Solid-organ transplant surgery is an accepted life-saving procedure with over 1300 recipients in Australia in 2015 (1). The most common organ transplanted is the kidney, followed by the liver, lungs, heart and pancreas. Often, the major indications for organ transplantation are chronic end-stage diseases specific to each organ (e.g. end-stage kidney disease). Following transplantation, patients are treated with immunosuppression therapy to prevent organ rejection. Consequently, these medications may result in significant loss of fitness and weight gain, contributing to the development of the metabolic syndrome and cardiovascular disease (2).
There are several benefits for all who participate in exercise training. These include:
Patients awaiting solid-organ transplantation are often severely deconditioned, exhibiting a wide variety of health-related physiological and psychological complications. Research suggests that impaired cardiorespiratory fitness and reduced muscle mass are associated with poor outcomes before and after solid-organ transplant surgery (3-5). Exercise training appears safe in this population and it is recommended that patients remain physically active while listed for transplantation to minimise any further disease-related deconditioning.
A recent systematic review and meta-analysis (the highest level of evidence) examined 15 studies comprising of over 600 patients investigating the impact of exercise training across all solid-organ transplant recipients compared to standard care (6). The majority of studies were in heart transplant recipients, but also included patients who have received a lung, liver and kidney transplant. Across the studies, participants performed a wide variety of aerobic (cycling, walking), resistance and stretching exercises. The authors concluded that exercise training is effective in improving cardiovascular health in solid organ transplant recipients.
The most common modes of exercise training that have been used in both solid-organ transplant candidates and recipients include aerobic (endurance), resistance (strength) and flexibility (stretching) (6). People that are awaiting or have received a solid-organ transplant are often deconditioned and should begin exercising slowly with gradual progression. It is recommended that people aim to achieve 20-60 minutes of aerobic exercise on 3-6 days per week at an intensity that suits the individual’s current condition. Resistance training should be performed on 2-3 days a week, with 8-10 different exercises, focusing on major muscle groups. It is suggested to perform one to three sets of 8-12 repetitions, with a weight requiring a moderate effort (50-80% of one-repetition maximum). Additionally, flexibility training can also be incorporated 2-3 times per week for 10 minutes.
A thorough assessment should take place by your GP or specialist before commencing your exercise program.
Accredited Exercise Physiologist (AEP)
It’s recommended you consult an Accredited Exercise Physiologist before you commence exercise, as it is essential for exercise prescription to be individualised according to your unique needs, including functional capacity, physical limitations, exercise history and preferences.
Exercise can then be supervised by an Accredited Exercise Physiologist.
It is important to seek medical approval prior to engaging in any exercise following solid-organ transplantation. Transplant recipients have commenced aerobic exercise training in as little as 8 weeks following surgery (7). It is suggested that exercise-induced improvements in health are maximised if patients commence exercise training within the first year after surgery (6).
The following factors should be considered when designing an exercise program: