Page 170 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

Summary
Solid organ transplantation is a life-saving intervention for people with end-stage organ
failure. In the past decades, signi

cant improvements have been made in short-term
survival and subsequently there has been an increased focus on long-term outcomes
following transplantation. Hence, quality of life, level of physical activity, new onset
diabetes after transplantation, and medication adherence have gained increasing attention.
Especially the latter mentioned factors are likely to be amenable for intervention to further
prolong long-term survival. Physical functioning is indicated as an important goal as
functional recovery after transplantation is not as good as it might be expected, based on
the restoration of (near) normal organ function after transplantation. Physical activity in
the transplant population is highly relevant as current evidence suggests that greater
physical functioning in transplant recipients is associated with improved outcomes.
e
level of physical activity is indicated to be positively associated with the capacity to perform
activities of daily life, experienced quality of life, and survival. Evidence based knowledge
concerning the level of physical activity and factors associated with this level of physical
activity following transplantation is, however, limited.

is knowledge is required in order
to develop rehabilitation programs or physical therapy interventions and to compose the
appropriate content and focus areas in program development.

erefore, the general aim of
this thesis was to gain additional insight into the physical activity level of recipients of solid
organ transplantation and into factors that are associated with this level. An overview of
the main
ndings per study (Chapter 2-7) and concluding remarks are provided below.
Low levels of physical activity are strongly associated with an increased risk for
cardiovascular and all-cause mortality in recipients of renal transplantation. However, as
the incidence of cardiovascular disease is three to

ve times higher in recipients of renal
transplantation than in the general population it is plausible that the associations are in
part explained by pre-existing cardiovascular disease. To determine whether the association
between physical activity and mortality is independent of cardiac function, the e

ects of
cardiac damage, as measured by cardiac biomarkers on the associations with mortality was
studied in
Chapter 2
. Analyses were performed with data on the physical activity level of
540 recipients of renal transplantation and three ascertained cardiac damage markers. Low
levels of physical activity and high levels of the cardiac biomarkers MR-proANP, NT-
proBNP, and Hs-TnT were all strongly associated with both cardiovascular and all-cause
mortality in recipients of renal transplantation. Nevertheless, the association between
physical activity, cardiovascular, and all-cause mortality was independent of these markers.

e cardiac markers did have a signi c
ant mediation e

ect on the association between
physical activity and outcome.

ese
ndings indicate pre-existing cardiac damage as an
intermediate step of the causal pathway between physical activity and cardiovascular
mortality in recipients of renal transplantation.
To study factors that potentially limit the level of physical activity in recipients of
solid organ transplantation a longitudinal historical cohort study on functional exercise
capacity was performed in recipients of lung transplantation. As described in
Chapter 3,
of lung transplantation and factors associated with this de
capacity have not been studied longitudinally.

ciency in functional exercise
erefore, this study aimed to analyze the
exercise capacity, muscle function, and physical activity levels remain reduced in recipients
168.