Exercise and sport for health in solid organ transplant recipients

Is well known that physical activity reduces rate of cardiovascular and all-cause mortality in the general population and in transplanted recipients. However, most of those investigations present limits. Few data are available on exercise effectiveness on kidney and liver transplant recipients and the correlation between practising exercise, lipid profile and renal function. Additionally, the knowledge on the amount of safe training for sport competitions for this population is limited. This thesis aims to increase the knowledge on the type of exercise and training adapted for transplant recipients and its relative effects on aerobic capacity, strength and quality of life. Moreover, correlation between exercise and blood pressure parameters in solid organ transplant are considered for safeguard of the graft function. The first part of this thesis focuses on the effects of exercise in kidney and liver transplant recipients by health pathways. The second part focus on the sport in solid organ transplant recipients to break down the prejudice that “transplantation” and “sport” cannot coexist. In detail, we investigate the renal function, metabolic profile, glycemia and the physical fitness after 12 months of supervised aerobic and resistance training in kidney and liver transplant recipients, compared with not supervised home-based physical activity. The results of these studies can provide information on the beneficial effects of combined exercise and identify the type of safe exercise to prescribe for the kidney and liver transplant population. These indications are intended to encourage the healthcare world to refer pre-and post-transplant patients to follow a healthy lifestyle including regular exercise for the prevention of cardiovascular diseases. To obtain more adherence in the prescription of exercise in transplant patients a study promote the network in which transplant centers, sports medicine centers and certified gyms collaborate to encourage the practice of prescribed and controlled exercise in pre- and post-transplant patients

GDF15 Plasma Level Is Inversely Associated With Level of Physical Activity and Correlates With Markers of Inflammation and Muscle Weakness

Growth differentiation factor 15 (GDF15) is a stress molecule produced in response to mitochondrial, metabolic and inflammatory stress with a number of beneficial effects on metabolism. However, at the level of skeletal muscle it is still unclear whether GDF15 is beneficial or detrimental. The aim of the study was to analyse the levels of circulating GDF15 in people of different age, characterized by different level of physical activity and to seek for correlation with hematological parameters related to inflammation. The plasma concentration of GDF15 was determined in a total of 228 subjects in the age range from 18 to 83 years. These subjects were recruited and divided into three different groups based on the level of physical activity: inactive patients with lower limb mobility impairment, active subjects represented by amateur endurance cyclists, and healthy controls taken from the general population. Cyclists were sampled before and after a strenuous physical bout (long distance cycling race). The plasma levels of GDF15 increase with age and are inversely associated with active lifestyle. In particular, at any age, circulating GDF15 is significantly higher in inactive patients and significantly lower in active people, such as cyclists before the race, with respect to control subjects. However, the strenuous physical exercise causes in cyclists a dramatic increase of GDF15 plasma levels, that after the race are similar to that of patients. Moreover, GDF15 plasma levels significantly correlate with quadriceps torque in patients and with the number of total leukocytes, neutrophils and lymphocytes in both cyclists (before and after race) and patients. Taken together, our data indicate that GDF15 is associated with decreased muscle performance and increased inflammation

Physical Activity in Solid Organ Transplant Recipients: Preliminary Results of the Italian Project

Background/Aims: The role of physical activity in transplanted patients is often underestimated. We discuss the Italian National Transplant Centre experience, which started in 2008 studying transplanted patients involved in sports activities. The study was then developed through a model of cooperation between surgeons, sports physicians and exercise specialists. Methods: A multicentre study was realized in 120 transplanted patients of which 60 treated with supervised physical activity (three sessions/week of aerobic and strengthening exercises) and 60 controls. We present the results of the first 26 patients (16 males, 10 females; 47.8±10.0 years; 21 kidney, 5 liver transplanted; time from transplant 2.3±1.4 years) who completed 12 months of supervised physical activity. Results: Data showed an increase of peak aerobic power (t=4.535; PConclusion: These preliminary results confirm the positive effects of supervised physical exercise. It can be considered as an input to promote other detailed exercise protocols

Renal Function in Kidney and Liver Transplant Recipients After A 130-km Road Cycling Race

