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Energy Expenditure During a Day of Sport Competitions in Kidney Transplant Recipients

2010; Wolters Kluwer; Volume: 90; Issue: 10 Linguagem: Inglês

10.1097/tp.0b013e3181f8699d

1534-6080

Giulio Sergio Roi, Matteo Parigino, Davide Pisoni, Giovanni Mosconi, Alessandro Nanni Costa, Sergio Stefoni,

Adolescent and Pediatric Healthcare

Kidney transplant recipients show a reduction in maximal exercise capacity and cardiorespiratory fitness that may be counteracted by physical and sporting activities (1). However, not all patients increase their physical activity after transplant, and kidney transplant recipients show a continuum of different attitudes: on one hand, patients may stay inactive because of fears of injuring the transplant graft or simple lack of motivation, whereas other patients may restart (or begin) strenuous sporting activities. This spectrum of attitudes may be influenced by a lack of counseling from transplant professionals and community nephrologists about the benefits of exercise or by those providers who may themselves fear the risk of cardiac complications from exercise (2). The overall population of kidney transplant recipients is heterogeneous, suggesting that tailored exercises regimens are needed to ensure patient safety (2), but to make effective exercise training recommendations without being overly cautious, it is helpful to know the upper limits of human performance also in kidney transplant recipients. Since the foundation of the Transplant Games in 1978 (3), participation in competitions for transplant recipients at international, national, and local levels has been growing, but the scientific literature contains only anecdotal reports of performance capacities, and only a few investigations have been published (4–6). The aim of this letter was to contribute to the debate about sport and transplantation by presenting some data collected “on the field.” The daily energy expenditure of 20 male kidney transplant recipients (age 47±10 years) who had undergone transplant surgery in different transplant centers 103±79 months before the study were evaluated by a multiple-sensor body monitor validated for exercise activities in healthy and ill populations (7) (Sense-Wear Armband; BodyMedia Inc., Pittsburgh, PA). Subjects were recruited in 2009, during a day of winter (alpine and cross country skiing) or summer (road cycling and track and field) sport competitions for transplanted athletes. They were in the normal weight body mass index category ( 30 kg/m2). Mean creatinine levels were 1.5±0.6 mg/dL; immunosuppressive regimens were being provided according to the institutional standard protocols. Eighteen patients had normal fasting glucose, whereas two had cases of diabetes that were well controlled on oral agents. The energy expenditure was 3376±739 kcal/day, corresponding to 43.7±13.6 kcal/kg per day, that is, approximately 25% higher than those of age-matched inactive healthy subjects. These patients were also able to perform physical activity at an intensity level greater than three multiples of the resting metabolic rate (metabolic equivalents) for 197±112 min, demonstrating the capacity for periods of moderate to heavy energy expenditure. Clearly, there is a wide range of observed energy expenditures in the patients who participated in this study (Table 1); nevertheless, these findings still importantly contradict the expectations that these patients have a low level of physical activity (1).TABLE 1: Daily energy expenditure (mean±SD) of 20 male kidney transplant recipients involved in a day of sporting competitions for transplanted patientsDespite the increase in physical fitness that comes with activity, our group of kidney transplant recipients performed significantly worse (from −27% to −53%) in comparison with the age-matched best performances of nationally competitive healthy athletes. One of the most important factors that may explain these differences is the genetic endowment that allows some healthy individuals to perform at top levels, although training, practice, motivation, and nutrition certainly contribute to high performance as well. This observation may indicate that kidney transplant recipients may be able to improve their performance capacities and eventually recover to their pretransplant levels of performance. This hypothesis gains support from the observation that some kidney transplant recipients were able to face healthy top-level athletes in various competitions. For example, the free encyclopedia, Wikipedia (accessed January 12, 2010) reports that at least four professional athletes have returned to professional sports after receiving a transplant: New Zealand Rugby Union player Jonah Lomu, German-Croatian soccer player Ivan Klasnić, and NBA basketballers Sean Elliott and Alonzo Mourning. Moreover, a recent case report describes a professional boxer whose kidney allograft remained in good health despite the violent nature of that sport (8). These reports raise the important issue of whether individuals with one functioning kidney should engage in contact or noncontact sports, a question that deserves further investigation. In conclusion, kidney transplant recipients involved in sport competitions are able to attain a level of daily physical activity consistent with a healthy lifestyle. These patients are representative of the upper limits of performance of kidney transplant recipients not of the entire population of kidney transplant recipients. It is our hope that this example may promote and inspire greater participation in exercise training and sports activities on the part of kidney transplant recipients including tailored exercise regimens. Giulio S. Roi1 Matteo Parigino1 Davide Pisoni1 Giovanni Mosconi2 Alessandro Nanni Costa3 Sergio Stefoni2 1 Education and Research Department Isokinetic Medical Group Bologna, Italy 2 Nephrology, Dialysis and Renal Transplant Unit Department of Internal Medicine, Aging and Renal Disease University Hospital St. Orsola Bologna, Italy 3 Italian National Transplant Centre Rome, Italy.