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Open Access 20-11-2023 | IM - ORIGINAL

Physical activity in liver transplant recipients: a large multicenter study

Authors: Stefano Gitto, Lucia Golfieri, Filippo Gabrielli, Margherita Falcini, Francesco Sofi, Maria Rosa Tamè, Nicola De Maria, Luca Marzi, Andrea Mega, Giovanna Valente, Alberto Borghi, Paolo Forte, Matteo Cescon, Fabrizio Di Benedetto, Pietro Andreone, Marco Petranelli, Maria Cristina Morelli, Paolo De Simone, Chloe Lau, Laura Stefani, Francesco Vizzutti, Francesca Chiesi, Fabio Marra, MEDITRA Research Group

Published in: Internal and Emergency Medicine | Issue 2/2024

Abstract

Aim

Healthy lifestyle and appropriate diet are of critical importance after liver transplant (LT). We provided an analysis of the main patterns of physical activity and found factors associated with physical activity itself.

Methods

Clinically stable LT recipients were enrolled between June and September 2021. Patients completed a composite questionnaire about physical activity, adherence to Mediterranean Diet (MD), quality of life (QoL), and employment. Correlations were analysed using the Pearson coefficients while different subgroups were compared by t-test for independent samples or ANOVAs. Multivariable logistic regression analysis was conducted to find predictors of inactivity.

Results

We enrolled 511 subjects (71% males, mean age 63 ± 10.8 years). One hundred and ninety-three patients reported high level of physical activity, 197 a minimal activity and 121 declared insufficient activity. Among these latter, 29 subjects were totally inactive. Considering the 482 LT recipients performing some kind of physical activity, almost all reported a low-quality, non-structured activity. At multivariate analysis, time from LT (odds ratio 0.94, 95% CI 0.89–0.99, p = 0.017), sedentary lifestyle (odds ratio 0.99, 95% CI 0.19–0.81, p = 0.012), low adherence to MD (odds ratio 1.22, 95% CI 1.01–1.48, p = 0.049), and low level of QoL (physical dimension) (odds ratio 1.13, 95% CI 1.08–1.17, p < 0.001), were independently associated with total inactivity.

Conclusion

A large portion of LT recipients report an insufficient level of physical activity or are wholly inactive. Inactivity increases with time from LT and was strongly associated with suboptimal diet and low QoL.

European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu (2016) EASL clinical practice guidelines: liver transplantation. J Hepatol 64:433–485. https://doi.org/10.1016/j.jhep.2015.10.006CrossRef

Beekman L, Berzigotti A, Banz V (2018) Physical activity in liver transplantation: a patient’s and physicians’ experience. Adv Ther 35:1729–1734. https://doi.org/10.1007/s12325-018-0797-7CrossRefPubMedPubMedCentral

Duarte-Rojo A, Ruiz-Margáin A, Montaño-Loza AJ et al (2018) Exercise and physical activity for patients with end-stage liver disease: improving functional status and sarcopenia while on the transplant waiting list. Liver Transpl 24:122–139. https://doi.org/10.1002/lt.24958CrossRefPubMed

Beyer N, Aadahl M, Strange B et al (1999) Improved physical performance after orthotopic liver transplantation. Liver Transpl Surg 5:301–309. https://doi.org/10.1002/lt.500050406CrossRefPubMed

Krasnoff JB, Vintro AQ, Ascher NL et al (2006) A randomized trial of exercise and dietary counseling after liver transplantation. Am J Transplant 6:1896–1905. https://doi.org/10.1111/j.1600-6143.2006.01391.xCrossRefPubMed

Gitto S, Falcini M, Marra F, MEDITRA Research Group (2021) Metabolic disorders after liver transplantation. Metab Syndr Relat Disord 19:65–69. https://doi.org/10.1089/met.2020.0068CrossRefPubMed

