Page 33 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

risk in RTR.
MET-min/day.

this population is substantially driven by CV-mortality.

erence in the level of PA (MET-min/day) resulted in a 13%
reduction of CV-mortality risk (hazard ratio 0.87). For example, a person spending 150
MET-min/day has 0.87 times the risk of CV-mortality compared to a person spending 75
e risk reduction of 13% is comparable to the change observed for the
risk of CV-mortality in heavy smokers who had stopped smoking.
fold or greater change in PA is likely to be highly attainable in many high-risk patients due
to their current low level of PA. Participants in the lowest tertile of this cohort performed
uenced by controlling for the levels of the cardiac markers, and no signi
ndings demonstrate that the cardiac markers are not confounding the indicated
association. To facilitate a better understanding of the pathways through which the
association between PA and CV-mortality could be explained, mediation analyses were
performed.

e generally accepted hypothesis that an increase in PA will result in a
reduction in CV-risk was applied as a basis for the mediation model.
showed that all markers signi
data, preferably from a controlled trial, is required to con
Physical activity in recipients of solid organ transplantation
cant results on the association between PA and non-
cardiovascular death indicated that the association between PA and all-cause mortality in
A two-fold di

interaction e ects were detected between the cardiac markers and level of PA. ese
markers. is indirect e ect accounts for 21% to 33% of the total observed e ect which is
37 38–40
41
dependent vasodilatation through increased production of nitric oxide where high intensity
cantly mediated the association between PA and CV-
intensity of PA that is required to generate cardiovascular health bene
adults, patients with hypertension, and patients with coronary artery disease and chronic

33
Importantly, a two-
the equivalent of

ve minutes or less of PA per day whereas the recommended amount is
30 minutes of moderate to vigorous intensity PA per day (=150 MET-min/day).
Examples of activities of this type are washing the windows, mowing the lawn, playing golf,
and brisk walking (>5 km/h).
in

35
e hazard ratio for the association of PA with CV-mortality was only minimally
1,36

rm the possible cardiovascular

cant
34
ese analyses

mortality.

ere is a signi

cant indirect e

substantial and, therefore, indicates an important pathway.
ect of PA on CV-mortality through the cardiac

e notable proportion of the indirect e
possible intermediate steps in the causal pathway leading from PA to mortality reduction.
improvements in cardiovascular health.

ect suggests pre-existent HF and CAD as
If so, the mortality reduction associated with PA is likely to be related to general
is hypothesis is supported by literature showing
that physical exercise may lower cardiac biomarker levels in other populations. PA is known
to lower Hs-TnT in elderly patients
intervention studies showed that NT-proBNP could be signi
and, similarly, a systematic review and several

cantly lowered by exercise
training in patients with heart failure.
However, this position has been questioned in a
recent randomized controlled trial of 928 patients with heart failure whereby exercise
training did not induce a meaningful change in NT-pro-BNP or Hs-TnT.
Longitudinal
health bene

ts of PA in RTR. More insight should also be provided into the amount and

ts in RTR. As is
already known, aerobic exercise enhances endothelial-dependent vasodilatation in healthy
heart failure.
42,43
e non-signi

It is suggested that moderate-intensity PA augments endothelial-
31.
2