Graded Exercise Testing and Training After Renal Transplantation: A Preliminary Study

Miller, Todd D.; Squires, Ray W.; Gau, Gerald T.; Ilstrup, Duane M.; Frohnert, Peter P.; Sterioff, Sylvester

doi:10.1016/s0025-6196(12)62329-5

Cited by 28 publications

(16 citation statements)

References 15 publications

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“…Those who are more physically active have a reduced CV risk [111] and exercise programmes designed for RTRs have been shown to improve a number of physiological and psychological parameters [112,113] . However, blood pressure has been measured in several studies and there are no overall significant effects of exercise [114,115] . Many patients are taking various classes of antihypertensive medications and exercise does not seem to interact with these either [112] .…”

Section: Lifestyle Factorsmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

119

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Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

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Section: Lifestyle Factorsmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

119

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“…Many studies [3][4][5][6]22], especially in adults, have found reduced work tolerance in CRF patients.…”

Section: Discussionmentioning

confidence: 99%

“…Miller et al [3] report their experience with early and late graded exercise testing and training in adult trans planted patients and conclude that training improves exercise capacity. In children and adolescents with renal transplant there are only two reports of spirometric per formance and/or submaximal physical testing [5,6], which show only a partially restored spiroergometric per formance and an unchanged physical working capacity, 8-89 months after transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…In Italy, a certifica tion of physical fitness is required by law for participation in sports [2] and request for this certification by patients or their families is widely increasing. Cardiovascular per formance during renal replacement therapy has been extensively studied in adults [3,4]. To our knowledge, the results of Spiroergometrie performance of children and adolescents with renal transplants have been reported by only one group [5,6], There is little information about the exercise habits in children with long-term transplanta tion, most of them studied by means of a questionnaire or interview on 'quality of life' [7,8], Studies on physical activity have never been evaluated with a specific ques tionnaire.…”

Section: Introductionmentioning

confidence: 99%

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Abnormal Hypertensive Response during Exercise Test in Normotensive Transplanted Children and Adolescents

Matteucci

Calzolari

Pompei

et al. 1996

Nephron

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We investigated the cardiovascular and respiratory conditions, at rest and in response to stress testing, in 10 children and adolescents with successful renal transplantation, to release certifications for participation in sports. Our patients were aged more than 6 years, transplanted 6 months or more before the study, with creatinine clearance > 40 ml/min/1.73 m², without hypertension at rest. All but 1 were on cyclosporine A, prednisone and azathioprine. Two control study groups with the same chronological age and body surface area were paired with our patients. They underwent a graded exercise treadmill test, during which maximal blood pressure and heart rate were recorded. Resting electrocardiogram, dynamic 24-hour electrocardiogram Holier monitoring and mono- and bidimensional echocardiograms were obtained before the test. Spirometry was performed to study lung flow and volume. A questionnaire collected information about physical activity patterns. Four categories, according to practice, frequency and duration of exercise, were identified: nonactive, starters, experienced and very experienced. Most children and adolescents were sedentary or mildly interested in sports and during treadmill test we observed reduced exercise capacity and systolic hypertensive response to increasing exercise testing.

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“…However, although supervised exercise sessions improve aerobic capacity and muscle function in renal transplant patients [38,40] no data as yet are present regarding the effect of exercise training on body composition in renal transplant patients. This aspect is currently under investigation in our hospital.…”

Section: Relation Between Physical Activity and Body Composition In Rmentioning

confidence: 99%

Nutritional Considerations in Renal Transplant Patients

2002

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In renal transplant patients, weight gain generally increases after renal transplantation, which will be influenced by improved appetite and a reversal of the uremic state. However, at least in the early posttransplant period, the increase in body weight is mainly due to an increase in body fat mass. This phenomenon may be partly due to relatively high doses of steroids in the early period after renal transplantation, possibly mediated by their inhibiting effect on lipid peroxidation, but also appears to be related to physical inactivity. The increase in body fat mass may contribute to posttransplant hyperlipidemia, which is improved but not completely normalized by dietary intervention. Current dietary recommendations in stable renal transplant patients do not generally differ from those of the general population, although intense dietary counselling may be indicated in patients with excessive posttransplant weight gain. The effect of supervised exercise training on body composition is currently under investigation.

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Graded Exercise Testing and Training After Renal Transplantation: A Preliminary Study

Cited by 28 publications

References 15 publications

Cardiovascular risk factors following renal transplant

Cardiovascular risk factors following renal transplant

Abnormal Hypertensive Response during Exercise Test in Normotensive Transplanted Children and Adolescents

Nutritional Considerations in Renal Transplant Patients

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