Harrington CR, Levy P, Cabrera E et al (2023) Evolution of pretransplant cardiac risk factor burden and major adverse cardiovascular events in liver transplant recipients over time. Liver Transpl 29:581–590. https://doi.org/10.1097/LVT.0000000000000013CrossRefPubMed

Kallwitz ER, Loy V, Mettu P et al (2013) Physical activity and metabolic syndrome in liver transplant recipients. Liver Transpl 19:1125–1131. https://doi.org/10.1002/lt.23710CrossRefPubMed

Fussner LA, Heimbach JK, Fan C et al (2015) Cardiovascular disease after liver transplantation: when, what, and who is at risk. Liver Transpl 21:889–896. https://doi.org/10.1002/lt.24137CrossRefPubMed

10.

Richards J, Gunson B, Johnson J, Neuberger J (2005) Weight gain and obesity after liver transplantation. Transpl Int 18:461–466. https://doi.org/10.1111/j.1432-2277.2004.00067.xCrossRefPubMed

11.

Masala D, Mannocci A, Unim B et al (2012) Quality of life and physical activity in liver transplantation patients: results of a case-control study in Italy. Transpl Proc 44:1346–1350. https://doi.org/10.1016/j.transproceed.2012.01.123CrossRef

12.

Craig CL, Marshall AL, Sjöström M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395. https://doi.org/10.1249/01.MSS.0000078924.61453.FBCrossRefPubMed

13.

International Physical Activity Questionnaire:… | Mannocci | Italian Journal of Public Health. https://ijphjournal.it/article/view/5694. Accessed 13 June 2023

14.

Dasso NA (2019) How is exercise different from physical activity? A concept analysis. Nurs Forum 54:45–52. https://doi.org/10.1111/nuf.12296CrossRefPubMed

15.

Physical Activity Guidelines for Americans, 2nd edition

16.

Sofi F, Macchi C, Abbate R et al (2014) Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 17:2769–2782. https://doi.org/10.1017/S1368980013003169CrossRefPubMed

17.

Gandek B, Ware JE, Aaronson NK et al (1998) Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51:1171–1178. https://doi.org/10.1016/s0895-4356(98)00109-7CrossRefPubMed

18.

Gitto S, Golfieri L, Sofi F et al (2023) Adherence to Mediterranean diet in liver transplant recipients: a cross-sectional multicenter study. Minerva Gastroenterol (Torino). https://doi.org/10.23736/S2724-5985.22.03290-9

19.

Hosmer DW, Lemeshow S (2000) Applied logistic regression. Wiley, LondonCrossRef

20.

Nagelkerke NJD (1991) A note on a general definition of the coefficient of determination. Biometrika 78:691–692. https://doi.org/10.1093/biomet/78.3.691MathSciNetCrossRef

21.

Bujang MA, Sa’at N, Sidik TMITAB, Joo LC (2018) Sample size guidelines for logistic regression from observational studies with large population: emphasis on the accuracy between statistics and parameters based on real life clinical data. Malays J Med Sci 25:122–130. https://doi.org/10.21315/mjms2018.25.4.12

22.

Goodyear MDE, Krleza-Jeric K, Lemmens T (2007) The declaration of Helsinki. BMJ 335:624–625. https://doi.org/10.1136/bmj.39339.610000.BECrossRefPubMedPubMedCentral

23.

Biddle SJH (2007) Sedentary behavior. Am J Prev Med 33:502–504. https://doi.org/10.1016/j.amepre.2007.08.002CrossRefPubMed

24.

Nurwanti E, Uddin M, Chang J-S et al (2018) Roles of sedentary behaviors and unhealthy foods in increasing the obesity risk in adult men and women: a cross-sectional national study. Nutrients 10:704. https://doi.org/10.3390/nu10060704CrossRefPubMedPubMedCentral

25.

Warburton DER, Nicol CW, Bredin SSD (2006) Health benefits of physical activity: the evidence. CMAJ 174:801–809. https://doi.org/10.1503/cmaj.051351CrossRefPubMedPubMedCentral

26.

