Clinical Trials Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Feb 24, 2018; 8(1): 13-22
Published online Feb 24, 2018. doi: 10.5500/wjt.v8.i1.13
Renal function and physical fitness after 12-mo supervised training in kidney transplant recipients
Giulio Sergio Roi, Giovanni Mosconi, Valentina Totti, Maria Laura Angelini, Erica Brugin, Patrizio Sarto, Laura Merlo, Sergio Sgarzi, Michele Stancari, Paola Todeschini, Gaetano La Manna, Andrea Ermolao, Ferdinando Tripi, Lucia Andreoli, Gianluigi Sella, Alberto Anedda, Laura Stefani, Giorgio Galanti, Rocco Di Michele, Franco Merni, Manuela Trerotola, Daniela Storani, Alessandro Nanni Costa
Giulio Sergio Roi, Department of Education and Research, Isokinetic Medical Group, Bologna 40123, Italy
Giovanni Mosconi, Maria Laura Angelini, Department of Nephrology and Dialysis, Morgagni-Pierantoni Hospital, Forlì 47121, Italy
Valentina Totti, Rocco Di Michele, Franco Merni, Department of Biomedical & Neuromotor Sciences, University of Bologna, Bologna 40121, Italy
Valentina Totti, Associazione Nazionale Emodializzati, Dialisi e Trapianto, Milano 20121, Italy
Erica Brugin, Department of Cardiovascular, Sports Medicine, Noale 30033, Italy
Patrizio Sarto, Laura Merlo, Sports Medicine, ULSS Company 9, Treviso 31100, Italy
Sergio Sgarzi, Michele Stancari, Sports Medicine, Regional Hospital of Bologna, Bologna 40121, Italy
Paola Todeschini, Gaetano La Manna, Department of Nephrology and Dialysis, S. Orsola Hospital, Bologna 40121, Italy
Andrea Ermolao, Sports Medicine Unit DIMED, Department of Medicine, University of Padua, Padua 35100, Italy
Ferdinando Tripi, Lucia Andreoli, Sports Medicine, Regional Hospital of Modena, Modena 41100, Italy
Gianluigi Sella, Sports Medicine, Regional Hospital of Ravenna, Ravenna 48121, Italy
Alberto Anedda, Sports Medicine, Regional Hospital of Parma, Parma 43121, Italy
Laura Stefani, Giorgio Galanti, Department of Experimental and Clinical Medicine, School of Sports Medicine, University of Florence, Sports Medicine Centre, Florence 50100, Italy
Manuela Trerotola, Daniela Storani, Alessandro Nanni Costa, Italian National Transplant Centre, Rome 00161, Italy
Author contributions: Roi GS and Mosconi G have participated in research design, drafting the paper, performance of the research and critical revision of the paper; Totti V and Angelini ML has participated in drafting the paper, performance of the research and critical revision of the paper; Brugin E, Sarto P, Merlo L, Sgarzi S, Stancari M, Todeschini P, La Manna G, Ermolao A, Capone S, Tripi F, Andreoli L, Sella G, Anedda A, Stefani L, Galanti G and Trerotola M have participated in the performance of the research and data collection; Di Michele R and Merni F have participated in drafting the paper, data analysis and statistics; Nanni Costa A has participated in research design and in the performance of the research.
Institutional review board statement: 118/2010/O/Sper approved 20-07-2010.
Clinical trial registration statement: This study is registered at http://www.isrctn.com/ISRCTN66295470. The registration identification number is ISRCTN66295470.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Dr. Nanni Costa has nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alessandro Nanni Costa, MD, Doctor, Italian National Transplant Centre, Istituto Superiore di Sanità, Viale Regina Elena 299, Roma 00161, Italy. daniela.storani@iss.it
Telephone: +39-06-49904040 Fax: +39-06-49904101
Received: October 31, 2017
Peer-review started: November 1, 2017
First decision: November 30, 2017
Revised: December 6, 2017
Accepted: December 28, 2017
Article in press: December 28, 2017
Published online: February 24, 2018
Abstract
AIM

To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations.

METHODS

Ninety-nine kidney transplant recipients (KTRs) were assigned to interventional exercise (Group A; n = 52) and a usual care cohort (Group B; n = 47). Blood and urine chemistry, exercise capacity, muscular strength, anthropometric measures and health-related quality of life (HRQoL) were assessed at baseline, and after 6 and 12 mo. Group A underwent a supervised training three times per week for 12 mo. Group B received only general recommendations about home-based physical activities.

RESULTS

Eighty-five KTRs completed the study (Group A, n = 44; Group B, n = 41). After 12 mo, renal function remained stable in both groups. Group A significantly increased maximum workload (+13 W, P = 0.0003), V’O2 peak (+3.1 mL/kg per minute, P = 0.0099), muscular strength in plantar flexor (+12 kg, P = 0.0368), height in the countermovement jump (+1.9 cm, P = 0.0293) and decreased in Body Mass Index (-0.5 kg/m2, P = 0.0013). HRQoL significantly improved in physical function (P = 0.0019), physical-role limitations (P = 0.0321) and social functioning scales (P = 0.0346). No improvements were found in Group B.

CONCLUSION

Twelve-month of supervised aerobic and resistance training improves the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Recommendations alone are not sufficient to induce changes in exercise capacity of KTRs. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities.

Keywords: Kidney transplant recipients, Renal function, Supervised exercise, Aerobic exercise, Muscle strength

Core tip: This paper shows that developing a supervised exercise protocol for kidney transplant recipients is a useful and safe non-pharmacologic contribution to usual after-transplant treatments, which can improve the physiological variables related to physical fitness and cardiovascular risks without consequences on renal function. Our study is an example of collaborative working between transplant centres, sports medicine and exercise facilities, aimed to apply the concepts of “exercise is medicine”.