Articles That Are Related to Physical Activity After Transplant

Quality of Life Measures

Quality of life is measured using a variety of surveys. The most common of these surveys is the Short-Form Health Survey (SF-36), which measures several categories of physical functioning, as well as containing a Mental Health Component (MCS). Another commonly used quality of life measure is the Dutch RAND-36. Masala, etl al (2012) used the International Physical Activity Questionnaire (IPAQ) and the 36-item Medical Outcomes Study as well as the SF-36. The van Ginneken et al. (2010) study employed the Sickness Impact Profile (SIP-68), Impact on Participation and Autonomy (IPA) scale, and the Hospital Anxiety and Depression Scale (HADS) in addition to the RAND-36.

Physical Activities Measures

Physical activity is measured with a number of self-assessment and objective tools including peak oxygen uptake during cycle ergometry, walking distance in a timed exercise, "isokinetic muscle strength of knee extensors, body mass index, waist circumference, skinfold thickness," and severity of fatigue (van Ginneken, et al., 2007, p. 345). Masala et al. (2012) used the Metabolic Equivalent (MET), which measures amount of time spent in physical activity, expressed in minutes per week. Van den Berg-Emons (2006) relied on additional measures such as the Activity Monitor (AM), and the Fatigue Severity Scale.

3. Intervention

Several studies did not use an intervention and simply compared transplant populations with non-transplant populations. Those that did use interventions generally relied on exercise and diet interventions involving counseling coupled with food and exercise diaries. Roi et al. (2011) used cardiovascular and strengthening exercises on the stationary bike. The van Ginneken et al. (2010) study used supervised exercise training plus counseling for 12 weeks.

4. Summaries

All the studies point to prior literature showing that liver transplant recipients experience poorer quality of life, measured on standardized evaluated surveys such as the RAND-36 and the SF-36. Van den Berg-Emons et al. (2006) found, however, that there was no statistically significant difference between the transplantation group and the non-transplantation group in terms of levels of physical activity reported, and suggest that fatigue and quality of life are more closely connected with the amount of activity performed. Moreover, all studies note that liver transplantation has the potential to reduce rates of physical activity, which compounds the low quality of life. Based on this evidence, several of the studies employ interventions that are designed to increase physical activity and improve diet. Van Ginneken, et al. (2007), Masala, et al. (2012), Rongies et al. (2011), and Van Den Berg-Emons, et al. (2006) did not use interventions but instead compared non-transplant individuals' level of activity with a transplant group.

Physical activity has been shown to significantly improve quality of life, measured on established scales. All studies employing specific physical activity interventions resulted in statistically significant improvements in quality of life scores for the participant populations. For example, Roi et al. (2014) found that the prescribed exercise program (consisting of three sessions per week for one year of both aerobic and strength training) led to significant health and quality of life improvements including decrease in body mass index (t = 1.966; P

Rongies, et al. (2011) retroactively measured participants' duration and frequency of physical activity over the prior year, finding that patients who engaged in more exercise reported higher quality of life after five years. Improved quality of life therefore led to increased physical activity levels, which in turn improved quality of life.

The 12-week rehabilitative program employed as an intervention in the van Ginneken et al. (2010) study showed statistically significant daily functioning (23.6%; P = .007), as well as specific improvements in outdoor autonomy measures, and various quality of life factors relative to vitality and physical functioning. Interestingly though, the researchers found that anxiety and depression levels remained unchanged.

Krasnoff et al. (2006) used a randomized trial assigning some transplant recipients to an exercise and diet intervention program including counseling in both nutrition and physical activity, as well as the maintenance of food diaries and an exercise log. Improvements in the intervention group were noted versus the control group.