Patients present for kidney (RTX) or liver transplantation (LTX) in a severely deconditioned state. Although transplantation improves well-being and clinical profile, it does not necessarily optimize physical functioning. Advice for physical activity is rarely given. Objectives: To determine the effects of regular physical activity on physical functioning and quality of life in kidney and liver transplant recipients. Population: We have tested physically active and inactive transplant recipients who were participants in the U.S. Transplant Games (n=128) and a longitudinal population of kidney (n=171) and liver (n=137) transplant recipients over 1 year following transplant. Outcome Variables: Patients were tested for cardiorespiratory fitness (VO2peak), muscle strength (quadriceps peak torque) and health-related quality of life (SF-36). Design and Methods: The cross sectional study was performed at the 1996 U.S. Transplant Games. Participants interested in being tested were enrolled and testing during the event. The longitudinal studies were randomized clinical trials in which patients were randomized into one of two groups: usual care and exercise intervention. The exercise intervention was individually prescribed cardiovascular exercise for independent participation at home. Regular phone follow-up was used to progress patients with their program, assess adherence and provide encouragement. Findings: Transplant recipients who are physically active have significantly higher fitness measures and quality of life scores than those who are inactive. In the randomized clinical trial, RTX recipients who were randomized into an exercise intervention had significantly higher VO2peak, muscle strength and self-reported physical functioning at 1 year compared to those receiving usual care (p<.05). At one year, the usual care group had fitness levels similar to well-trained dialysis patients. Exercise alone is not effective in attenuating weight gain following transplant, which may require dietary and behavior modification interventions. Conclusions: Patients who participate in regular physical activity following transplant will have higher health-related fitness and quality of life compared to those who remain inactive. Implications: There are significant challenges in motivating patients to exercise following transplantation, including rejection episodes, surgical complications (i.e., wound infections, incisional hernias, anastomosis obstructions), fatigue symptoms resulting from interferon or ribavirin treatment for recurrent hepatitis C, depression, and lack of history of physical activity. Patients are physically capable of participating in the prescribed levels of exercise following transplant, however although many patients will participate in some form of physical activity regularly, it is difficult to influence them to obtain the recommended frequency, intensity, and duration levels that will result in significant improvements over time. Those who follow the prescribed program clearly benefit and optimize their functioning following transplantation.
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