Background: A few patients, after receiving solid organ transplantation, return to performing various sports and competitions; however, at present, data no study had evaluated the effects of endurance cycling races on their renal function. Methods: Race times and short form (36) health survey questionnaires of 10 kidney transplant recipients (KTR) and 8 liver transplant recipients (LTR) transplanted recipients involved in a road cycling race (130 km) were compared with 35 healthy control subjects (HCS), also taking laboratory blood and urine tests the day before the race, at the end of the race, and 18 to 24 hours after competing. Results: The 3 groups showed similar race times (KTR, 5 hours 59 minutes \ub1 0 hours 39 minutes; LTR, 6 hours 20 minutes \ub1 1 hour 11 minutes; HCS, 5 hours 40 minutes \ub1 1 hour 28 minutes), similar short form (36) health survey scores, and similar trend of laboratory parameters which returned to baseline after 18 to 24 hours. After the race, there was an increase in creatinine (0.24 mg/dL; effect size [ES] = 0.78; P < 0.001), urea (22 mg/dL; ES = 1.42; P < 0.001), and a decrease of estimated glomerular filtration rate ( 1217 mL/min; ES = 0.85; P < 0.001). The increase of blood uric acid was more remarkable in HCS and KTR (2.3 mg/dL; ES = 1.39; P < 0.001). The KTR showed an increase of microalbuminuria (167.4 mg/L; ES = 1.20; P < 0.001) and proteinuria (175 mg/mL; ES = 0.97; P < 0.001) similar to LTR (microalbuminuria: 176.0 mg/L; ES = 1.26; P < 0.001; proteinuria: 213 mg/mL; ES = 1.18; P < 0.001), with high individual variability. The HCS had a nonsignificant increase of microalbuminuria (4.4 mg/L; ES = 0.03; P = 0.338) and proteinuria (59 mg/mL; ES = 0.33; P = 0.084). Conclusions: Selected and well-trained KTR and LTR patients can participate to an endurance cycling race showing final race times and temporary modifications of kidney function similar to those of HCS group, despite some differences related to baseline clinical conditions and pharmacological therapies. Patients involved in this study represent the upper limit of performance currently available for transplant recipients and cannot be considered representative of the entire transplanted population

Renal function and physical fitness after 12-mo supervised training in kidney transplant recipients

To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations

Effects of combined strength and endurance training on exercise capacity in kidney transplant cyclists and runners

Introduction: After transplantation, engaging in regular physical activity (PA) or sport is recommended for health. Participation to competitive sports is increasingly common among kidney transplant recipients while little is known on how training affects the physical performance in transplanted athletes. Aim: The purpose of this case study was to assess the effects of a tailored training program on exercise parameters in kidney transplant cyclists (CKTRs) and runners (RKTRs). Methods: Twelve male transplanted athletes were enrolled. The workload at aerobic and anaerobic thresholds, the submaximal aerobic power (V'O2 stage) and rate of perceived exertion (RPE) during an incremental cycling or running test, and the peak instantaneous force (PIF) during a countermovement jump were assessed at baseline (T0) and after 6 months of tailored training (T6) consisting in strength and aerobic exercises. Exercise adherence, blood lipid profile and renal function were also investigated. Results: Eight CKTRs and 4 RKTRs completed the 6-month training period, with a significant increase of training volume (minutes/week). The exercise adherence was met by 90% in both groups. At T6, there were significant (p<0.05) improvements of maximum workload attained, the workload corresponding to the aerobic threshold and PIF, while workloads at anaerobic threshold, V'O2 stage and RPE were unchanged. Blood cholesterol significantly decreased (p<0.01), while the other blood parameters were unchanged. Conclusions: These findings indicate that the combined strength and endurance training is well tolerated and may improve exercise performance in this selected population of KTRs

Longitudinal Analysis of Cardiovascular Risk Factors in Active and Sedentary Kidney Transplant Recipients

Despite the benefits of physical activity on cardiovascular risk in kidney transplant recipients (KTRs), the long-term effects of exercise have been poorly investigated. This is a three-year observational study comparing graft function and cardiovascular risk factors in active KTRs (AKTRs) vs. sedentary KTRs (SKTRs). Methods: KTRs with stable renal function were assigned to active or sedentary group in relation to the level of daily physical activity based on World Health Organization (WHO) recommendations (<150 or >150 min/week, respectively). Complete blood count, renal function indices, lipid profile, blood pressure and anthropometric measures were collected yearly for an observation period of three years. The comparisons between the two groups were performed by repeated measures analyses of covariance (ANCOVAs), with age as a covariate. Results: Fifty-four subjects were included in the study. Thirty of them were identified as AKTRs (M/F 26/4, aged 45 \ub1 12 years) and 24 as SKTRs (M/F 18/6, aged 51 \ub1 14 years). Baseline characteristics were similar between the groups except body mass index (BMI) that was significantly higher in SKTRs (p = 0.043). Furthermore, over the three-year observation period, BMI decreased in AKTRs and increased in SKTRs (p = 0.006). Graft function was stable in AKTRs, while it showed a decline over time in SKTRs, as indicated by the rise in serum creatinine levels (p = 0.006) and lower eGFR (p = 0.050). Proteinuria, glucose and uric acid levels displayed a decrease in AKTRs and an increase in SKTRs during the three-year period (p = 0.015, p = 0.004 and p = 0.013, respectively). Finally, concerning lipid profiles, AKTRs had a significant reduction over time of triglycerides levels, which conversely showed a clinically relevant increase in SKTRs (p = 0.014). Conclusions: Our findings indicate that regular weekly exercise training may counteract the increased cardiovascular risks and also prevent graft function decline in KTRs

