Effects of exercise and sport in solid organ transplant recipients: a review

Solid organ transplantation is the gold-standard treatment for many with end-organ failure and can offer a new independence from the burden of disease. However solid organ transplant recipients (SOTRs) remain at high risk of cardiovascular disease (CVD), poor quality of life and physical functioning. Increasing physical activity and exercise can improve the health of the general population, however the effects on those with a transplant remain unclear. Intensive exercise and sporting activity has the potential to be beneficial, although there remain concerns particularly around the effects on immune function and the CV system. This review summarises what is known about the effects of exercise on determinants of health in SOTR and then collates the available literature investigating the consequences of intensive exercise and sport on the health of SOTR. There is a paucity of high-quality research, with most evidence being case-studies or anecdotal; this is understandable given the relatively few numbers of SOTR who are performing sport and exercise at a high level. However if suitable evidence-based guidelines are to be formed and SOTR are to be given reassurances that their activity levels are not detrimental to their transplanted organ and overall health, then more high-quality studies are required

The Impact of Exercising During Haemodialysis on Blood Pressure, Markers of Cardiac Injury and Systemic Inflammation - Preliminary Results of a Pilot Study

This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.Background/Aims: Patients requiring haemodialysis have cardiovascular and immune dysfunction. Little is known about the acute effects of exercise during haemodialysis. Exercise has numerous health benefits but in other populations has a profound impact upon blood pressure, inflammation and immune function; therefore having the potential to exacerbate cardiovascular and immune dysfunction in this vulnerable population. Methods: Fifteen patients took part in a randomised-crossover study investigating the effect of a 30-min bout of exercise during haemodialysis compared to resting haemodialysis. We assessed blood pressure, plasma markers of cardiac injury and systemic inflammation and neutrophil degranulation. Results: Exercise increased blood pressure immediately post-exercise; however, 1 hour after exercise blood pressure was lower than resting levels (106±22 vs. 117±25 mm Hg). No differences in h-FABP, cTnI, myoglobin or CKMB were observed between trial arms. Exercise did not alter circulating concentrations of IL-6, TNF-α or IL-1ra nor clearly suppress neutrophil function. Conclusions: This study demonstrates fluctuations in blood pressure during haemodialysis in response to exercise. However, since the fall in blood pressure occurred without evidence of cardiac injury, we regard it as a normal response to exercise superimposed onto the haemodynamic response to haemodialysis. Importantly, exercise did not exacerbate systemic inflammation or immune dysfunction; intradialytic exercise was well tolerated

Releasing The Anti-inflammatory Potential of Paralysed Skeletal Muscle: The Circulating Cytokine Response to Voluntary Upper-limb Exercise With/Without The Addition of Functional Electrical Stimulation (FES)-evoked Lower-limb Contractions

Skeletal muscle is a rich store of inflammatory mediating ‘myokines’. Following release from contracting muscle, the myokine interleukin-6 (IL-6) promotes a circulating anti-inflammatory environment associated with a reduced risk of cardiovascular disease (CVD). The metabolic and functional consequences of lower-limb paralysis, including the gain in relative adiposity and physical inactivity, result in a high prevalence of CVD in individuals with a spinal cord injury (SCI). However, the magnitude of any contraction-induced myokine response in this population may be limited by the small active muscle mass of the upper-limb. The combination of voluntary, upper-limb exercise and involuntary, functional electrical stimulation (FES)-evoked lower-limb cycling termed ‘hybrid’ exercise, may augment the acute myokine response by activating a greater volume of muscle mass than upper-limb exercise alone. Five community-based individuals with motor complete, thoracic SCI (Age=44±15 years; Body mass=66.6±14.3 kg) and at least 3 months FES-evoked cycling experience volunteered to participate. On separate occasions, each participant performed 30 min of voluntary upper-limb, hand cycling exercise with (HYBRID) and without (ARM only) the addition of FES-evoked lower-limb cycling at a fixed workload. Blood samples were collected at rest, immediately post-exercise, and 1 and 2 h post-exercise. Plasma concentrations of IL-6, IL-10 and IL-1ra were subsequently determined by enzyme linked immunoassay. Estimated energy expenditure was significantly higher in HYBRID (154±25 kcal) than ARM (132±21 kcal) (P=0.01; ES=0.90). Plasma IL-6 concentrations were significantly elevated following HYBRID, with values 1 h and 2 h post-exercise significantly higher than rest and immediately post-exercise (P\u3c0.04). A small (~50%) non-significant increase in IL-6 was present 1 h and 2 h post-exercise following ARM, however concentrations were significantly higher in HYBRID than ARM at the same time points (P\u3c0.02). Plasma IL-10 concentrations were unaffected by exercise in ARM. Although not attaining statistical significance, there was a tendency for IL-10 concentrations to rise in HYBRID, with an 85% increase in IL-10 concentrations at 2 h post exercise. Plasma IL-1ra was unaffected by exercise in both trials. Initial findings suggest paralysed skeletal muscle releases the myokine IL-6 in response to electrically evoked contractions. Further, voluntary upper-limb exercise combined with involuntary lower-limb FES-evoked exercise had the tendency to elevate plasma concentrations of the anti-inflammatory cytokine IL-10; this effect was not present when performing arm exercise alone. Hybrid exercise may offer a method of maximising the anti-inflammatory potential of acute exercise in individuals with a SCI. The current findings require verification in a larger cohort

