EXPERIMENTAL AND CLINICAL TRANSPLANTATION

Objectives: Physical activity has an effect on long-term recovery after major surgical operations including liver transplant. Seven-Day Physical Activity Recall Questionnaire is a semistructured survey that assesses an individual's time spent in physical activity, strength, and flexibility activities during the 7 days prior to the interview. In this study we applied the Seven-Day Physical Activity Recall Questionnaire in patients who underwent liver transplant in our center.

Materials and Methods: We surveyed 107 consecutive patients (62 male and 45 female), who were ≥ 6 months after liver transplant. Patients were divided into 3 groups, depending on time after liver transplant: group A (n = 21), 6 to 12 months posttransplant; group B (n = 48), 13 to 36 months posttransplant; and group C (n = 38), > 37 months posttransplant. Relations were analyzed between physical activity and various factors including sex, age at procedure and survey, time after grafting, original diagnosis, and body mass index.

Results: Female patients were significantly less active in daily and weekly measurements (981 ± 212 kcal vs 1267 ± 229 kcal; P < .0001) (6864 ± 1484 kcal vs 8866 ± 1607 kcal; P < .0001). There was a negative correlation between physical activity and age at transplant (P = .02) and survey (P = .02). Neither the time after liver transplant nor the original diagnosis before grafting affected physical activity.

Conclusions: Female patients, when assessed with Seven-Day Physical Activity Recall Questionnaire, were significantly less physically active than male subjects after liver transplant. Younger patients were more active, but primary diagnosis had no significant effect on physical activity after grafting.

Key words : End-stage liver disease, Seven-Day Physical Activity Recall Questionnaire

Physical activity may affect both mental and physical recovery after various surgical procedures including transplant. Wickerson and associates have shown that regular physical exercises exert a positive effect on the return to routine activities after lung transplant.¹ Similar observations were made in subjects who underwent kidney transplant.² In addition, patients after heart transplant who exercised regularly showed significant improvement in their general physical and mental states.³ Positive effects of regular exercising have been observed in subjects after myocardial infarction and neoplastic diseases.^4-6

Seven-Day Physical Activity Recall Questionnaire (PAR) assesses both physical and work-related activity. This semistructured assessment focuses on these activities evaluated during the 7 days prior to the interview.

The aim of the present study was to use the PAR in patients who received liver transplant in our center.

Materials and Methods

There were 107 patients (62 male and 45 female) who underwent liver transplant in our center and were included in this study. All enrolled subjects were ≥ 6 months after their surgery. They were divided into 3 groups, depending on the time after liver transplant: group A (n = 21), 6 to 12 months posttransplant; group B (n = 48), 13 to 36 months posttransplant; and group C (n = 38), > 37 months posttransplant. They also were divided into 4 groups, depending on the original diagnosis at transplant, including alcoholic, viral, autoimmune or cholestatic, and other. Patients did not have severe comorbidities that could affect their physical activity, such as graft rejection, infections, or wound problems. Demographic data about analyzed subjects were summarized (Table 1).

The PAR questionnaire was a semistructured interview that estimated an individual’s time involved in physical activity, strength, and flexibility activities for the 7 days prior to the interview. The PAR included a variety of physical activities such as aerobic exercise, work-related activities, gardening, walking, recreation, and leisure-time physical activities. Only physical activities of moderate intensity or greater were included. Total physical activity (quantified as kcal/d) was estimated from hours spent in moderate, difficult, and very difficult intensity physical activities.⁷

The study protocol was approved by the Ethics Committee of Pomeranian Medical University. Written informed consent was obtained from each patient. Data were reported as mean ± standard deviation and analyzed with statistical software (StatView, Version 5.0, SAS Institute, Cary, NC, USA). Correlations were tested with Pearson correlation. To identify independent relations and adjust the effects of covariates, multiple stepwise regression analysis was performed including all parameters with highly significant correlations in the univariate analysis as covariates. P < .05 was considered statistically significant.

When total daily and weekly activities were assessed, female patients showed significantly less activity than male subjects (Table 2). Time after liver transplant had no effect on physical activity (Table 3). The original diagnosis before liver transplant had no significant effect on physical activity except that total daily activity was significantly greater in patients transplanted for autoimmune liver disease than other indications (Table 4). A negative correlation was observed between physical activity and both age at transplant and age at survey, and there was a trend observed toward negative correlation between body mass index and physical activity after liver transplant (Table 5).

To identify independent relations, stepwise regression analysis was performed including parameters with highly significant correlations in the univariate analysis as covariates: age at liver transplant and age at survey. In the multivariate analysis, age at survey was the only independent variable affecting physical activity after liver transplant (P = .02).

Liver transplant provides the opportunity for full recovery and return to an active life after the procedure. Physical activity is 1 of the key factors that markedly affect general health. However, many patients after liver transplant continue with a sedentary lifestyle.^8,9 This may increase the risk of cardiovascular and metabolic complications that are the third main causes of death long term after transplant.^9,10 Albeldawi and coworkers showed that components of metabolic syndrome before transplant predicted an increased risk of major cardiovascular events.¹¹Payne and associates have shown that regular physical activity improves general health of patients after liver transplant.¹² The relation between physical activity and graft outcomes is under-standable in consideration of other related research on the effects of physical activity on health. In patients after kidney transplant, physical activity improves cardiovascular function, and this probably increases perfusion and oxygen delivery to the kidney graft. Physical activity also may delay development of atherosclerosis, which is the primary cause of death in kidney transplant recipients.^13,14 Extensive research also has been performed about the relation between physical activity and cancer. Numerous reviews of epidemiologic and randomized controlled trials have confirmed an inverse relation between physical activity and the incidence of cancer.⁶

The main observation of this study was that female patients remained significantly less active than male subjects. This is consistent with studies on the physical activity of heart transplant patients, that also show that men have a higher level of activity compared with women in America and Europe.¹⁵ In many reports, males show a higher level of activity in all age groups. Men are more likely to perform regular exercise.^16,17 We also observed that younger patients after liver transplant are more physically active than older patients. Overweight and obesity reduce physical activity and negatively affect quality of life.^8,18 Although age-related decreases in fitness and exercise capacity may be physiologic and inevitable, these decreases may occur at varied rate and severity and may be delayed by maintenance or increased physical activity.¹⁸ Our study confirms that obesity and overweight in patients after liver transplant coincides with low levels of physical activity. It also shows lower levels of physical activity among women, which could be related to their lifestyle. The etiology of the disease and time after transplant had no effect on the physical activity of individuals.

The results of numerous studies confirm that regular physical exercise undertaken with different intensities increases the resistance and exercise capacity of most patients in most groups of recipients after transplant (kidney, lung, liver, heart, and bone marrow transplant). With properly selected physical activity, patients can obtain results comparable to healthy individuals at a similar age.¹⁹ Although this study shows the benefits of exercise in patients after liver transplant, very few studies have focused on the assessment of physical activity in patients after liver transplant, and a lack of standardized testing methods makes it difficult and often impossible to compare results with other papers.

In summary, in this cross-sectional prospective study, we have shown that female patients remain significantly less physically active than male patients after liver transplant. Primary diagnosis does not affect physical activity level, and patients with lower body mass index and younger patients tend to be more physically active after the procedure.

Volume: 13 Issue: 3 June 2015

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