Myers J, Kaykha A, George S et al (2004) Fitness versus physical activity patterns in predicting mortality in men. Am J Med 117:912–918. https://doi.org/10.1016/j.amjmed.2004.06.047CrossRefPubMed

27.

Oliveira JM, Spositon T, Rugila DF et al (2023) Validity of the international physical activity questionnaire (short form) in adults with asthma. PLoS ONE 18:e0282137. https://doi.org/10.1371/journal.pone.0282137CrossRefPubMedPubMedCentral

28.

Kohlbrenner D, von Moos S, Schmid-Mohler G (2022) Criterion validity and test-retest reliability of a modified version of the international physical activity questionnaire-short form (IPAQ-SF) in kidney transplant recipients. Front Rehabil Sci 3:808476. https://doi.org/10.3389/fresc.2022.808476CrossRefPubMedPubMedCentral

29.

Chun MY (2012) Validity and reliability of Korean version of international physical activity questionnaire short form in the elderly. Korean J Fam Med 33:144–151. https://doi.org/10.4082/kjfm.2012.33.3.144CrossRefPubMedPubMedCentral

30.

Lee PH, Macfarlane DJ, Lam TH, Stewart SM (2011) Validity of the international physical activity questionnaire short form (IPAQ-SF): a systematic review. Int J Behav Nutr Phys Act 8:115. https://doi.org/10.1186/1479-5868-8-115CrossRefPubMedPubMedCentral

31.

Couzi L, Moulin B, Morin M-P et al (2013) Factors predictive of medication nonadherence after renal transplantation: a French observational study. Transplantation 95:326–332. https://doi.org/10.1097/TP.0b013e318271d7c1CrossRefPubMed

32.

De Geest S, Burkhalter H, Bogert L et al (2014) Describing the evolution of medication nonadherence from pretransplant until 3 years post-transplant and determining pretransplant medication nonadherence as risk factor for post-transplant nonadherence to immunosuppressives: the Swiss Transplant Cohort Study. Transpl Int 27:657–666. https://doi.org/10.1111/tri.12312CrossRefPubMed

33.

Villeneuve C, Rousseau A, Rerolle J-P et al (2020) Adherence profiles in kidney transplant patients: Causes and consequences. Patient Educ Couns 103:189–198. https://doi.org/10.1016/j.pec.2019.08.002CrossRefPubMed

34.

Suryadinata RV, Wirjatmadi B, Adriani M, Lorensia A (2020) Effect of age and weight on physical activity. J Public Health Res 9(2):1840. https://doi.org/10.4081/jphr.2020.1840CrossRefPubMedPubMedCentral

35.

Kotarska K, Wunsch E, Raszeja-Wyszomirska J et al (2015) Female sex but not original indication affects physical activity after liver transplant: a prospective. Single Center Study Exp Clin Transpl 13(3):243–246

36.

Painter P, Krasnoff J, Paul SM, Ascher NL (2001) Physical activity and health-related quality of life in liver transplant recipients. Liver Transpl 7:213–219. https://doi.org/10.1053/jlts.2001.22184CrossRefPubMed

37.

Cicognani E, Mazzoni D, Totti V et al (2015) Health-related quality of life after solid organ transplantation: the role of sport activity. Psychol Health Med 20:997–1004. https://doi.org/10.1080/13548506.2014.993404CrossRefPubMed

38.

Neale J, Smith AC, Bishop NC (2017) Effects of exercise and sport in solid organ transplant recipients: a review. Am J Phys Med Rehabil 96:273–288. https://doi.org/10.1097/PHM.0000000000000599CrossRefPubMed

39.

Pérez-Amate È, Roqué-Figuls M, Fernández-González M, Giné-Garriga M (2023) Exercise interventions for adults after liver transplantation. Cochrane Datab Syst Rev 5:CD013204. https://doi.org/10.1002/14651858.CD013204.pub2CrossRef

40.