Upper respiratory tract symptoms and salivary immunoglobulin A of elite female gymnasts : a full year longitudinal field study

The aim of this study was to determine the frequency of upper respiratory tract symptoms (URS) in elite female gymnasts during a training season. In addition, we aimed to observe the extent to which salivary immunoglobulin A (sIgA) is associated with URS in these athletes, including potential effects of the season and timing of sample collection. Over one year, 18 elite female gymnasts completed URS and fatigue questionnaires weekly and provided 1 mL of saliva after a minimum 36 h of rest (morning or afternoon) to measure relative sIgA concentration (= mean absolute sIgA value of the week divided by the mean absolute sIgA value of the weeks without URS). Mean weekly URS and mean relative sIgA values per gymnast correlated negatively (r = -0.606, P = 0.022). Most URS were noted in the most fatigued gymnasts (7.4 ± 10.1 vs. 2.5 ± 5.6 (P < 0.001) for ‘normal’ and 2.1 ± 3.7 (P = 0.001) for ‘better than normal’ rested). In spring, relative sIgA was higher compared to autumn (112 ± 55 vs. 89 ± 41%, P < 0.001) and winter (92 ± 35%, P = 0.001), while during summer, relative sIgA appeared higher compared to autumn (110 ± 55 vs. 89 ± 41%, P = 0.016). The interaction effect with timing of sample collection showed higher relative sIgA values in morning samples in spring and summer compared to afternoon samples, with the inverse observed in autumn and winter (F = 3.565, P = 0.014). During a gymnastics season, lower relative sIgA values were linked to higher susceptibility to URS in elite gymnasts. However, relative sIgA values were influenced by season and timing of sample collection and thus should be considered when interpreting sIgA data

Microparticles and exercise in clinical populations

Microparticles (MPs) are shed membrane vesicles released from a variety of cell types in response to cellular activation or apoptosis. They are elevated in a wide variety of disease states and have been previously measured to assess both disease activity and severity. However, recent research suggests that they also possess bioeffector functions, including but not limited to promoting coagulation and thrombosis, inducing endothelial dysfunction, increasing pro‐inflammatory cytokine release and driving angiogenesis, thereby increasing cardiovascular risk. Current evidence suggests that exercise may reduce both the number and pathophysiological potential of circulating MPs, making them an attractive therapeutic target. However, the existing body of literature is largely comprised of in vitro or animal studies and thus drawing meaningful conclusions with regards to health and disease remains difficult. In this review, we highlight the role of microparticles in disease, comment on the use of exercise and dietary manipulation as a therapeutic strategy, and suggest future research directions that would serve to address some of the limitations present in the research to date

Effects of a Lactobacillus salivarius probiotic intervention on infection, cold symptom duration and severity, and mucosal immunity in endurance athletes