Physical Activity in Solid Organ Transplant Recipients: Preliminary Results of the Italian Project

Background/Aims: The role of physical activity in transplanted patients is often underestimated. We discuss the Italian National Transplant Centre experience, which started in 2008 studying transplanted patients involved in sports activities. The study was then developed through a model of cooperation between surgeons, sports physicians and exercise specialists. Methods: A multicentre study was realized in 120 transplanted patients of which 60 treated with supervised physical activity (three sessions/week of aerobic and strengthening exercises) and 60 controls. We present the results of the first 26 patients (16 males, 10 females; 47.8±10.0 years; 21 kidney, 5 liver transplanted; time from transplant 2.3±1.4 years) who completed 12 months of supervised physical activity. Results: Data showed an increase of peak aerobic power (t=4.535; PConclusion: These preliminary results confirm the positive effects of supervised physical exercise. It can be considered as an input to promote other detailed exercise protocols

A Comparison Between The Recovery Responses Following an Eccentrically Loaded Bench Press Protocol Vs. Regular Loading in Highly Trained Men

The purpose of this study was to compare the physiological responses of a single bout of an eccentric accentuated bench press protocol (120% of 1RM in the eccentric phase/80% in the concentric phase; [120/80]) versus a regular high-intensity exercise protocol (80%/80%; [80/80]) in resistance-trained men. Eleven men (age = 25.6 \ub1 3.9 y; body mass = 84.6 \ub1 11.2 kg; body height = 176.4 \ub1 3.9 cm) with 6.3 \ub1 3.4 y of resistance training experience performed each protocol in counterbalanced, randomized order. Isometric, isokinetic and ballistic tests were performed at the bench press (IBPF, ISOK and BTP, respectively) at baseline (BL), 15-min (15P), 24-h (24P), and 48-h (48P) post-exercise for each testing session. In addition, muscle thickness of the pectoralis major (PecMT) was measured at the same timepoints via ultrasound. Significantly greater reductions in BTP (p < 0.001), peak force during both ISOK (p =0.005) and IBPF (p = 0.006) at 15P were detected in 120/80 compared to 80/80. BTP was still significantly (p = 0.009) impaired at 48P following the 120/80 protocol, while no differences were noted following 80/80. PecMt was significantly elevated following both 120/80 and 80/80 (p < 0.05) at 15P, but significant differences between the trials were present at 15P and 24P (p = 0.005 and p = 0.008, respectively). Results indicated that heavy eccentric loading during the bench press exercise caused greater performance deficits than a bout of traditionally loaded high intensity resistance exercise. Power performance appears to be more influenced by the 120/80 protocol than isometric peak force. Eccentrically loaded exercise sessions should be separated by at least 48 hours to obtain a complete recovery of the initial muscle morphology and performance

High Level Cycling Performance 10 Years after Cardiac Transplantation

Purpose: To describe cycling performance in a well-trained male a decade after Cardiac Transplantation (CTX). Case report: The patient was diagnosed with arrhythmo- genic right ventricular cardiomyopathy at 14 years of age and underwent CTX at 35 years. Exercise training began 3 weeks after CTX, and progressively increased in volume and intensity. Ten years after CTX he participated in twelve one-day cycling races over an eight-month period. Maximal cardiopulmonary exercise test was performed before the study. One race was monitored using a power meter. Results: VO2peak (47.2 mL/kg/min), maximal HR (161 bpm), and oxygen pulse (18.8 mL/bpm) were 113%, 92%, and 118% of age-predicted values respectively. HR, W, and relative VO2 at the ventilatory threshold and at the respira- tory compensation point were 128 bpm, 120 W, and 75% VO2peak, and 142 bpm, 155 W, and 86% VO2peak respec- tively. Cycling economy was ~80 W per liters per O2/min. The race was completed in 7 hours and 56 minutes, at an average of 141 bpm and 162 W, remaining between moder- ate-to-high intensity (4 h 2 min), and above high-to-severe intensity (2 h 19 min). Conclusion: Long-term aerobic training may result in a re- markable cycling performance a decade after CTX, likely because of cardiovascular adaptations