Rehabilitation and 6-Minute Walk Test After Liver Transplantation (original) (raw)
Related papers
Journal of Basic and Clinical Health Sciences
Purpose: Exercise capacity is an independent predictor of the disease prognosis in many clinical conditions. This study aims to predict the functional exercise capacity determinants and investigate the association between the functional status variables in liver transplant candidates. Methods: This prospective cross-sectional study consisted of thirty patients who were scheduled for liver transplantation. Respiratory and peripheral muscle strengths were measured using a mouth pressure device and a hand-held dynamometer, respectively. Dyspnea, physical activity, fatigue, exercise capacity, physical performance, and quality of life of participants were evaluated using the Modified Borg Scale, the International Physical Activity Questionnaire, the Turkish version of the Checklist Individual Strength Questionnaire, the Six-minute Walk Test, the 30-sec Sit-to-Stand Test, and the Liver Disease Symptom Index 2.0, respectively. A multivariate linear regression analysis was conducted to iden...
Advances in Rehabilitation, 2021
Introduction: Regular physical activity results in many health benefits, however many studies indicate that the level of activity of patients after transplantation is low. The purpose of the study was to assess the level of daily physical activity in patients after liver (LTx) or kidney transplantation (KTx) and the usefulness of a selfmonitoring method in increasing their daily physical activity. Material and methods: Patients after LTx or KTx (n=100) has been enrolled to the study and were randomly assigned to either an intervention (IG) or control group (CG). Ninety-four participants completed the 3 month period of observation. Participants assigned to IG were monitoring their daily physical activity using a pedometer and were required to complete a diary of daily number of steps. The level of physical activity was also assessed by International Physical Activity Questionnaire (IPAQ). In the statistical analysis the parametric and non-parametric tests has been used in consistency with data distribution. A value of P ≤ 0.05 was considered significant. Results: The average daily number of steps in pre/posttest in both study groups was less than 7600. A significant relationship between the average daily number of steps and daily Total Physical Activity Score TPAS/day [MET-min/day] (p<0.001; r=0.57). The study did not revealed any effects of intervention. Conclusions: Daily physical activity in patients after KTx or LTx is low, but it does not differ from healthy populations (<7500 steps). In post-transplant comprehensive medical management, long-term physical activity recommendations could be included on a par with the early post-surgery physiotherapy.
Japan Journal of Nursing Science, 2020
The aims of this study were to: (1) describe the physical activity (PA) and quality of life (QOL) in living donor liver transplant (LDLT) recipients pre-operatively and at 3 months and 6 months post-operatively; (2) compare PA and QOL at 6 months post-operatively with a healthy control group; and (3) explore pre-operative factors that predict PA changes. Methods: Patients over 20 years of age who were undergoing LDLT were recruited. PA was measured based on the number of steps/day and time spent performing moderate-to-vigorous PA (MVPA) during 1 week using an accelerometer. QOL was assessed based on a physical (PCS) and mental (MCS) component summary of the eight-item Short-Form Health Survey. The LDLT and healthy control groups were matched for age (±3 years) and sex. Pre-operative factors predicting a change in PA were calculated using a generalized linear mixed model. Results: Twenty-four patients completed the study. By 6-months post-LDLT, the MCS and PCS were comparable to those in the control group. The number of steps (3887 steps/day) and MVPA (29.3 min/week) showed significant improvement by 6 months post-operatively, but remained much lower compared with those in the control group. The multi-variate analysis showed that younger age (p<0.01, p=0.04) and higher skeletal muscle mass (SMM; p<0.01, p=0.03) were 2 predictors of improvement in number of steps and MVPA. Conclusion: This study suggests the need for pre-operative interventions by healthcare professionals that focus on outcomes such as improving low SMM to facilitate post-operative PA recovery.
