Fitness testing of pediatric liver transplant recipients

Abstract

Liver transplantation is accepted as the standard management for end-stage liver disease in children. Pediatric heart and heart-lung transplant recipients have shown significantly diminished exercise capacities compared with age-matched, able-bodied, control subjects. The primary aim of this study is to compare the fitness levels of a group of pediatric liver transplant (LT) recipients (LT group, 20 boys, 9 girls; age, 8.9 ؎ 4.8 years; 56 ؎ 35 months posttransplantation) with a group of able-bodied control subjects ( T ransplantation is the accepted therapy for endstage organ failure. Thirty five thousand individuals received organ transplants in 1998, and this number is growing. One of the major reasons for this increase over previous years is the better long-term prognosis for these individuals. 1 Common to all adult liver transplant (LT) candidates is an impaired physical performance level before transplantation. [2][3][4] It is expected that impaired exercise capacity affects the performance of adults in their daily recreational activities and inhibits the accomplishment of simple physical tasks. Although improved physical functioning is assumed after transplantation, limited information exists regarding the physical functioning of adult and pediatric transplant recipients. 2 The limited cross-sectional data that exist in pediatric heart, heart-lung, and lung transplant recipients showed significant (43% to 64%) reductions in physical work capacity compared with able-bodied control subjects. 5 The limitations to exercise performance more likely stem from central limitations in heart and heartlung transplant recipients and pretransplantation exercise intolerance. Both reduced exercise tolerance on a treadmill walking test 6 and reduced cardiorespiratory fitness (maximal oxygen consumption [VO 2 max]) on a cycle ergometer 7 compared with able-bodied control subjects have been shown in adolescent renal transplant recipients. Reductions in VO 2 max compared with agematched healthy individuals 8 and limitations in daily functioning were noted in adult LT recipients. [9][10][11] To the best of our knowledge, no research has been conducted on the assessment of fitness levels in pediatric LT recipients. The purpose of this study is to use simple field tests of the basic components of physical fitness (cardiorespiratory fitness and muscular endurance, specifically abdominal and flexibility) to (1) compare the fitness level of pediatric LT recipients with able-bodied control subjects and (2) assess the proportion of pediatric LT recipients capable of achieving able-bodied pediatric criterion fitness standards.

Exercise capacity and physical fitness in pediatric dialysis and kidney transplant patients

“…The FITNESSGRAM has been used to assess the physical fitness of pediatric liver TX recipients by Unnithan et al [27] and Krasnoff et al [37]. Similar to our results, there was only one subject who achieved the HFZ for the PACER test of cardiorespiratory fitness in the Krasnoff study.…”

“…This testing has not been widely used in clinical pediatric populations. Unnithan et al [27] reported FITNESSGRAM data on 29 pediatric liver TX recipients (12 girls, 22 boys). None of the children achieved criterion-referenced healthy fitness standards for cardiorespiratory fitness, and only 35% of the sample attained the muscle strength standard.…”

Accelerometry-based physical activity and exercise capacity in pediatric kidney transplant patients

“…These included aerobic capacity (progressive aerobic cardiovascular endurance run, PAC-ER); muscle endurance (curlup), and flexibility (backsaver sit and reach). The FITNESSGRAM has been found useful in clinical research in children with solid organ transplants [5,6,26]. Our study applied a similar protocol as that used by two earlier studies [5,6] in order to determine whether children with kidney transplants achieved the HFZ.…”

Prevention of Post-transplant Cardiovascular Disease – Report and Recommendations of an Ad Hoc Group

“…Excessive weight gain post-transplant occurs in a large number of pediatric solid organ recipients; however, the natural history of obesity in this population has not been addressed (95). In a study by McDiarmid et al, only 10% of pediatric liver recipients with hyperlipidemia engaged in routine exercise (McDiarmid, UCLA, personal communication 2000).…”