients with preserved muscle mass
, and frailty is emerging as an
159.
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