Transplantation Proceedings, 2019
Background and aims. Despite the excellent long-term outcomes in liver transplant (LT) recipients, several medical complications related to lifestyle still represent an issue. This study examined the effects of a 12-month supervised aerobic and strength training program on the aerobic capacity, muscle strength, metabolic profile, liver function, and quality of life of a cohort of LT recipients. Methods. LT recipients with stable liver function were assigned to interventional exercise (group A) or usual care (group B). Aerobic capacity, muscle strength, metabolic profile, liver and kidney function, and health-related quality of life were assessed at baseline and after 6 and 12 months. Group A attended supervised training sessions 3 times per week for 12 months. Group B received general recommendations about home-based exercise. Results. Forty patients from 6 Italian LT centers were randomized. Twenty-nine (72.5%, men-to-women ratio 23:6, mean age, 52 AE 8 years) LT recipients completed the study. Baseline characteristics were similar between groups except for body mass index and time from LT. No episode of acute rejection nor increase of transaminases occurred. Maximum workload and body mass index increased in both groups over time, but fasting glucose significantly decreased in group A (94.0 AE 15.0 mg/dL vs 90.0 AE 17.0 mg/dL; P ¼ .037) and increased in controls (95.0 AE 24.0 mg/dL vs 102.0 AE 34.0 mg/dL, P ¼ .04). Upper limb muscle strength increased only in supervised LT recipients. Vitality and general and mental health domains significantly improved after physical exercise. Conclusions. Supervised combined training was safe and effective in increasing aerobic capacity, muscle strength, and quality of life and in improving glucose metabolism in stable LT recipients. This study is registered at http://www.isrctn.com under ID No. ISRCTN66295470.
Physical fitness, fatigue, and quality of life after liver transplantation
European Journal of Applied Physiology, 2007
Fatigue is often experienced after liver transplantation. The aims of this cross-sectional study were to assess physical Wtness (cardiorespiratory Wtness, neuromuscular Wtness, body composition) in liver transplant recipients and to explore whether physical Wtness is related to severity of fatigue. In addition, we explored the relationship between physical Wtness and health-related quality of life. Included were 18 patients 1-5 years after transplantation (aged 48.0 § 11.8 years) with varying severity of fatigue. Peak oxygen uptake during cycle ergometry, 6-min walk distance, isokinetic muscle strength of the knee extensors, body mass index, waist circumference, skinfold thickness, severity of fatigue, and health-related quality of life were measured. Cardiorespiratory Wtness in the liver transplant recipients was on average 16-34% lower than normative values (P · 0.05). Furthermore, the prevalence of obesity seemed to be higher than in the general population (17 vs. 10%). We found no deWcit in neuromuscular Wtness. Cardiorespiratory Wtness was the only Wtness component that was related with severity of fatigue (r s = ¡0.61 to r s = -0.50, P · 0.05). Particularly cardiorespiratory Wtness was related with several aspects of health-related quality of life (r s = 0.48 to r s = 0.70, P · 0.05). Results of our study imply that cardiorespiratory Wtness and body composition are impaired in liver transplant recipients and that Wtness is related with severity of fatigue (only cardiorespiratory Wtness) and quality of life (particularly cardiorespiratory Wtness) in this group. These Wndings have implications for the development of rehabilitation programs for liver transplant recipients.
Improved physical performance after orthotopic liver transplantation
Liver Transplantation and Surgery, 1999
Orthotopic liver transplantation (OLT) has become a frequently used treatment for end-stage liver disease and acute liver failure, and liver function is markedly improved after transplantation. However, no studies have investigated the development in physical capacity after OLT. On this basis, the aim of the present study is to study the influence of OLT on physical fitness during the first postoperative year. Twenty-three men with a mean age of 45.1 years (range, 24 to 62 years) and 15 women with a mean age of 44.6 years (range, 21 to 62 years) were included in the study. Preoperative maximal oxygen uptake (V O 2max ) during graded ergometer bicycling, isokinetic knee extension/flexion moments, and functional performance (i.e., 6-minute walking distance and standardized transfers and squats) was measured. Preoperative fitness and strength was 40% to 50% less than expected in the agematched general population. Post-OLT, all pa-tients underwent a supervised exercise program for 8 to 24 weeks. Follow-up data showed a significant increase in all tested physical performance parameters after OLT. Six months post-OLT, V O 2max had increased 43%; knee strength, 60% to 100%; and functional performance, 22% to 27%. One year postsurgery, general health was improved and perceived as excellent or good in all patients. All patients were independent in activities of daily living, and the level of physical activity increased after OLT. No further improvement in either physical performance parameters or self-assessed parameters was seen beyond 6 months after OLT. In conclusion, these findings indicate that OLT combined with a supervised post-OLT exercise program improves physical fitness, muscle strength, and functional performance in individuals with chronic liver disease.
