Transplant Support- Lung, Heart/Lung, Heart

Exercise and Fitness

What is the difference between muscular strength and muscular endurance? - Muscular strength refers to how much weight you can lift. Muscular endurance refers to the ability to repeatedly lift a certain amoung of weight, or the number of times you can lift something.

How do I get off a plateau? - Change your workouts. Change the exercise as well as the duratio and intensity. Once your body gets used to an activity, it adapts and no longer makes changes. You need to continually challenge yourself.

When is the best time of the day to exercise? - Exercise when you feel you have the most time to relax and enjoy it. You should not be stressed about exercising.

Will exercise help with the side effects of the medication? - Yes, it is critical that you incorporate exercise into your health care plan. As a recipient, you need to keep all your systems strong. You need to promote fat loss while increasing and preserving muscle mass.

Remember:

IT TAKES 21 DAYS TO CREATE A HABIT AND 8 TO 10 WEEKS TO BUILD A GOOD FITNESS LEVEL.
THE FIRST FOUR TO SIX MINUTES ARE ALWAYS THE TOUGHEST
THE LOSE ONE POUND OF FAT, YOU NEED TO BURN 3500 CALORIES.

What type of physical therapy is needed after a lung transplant?

Response from Dr. Marshall I. Hertz

Physical rehabilitation is a very important component of care for lung transplant recipients. At our program at University of Minnesota, the patient is enrolled in a 6-12 week, 3 times a week program of aerobic exercise (bicycle or treadmill) similar to that prescribed for outpatient pulmonary rehabilitation of patients with chronic obstructive pulmonary disease. Oximetry, heart rate, and workload are monitored during supervised therapy sessions and an exercise prescription is developed for ongoing therapy.

Formal rehab therapy results in significant improvements in exercise capacity, whether carried out early ( within 1 month) or late (6-12 months) after transplantation. Lung transplant recipients have low peak work rate, low peak oxygen consumption, and early lactate threshold, compared with healthy controls with similar pulmonary function. Multiple studies have suggested that this limitation is due to abnormal peripheral muscle function, either as a result of pretransplant deconditioning or toxic effects of immune suppressive medications. In this regard pre transplant exercise conditioning programs may be able to limit the degree of muscle deconditioning; pulmonary rehab should be a component of the care of most patients waiting for lung transplantation, except when contraindiated by pulmonary hypertension or other factors.

Transplant and Exercise - From Stadtlander

After transplant, patients are given high doses of prednisone therapy, which causes muscle weakness and wasting. Thus, although the disease is corected with the successful transpaltn and the patient feels better, full recovery of physical strength and endurance requires gradual progression of exercise. Prednisone is always working against the muscles, so exercise must be regular in order to counteract it. Exercise will also assist transplant recipients with controlling their weight. Exercise may also play an important role in stress management aftrer transplant. Many patients feel that they are losing control of their lives. They worry about things they can't change. Exercise is something that is controlled ONLY by the individual. No one else can exercise for us.

Here are some exercise guidelines for developing general fitness:

TYPE - The only restrictions are the types of physical activity that pose a threat of direct hit to your transplant (i.e. boxing or football). Activities that wil best develop over-all strength and endurance are walking, cycling, swimming, aerobics, cross country skiiing and smiliar acitivities. Regular participation in these activities will develop and maintain good levels of fitness.
FREQUENCY - Exercising four or five times per week is recommended to develop and maintain adequate levels of fitness. If exercise is being used as part of a weight management program, then daily exercise may be advised.
DURATION - Many individuals after transplant can tolerate only five minutes per session. From this starting point, add two or three minutes per session, gradually achieving 30 minutes of exercise at a time.
INTENSITY - Moderate, sustained effort is sufficient. The exercise session should start out slowly, with a two to five minute warm up period at an "easy" level of exertion. Then the intensity should increase, to a moderately hard conditioning period in which the breathing is increased, but is not so labored that a conversation can't be maintained. This conditioning period should be gradually increased to 30 minutes. The session should end with a cool down period, which is an easy level of exertion.
What's important is that transplant recipients are physically conditioned to do whatever they want - after all, that's why they went through the transplant.

The Role of Exercise in Health Outcomes in Solid Organ Transplant Recipients

What's new concerning the role of exercise in solid organ transplant recipients?

