Fitness for transplant recipients
Dr. Dinesh Jothimani is the Director of Hepatology at Dr.Rela Institute and Medical Centre and an Ultra Marathoner himself
Patients undergoing transplantation are in profound catabolic state leading to malnutrition, generalised weakness and easy fatiguability. This could be due to various reasons such as the disease process, poor appetite, nausea, medications related, altered bowel habit, recurrent infection, repeated third space fluid aspiration etc. These patients have poor exercise tolerance and most of them have restricted mobility
Transplant is a major surgery conducted on patients with severe end organ damage, with failed medical therapy. Presence of restricted mobility and physical inactivity can delay postoperative recovery. For these reasons, physically inactive patients may get delisted from transplantation. Therefore, we encourage patients to be physically active while waiting for transplantation. As clinicians, we should reiterate at every visit regarding physical fitness.
There are no set protocols available for these patients. In general, we recommend at least 45 minutes of mild physical activity such as walking or cycling or regular physiotherapy-aided mobility always helps. Regular activity helps both physical and mental well-being as they await a transplant.
On an equally important note, recovering from a transplant involves changes in haemodynamic as well as metabolic parameters, and is a gradual and continuous process with need for special attention to nutrition and healthy lifestyle.
Low physical activity and sedentary lifestyle following transplantation may lead to obesity causing poor quality of life. Coupled with immunosuppressive medications sedentary lifestyle can increase the risk of cardiovascular diseases, diabetes, dyslipidemia and fatty liver disease. The latter could be worrisome if the indication for liver transplant was NASH cirrhosis. Cardiovascular disease remains the leading cause of death in patients following solid organ transplantation. Improving fitness in transplant recipients is important to reduce long-term morbidity and mortality. Multiple methods should be adopted to encourage patients to carry out physical activity. Importance of exercise and diet should be discussed on every clinic visit, modern gadgets such as smart watches, mobile applications can be utilized to monitor activity.
Recipients should be encouraged to walk or jog at least 4 times a week. In the West, patients participating in Transplant Games is not an uncommon scenario, but rarely seen in our population. Mr. Nagaraj, a post liver transplant recipient, recently proved this notion wrong.
In his words- “After transplant, I decided that I will focus on my health and stay fit. During one of my Clinic visits, my doctor encouraged me to start jogging and mentioned about World Transplant Games for the recipients. I read more about the games and that motivated me to participate in it. I started training very intensively by running 10 to 12 km every day. I also set up a Home Gym for weight training and trained regularly. I participated in 21 km run (Half Marathon), 1500 m race, 5 km road race and 100 m relay at World Transplant Games (WTG) that was held at Newcastle, UK in August 2019. I recently joined swimming to improve my stamina. Every day I spend one hour running and one hour swimming. Alternate days I do weight training. It is two years after my transplant and I have not fallen sick. My medication has been reduced to the lowest level. I am sure that the physical activities are helping me to stay fit and healthy. I will participate in the next World Transplant Games which will be held at Houston, USA in May 2021. Hopefully, will win a few medals!”
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- Keywords: medication