Liver Transplantation, 2014
Chronic liver disease (CLD) is associated with muscle wasting, reduced exercise tolerance and aerobic capacity (AC). Measures of AC determined with cardiopulmonary exercise testing (CPET) may predict survival after liver transplantation (LT), but the relationship with nontransplant outcomes is uncertain. In patients assessed for LT, we examined the relationship of CPET AC parameters with the severity of liver disease, nutritional state, and survival with and without LT. Patients assessed for elective first LT who underwent CPET and an anthropometric assessment at a single center were studied. CPET-derived measures of AC that were evaluated included the peak oxygen consumption (VO 2 peak) and the anaerobic threshold (AT). Three hundred ninety-nine patients underwent CPET, and 223 underwent LT; 45% of the patients had a VO 2 peak < 50% of the predicted value, and 31% had an AT < 9 mL/kg/minute. The VO 2 peak and AT values correlated with the Model for End-Stage Liver Disease score, but they more closely correlated with serum sodium and albumin levels. The handgrip strength correlated strongly with the VO 2 peak. Patients with impaired AC had prolonged hospitalization after LT, and nonsurvivors had lower AT values than survivors 1 year after transplantation (P < 0.05); this was significant in a multivariate analysis. One hundred seventy-six patients did not undergo LT; the 1-year mortality rate was 34.6%. The AT (P < 0.05) and VO 2 peak values (P < 0.001) were lower for nonsurvivors. In a multivariate analysis, AT was independently associated with nonsurvival. In conclusion, AC was markedly impaired in many patients with CLD. In patients who did not undergo transplantation, impaired AT was predictive of mortality, and in patients undergoing LT, it was related to postoperative hospitalization and survival. AC should be evaluated as a modifiable factor for improving patient survival whether or not LT is anticipated.
Journal of Rehabilitation Medicine, 2001
Twenty-six men on a liver transplant waiting list (12 had alcoholic cirrhosis, 8 suffered from posthepatitic cirrhosis, and 6 from cirrhosis of other etiologies) were eligible for this observation. Nineteen subjects underwent exercise testing to determine oxygen uptake at anaerobic threshold. In all patients dynamometry was performed to determine isokinetic muscle strength of knee extensor muscles, and handgrip. Quality of life was evaluated in all patients with the MOS SF-36 questionnaire. Child-Pugh A patients showed 54 § 8%, Child-Pugh B patients 36 § 2%, and Child-Pugh C patients 31 § 4% of VO 2¡max predicted at the anaerobic threshold (Kruskal-Wallis ANOVA, p < 0.05). Isokinetic muscle strength of the quadriceps femoris (left/right) was 149 § 20/134 § 14 Nm in Child-Pugh A, 108 § 16/114 § 19 Nm in Child-Pugh B, and 89 § 10/81 § 11 Nm in Child-Pugh C patients (Kruskal-Wallis ANOVA, p < 0.05). MOS-SF36 revealed a Child-Pugh class dependent reduced functional status (Kruskal-Wallis ANOVA, p < 0.05). No signi cant differences in target parameters were found when analysed according to the etiology of cirrhosis. Patients on the liver transplant waiting list do have a stage dependent reduction in physical health. These data are the basis for longitudinal studies measuring the effects of preoperative rehabilitation programs in these patients.