Physical exercise has many well-known health benefits in the general population -- physical, mental, emotional, and psychosocial in nature. Regular exercise can improve mood, decrease anxiety and depression, aid in stress management, control weight, and maintain healthy bones, muscles, and joints. In addition, regular exercise can reduce the risk of heart disease and stroke, high blood pressure, non-insulin-dependent diabetes, obesity, colon cancer, and osteoporosis. Cardiovascular disease, in particular, is an important health problem after solid organ transplantation, related to multiple pretransplant comorbid conditions, and pharmacologic, metabolic, nutritional, and lifestyle factors. Cardiovascular disease accounts for 17% to 50% of deaths in renal transplant recipients.[1] Whether exercise could impact morbidity and mortality related to cardiovascular disease and other adverse health conditions in transplant recipients is largely unknown, as few studies have reported the effects of exercise training in these populations. More research is needed to identify the role of exercise as a lifestyle modification factor for improving health status and long-term outcomes in transplant recipients. (Source: Medscape Transplantation 4(2), 2003. � 2003 Medscape Posted 08/27/2003)

Resistance Training Prevents Vertebral Osteoporosis in Lung Transplant Recipients

Background: Osteoporosis and vertebral fractures are a consequence of glucocorticoid immunosuppression therapy in lung transplant recipients (LTR). The purpose of this study was to determine the therapeutic efficacy of a 6-month program of specific resistance exercise designed to reverse glucocorticoid-induced vertebral osteoporosis.

Methods: Sixteen lung transplant candidates were randomly and prospectively assigned to a group (n=8) that performed 6 months of exercise on a lumbar extensor machine or to a control group (n=8). Resistance exercise was initiated at 2 months after transplantation. Bone mineral density (BMD) of the lumbar vertebra (L2-3) was assessed using a dual-energy X-ray absorptiometer (DXA). DXA scans were performed before and 2 months after transplantation and after 6 months of lumbar extensor training or control period.

Results: Lumbar BMD did not differ (P>0.05) between the two groups at study entry. Both the trained (0.63 to 0.54 g/cm2 of hydroxyapatite) and control groups (0.62 to 0.53 g/cm2 of hydroxyapatite) lost significant and comparable amounts (-14.5%) of BMD between study entry and 2 months posttransplantation. The control group lost further (P</=0.05) BMD
between 2 and 8 months posttransplantation (0.53 to 0.50 g/cm2 of hydroxyapatite), decreasing to values that were 19.5% less than pretransplantation baseline. Lumbar BMD in the trained group increased significantly (+9.2%) after 6 months (0.54 to 0.60 g/cm2 of hydroxyapatite) and returned to values that were within 5% of pretransplantation baseline.

Conclusion: Mechanical loading associated with progressive resistance exercise, using a specific exercise that isolated the lumbar spine, was efficacious in preventing steroid-induced osteoporosis in LTR. (Source : Mitchell MJ, Baz MA, Fulton MN, Lisor CF, Braith RW Transplantation. 2003;76:557-562)

Exercise Delays Pulmonary Function Decline in Smokers and Nonsmokers

Laurie Barclay, MD

Aug. 22, 2003 - Exercise slows the rate of pulmonary function decline in both smokers and nonsmokers, according to the results of a study published in the August issue of the American Journal of Respiratory and Critical Care Medicine. Although more research is needed to determine whether this holds true for urban dwellers, the investigators encourage middle-aged and older people to exercise. "Our results suggest that physical activity may delay the decline in pulmonary function occurring in middle and older age," lead author Margit Pelkonen, MD, from the University of Kuopio in Finland, says in a news release. "The beneficial effect of physical activity on pulmonary function was independent of smoking and was similar in all smoking categories." Using the southwestern rural Finnish cohort of the Seven Countries Study, the investigators collected complete data from 429 men for 10 years, from 275 men for 20 years, and from 186 men for 25 years. At baseline in 1964, mean age was 55 years, and the percentage of occupational activity listed as heavy to very heavy was 70.9% in the lowest tertile of physical activity, 87.4% in the middle tertile, and 87.3% percent in the highest tertile. Most of the men were farmers, and all had retired by 1984. During the 25 years of the study, 37.8% to 42.6% of the men were continuous smokers. Compared with men in the lowest tertile of baseline physical activity estimated by kilometers walked, cycled, and skied daily, the decline in FEV0.75 during the first 10 years was 9.8 mL/year less among men in the highest tertile. This tertile also lost less pulmonary function over 20 years (P = .009) and over 25 years (P = .043). The benefit of physical exercise persisted in all smoking categories. Based on mortality analysis, continued high physical activity and an increase in activity to high level were associated with lower mortality. Loss of lung elastic recoil, chest wall compliance, and strength of respiratory muscles may be the most important factors contributing to age-related pulmonary function decline, the authors suggest, and physical activity may counteract these losses. "Physical activity is associated with a slower decline in pulmonary function and with lower mortality, and thus, middle-aged and older people should be encouraged to enjoy exercise," they write. (Source: Am J Respir Crit Care Med. 2003;168:494-499)