The purpose of this study was to examine the effects of a probiotic supplement during 4 mo of spring training in men and women engaged in endurance-based physical activities on incidence of upper respiratory tract infections (URTI) and mucosal immune markers. Sixty-six highly active individuals were randomized to probiotic (n = 33) or placebo (n = 33) groups and, under double-blind procedures, received probiotic (PRO: Lactobacillus salivarius, 2 × 1010 bacterium colony-forming units) or placebo (PLA) daily for 16 wk. Resting blood and saliva samples were collected at baseline and after 8 and 16 wk. Weekly training and illness logs were kept. Fifty-four subjects completed the study (n = 27 PRO, n = 27 PLA). The proportion of subjects on PRO who experienced 1 or more wk with URTI symptoms was not different from that of those on PLA (PRO .58, PLA .59; p = .947). The number of URTI episodes was similar in the 2 groups (PRO 1.6 ± 0.3, PLA 1.4 ± 0.3; p = .710). Severity and duration of symptoms were not significantly different between treatments. Blood leukocyte, neutrophil, monocyte, and lymphocyte counts; saliva IgA; and lysozyme concentrations did not change over the course of the study and were not different on PRO compared with PLA. Regular ingestion of L. salivarius does not appear to be beneficial in reducing the frequency of URTI in an athletic cohort and does not affect blood leukocyte counts or levels of salivary antimicrobial proteins during a spring period of training and competition

The impact of exercising during haemodialysis on blood pressure, markers of cardiac injury and systemic inflammation - preliminary results of a pilot study

Background/Aims: Patients requiring haemodialysis have cardiovascular and immune dysfunction. Little is known about the acute effects of exercise during haemodialysis. Exercise has numerous health benefits but in other populations has a profound impact upon blood pressure, inflammation and immune function; therefore having the potential to exacerbate cardiovascular and immune dysfunction in this vulnerable population. Methods: Fifteen patients took part in a randomised-crossover study investigating the effect of a 30-min bout of exercise during haemodialysis compared to resting haemodialysis. We assessed blood pressure, plasma markers of cardiac injury and systemic inflammation and neutrophil degranulation. Results: Exercise increased blood pressure immediately post-exercise; however, 1 hour after exercise blood pressure was lower than resting levels (106±22 vs. 117±25 mm Hg). No differences in h-FABP, cTnI, myoglobin or CKMB were observed between trial arms. Exercise did not alter circulating concentrations of IL-6, TNF-α or IL-1ra nor clearly suppress neutrophil function. Conclusions: This study demonstrates fluctuations in blood pressure during haemodialysis in response to exercise. However, since the fall in blood pressure occurred without evidence of cardiac injury, we regard it as a normal response to exercise superimposed onto the haemodynamic response to haemodialysis. Importantly, exercise did not exacerbate systemic inflammation or immune dysfunction; intradialytic exercise was well tolerated

Immunometabolism: Molecular mechanisms, diseases, and therapies 2018

Immunometabolism: Molecular mechanisms, diseases, and therapies 201

Relationships between illness representations, physical activity and depression in chronic kidney disease

Background: Chronic Kidney Disease (CKD) is exacerbated by depression and confers significant healthcare costs. Whilst adverse impacts may be mitigated by physical activity, many patients with CKD remain physically inactive, with this physical inactivity potentially influenced by how CKD is appraised. Objectives: The study aims to explore the relationship between physical activity, depression and illness representations in CKD. Methods: Non-dialysing patients with CKD completed the Revised Illness Perception Questionnaire (IPQ-R), Beck Depression Inventory (BDI-II) and Short-Form International Physical Activity Questionnaire (IPAQ-SF) while demographic information was obtained via medical records. Correlation and regression analyses were conducted to determine the relationship of illness representations with levels of physical activity. Moderation and mediation analyses were performed to investigate the role of depression in any relationship between illness representations and physical activity levels. Results: Seventy respondents, with a mean age of 60 ± 16 years, the majority being male (60%), took part in the study. Of illness representation dimensions, personal control was positively associated with levels of physical activity (r=.288, p<.05) while timeline cyclical was a significant predictor (Beta=-.423, p=.008). Severity of depression was neither a moderator (b= .023, 95% CI [-.015, .061], t=1.201, p=.23) nor a mediator (b=-.021, BCa CI [-.082, .008], p=.33). Conclusions: Facets of illness representations had significant relationships with levels of physical activity. Future research concerning the development and validation of psychological interventions based on an illness representations framework for patients with CKD not on renal-replacement therapy is proposed. The efficacy of such interventions could be then evaluated using a randomised controlled method

An increase in circulating monocyte and platelet derived microparticles during haemodialysis

An increase in circulating monocyte and platelet derived microparticles during haemodialysi