Mosconi G, Cuna V, Tonioli M et al (2014) Physical activity in solid organ transplant recipients: preliminary results of the Italian project. Kidney Blood Press Res 39(2–3):220–227. https://doi.org/10.1159/000355800CrossRefPubMed

41.

de Labra C, Guimaraes-Pinheiro C, Maseda A et al (2015) Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatr 15:154. https://doi.org/10.1186/s12877-015-0155-4CrossRefPubMedPubMedCentral

42.

Silva RB, Aldoradin-Cabeza H, Eslick GD et al (2017) The effect of physical exercise on frail older persons: a systematic review. J Frailty Aging 6:91–96. https://doi.org/10.14283/jfa.2017.7

43.

Slapak M (2005) Sport and transplantation. Ann Transpl 10:60–67

44.

Neuberger J, Armstrong MJ, Fisher J et al (2019) Sport and exercise in improving outcomes after solid organ transplantation: overview from a UK meeting. Transplantation 103:S1–S11. https://doi.org/10.1097/TP.0000000000002710CrossRefPubMed

45.

Yang LS, Shan LL, Saxena A, Morris DL (2014) Liver transplantation: a systematic review of long-term quality of life. Liver Int 34:1298–1313. https://doi.org/10.1111/liv.12553CrossRefPubMed

46.

Rosenberg DE, Norman GJ, Sallis JF et al (2007) Covariation of adolescent physical activity and dietary behaviors over 12 months. J Adolesc Health 41:472–478. https://doi.org/10.1016/j.jadohealth.2007.05.018CrossRefPubMedPubMedCentral

47.

Hobbs M, Pearson N, Foster PJ, Biddle SJH (2015) Sedentary behaviour and diet across the lifespan: an updated systematic review. Br J Sports Med 49:1179–1188. https://doi.org/10.1136/bjsports-2014-093754CrossRefPubMed

48.

Compernolle S, De Cocker K, Teixeira PJ et al (2016) The associations between domain-specific sedentary behaviours and dietary habits in European adults: a cross-sectional analysis of the SPOTLIGHT survey. BMC Public Health 16:1057. https://doi.org/10.1186/s12889-016-3708-3CrossRefPubMedPubMedCentral

49.

Mantzorou M, Mentzelou M, Vasios GK et al (2023) Mediterranean diet adherence is associated with favorable health-related quality of life, physical activity, and sleep quality in a community-dwelling greek older population. Antioxidants (Basel) 12:983. https://doi.org/10.3390/antiox12050983CrossRefPubMed

50.

U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. The Department; 2008

51.

Dunn MA, Rogal SS, Duarte-Rojo A, Lai JC (2020) Physical function, physical activity, and quality of life after liver transplantation. Liver Transpl 26:702–708. https://doi.org/10.1002/lt.25742CrossRefPubMedPubMedCentral

52.

Hickman IJ, Hannigan AK, Johnston HE et al (2021) Telehealth-delivered, cardioprotective diet and exercise program for liver transplant recipients: a randomized feasibility study. Transplant Direct 7:e667. https://doi.org/10.1097/TXD.0000000000001118CrossRefPubMedPubMedCentral

Title: Physical activity in liver transplant recipients: a large multicenter study
Authors: Stefano Gitto
Lucia Golfieri
Filippo Gabrielli
Margherita Falcini
Francesco Sofi
Maria Rosa Tamè
Nicola De Maria
Luca Marzi
Andrea Mega
Giovanna Valente
Alberto Borghi
Paolo Forte
Matteo Cescon
Fabrizio Di Benedetto
Pietro Andreone
Marco Petranelli
Maria Cristina Morelli
Paolo De Simone
Chloe Lau
Laura Stefani
Francesco Vizzutti
Francesca Chiesi
Fabio Marra
MEDITRA Research Group
Publication date: 20-11-2023
Publisher: Springer International Publishing
Published in: Internal and Emergency Medicine / Issue 2/2024
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-023-03474-7

PD Dr. Carsten W. Israel

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