Page 61 - Physical activity in recipients of solid organ transplantation - Edwin J. van Adrichem

recipients.2
Physical activity in recipients of solid organ transplantation
Introduction
In 2014 a total of 7,741 solid organ transplants (SOT) were performed in the
EuroTransplant region, resulting in 46.8 transplants per million persons in the entire
region and 46.6 per million persons in the Netherlands.1
Short-term survival after SOT
has been greatly improved in the past decades due to advances in organ preservation,
surgical techniques, and immunosuppressant medication.2
As a result, long-term survival
and the associated issues like new onset diabetes, medication adherence, and quality of life
have gained increased attention, as has the level of physical activity (PA) after SOT.
While clinical experience and a few small studies indicate that SOT recipients can
achieve average to above average levels of PA,
6–14
the majority of recipients do not meet the
recommended amount and type of PA.
Movement behavior is below the levels of the
average population, which results in a generally sedentary and inactive lifestyle.

is occurs
despite the fact that a higher level of PA has been shown to be associated with decreased
cardiovascular and all-cause mortality in renal transplant recipients and improved outcomes
like a shorter hospital stay and increased short-term survival in lung and liver transplant
and quality of life in SOT recipients
factors.
health status’, ‘concerns about aggravation’, ‘fatigue’, ‘shortness of breath’, ‘fear of falling’,
‘lack of support’, and ‘lack of motivation’.
29
3–5
Furthermore, exercise training has been shown to improve physical functioning
15,16
and has the potential to reduce cardiovascular risk
15
It is not fully clear why solid organ transplant recipients do not regain a normal
level of physical activity, but several physical factors are likely to contribute to the low PA
levels in this population. Firstly, peripheral muscle dysfunction exists pre-transplantation in
all organ recipient groups.
2,17

factors including the use of immunosuppressive medication.
is condition is aggravated post-transplantation by many
Secondly, a reduction in
VO2 peak ranging from 20–50% is observed despite near normal functioning of the
21–28
17–19
transplanted organ.
17
In general, several personal and environmental factors may also in

uence PA
behavior. However, perceived barriers to and facilitators of PA in SOT recipients are
primarily unexplored. Barriers refer to perceived obstacles that hinder the performance of
PA, and facilitators refer to factors increasing the likelihood of performing PA.
20
Several
barriers to and facilitators of PA are indicated in end-stage kidney, liver, lung, and heart
disease. Salient barriers in the end-stage disease populations being indicated are ‘

uctuating
Important facilitators being indicated in the
end-stage disease phase are ‘exercising for health’, ‘social support’, ‘professional support’,
‘enjoying the activity’, ‘control of the condition’, and ‘social interactions’. While several
barriers to and facilitators of PA in the transplant population have been proposed, only one
study has examined them in a single group of SOT recipients by means of a questionnaire.
Examples of important barriers ascertained in kidney transplant recipients are ‘lack of
motivation’ and ‘preferring to spend time otherwise’, whereas important facilitators were
‘feeling healthy’ and ‘wanting to feel better’. However, the use of the questionnaire did not
provide insight into the recipients’ experiences of these barriers and facilitators and was
limited to only kidney transplant recipients.

e most appropriate research technique
59.
4