A Novel and Personalized Rehabilitation Program for Obese Kidney Transplant Recipients.
Tzvetanov I, West-Thielke P, D’Amico G, et al.Transplantation Proceedings 2014; 46:3431-3437.
Aims
To examine the effectiveness of an original physical exercise program which included behaviour modification and nutritional training, in comparison to the standard level of care for obese kidney transplant recipients.
Interventions
The GH (Greg Hachaj) method of rehabilitation incorporating physical fitness, psychology and nutrition was applied to patients in the intervention group. This included individual physical training using low-impact, low-repetition, resistance-based weight training with two 1-hour sessions each week in a private environment. The control group received the standard care for kidney transplant recipients.
Participants
17 patients aged between 18 and 65 years who had a successful kidney transplant at least 1 month before enrolment, had normal and stable renal function, and a body mass index (BMI) of 30 or greater.
Outcomes
Physiological outcomes measured were body mass index (BMI), body composition, blood pressure control, serum creatinine, glomerular filtration rate (GFR), total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, fasting blood glucose, and hemoglobin A1c. Health status and also employment status were also measured. For the intervention group only the outcomes of subjective pain assessment, compliance and weight lifting capacity were measured.
Follow-up
12 months.
CET Conclusions
This is a small but an interesting study whose preliminary results suggest that a comprehensive approach to physical rehabilitation, physical exercise, behavioural interventions and nutritional guidance after renal transplantation can result in improved adherence to treatment, better kidney function, better quality of life and a better employment rate for obese patients. Although only 17 patients participated in this small trial, the results are really quite suggestive of a considerable benefit of a personalised rehabilitation programme in obese (BMI>30) recipients of a kidney transplant. Previous related studies have suggested a very poor compliance with rehabilitation programmes which was in contrast to the compliance in the intervention arm in this small study. On the numbers involved, I am hesitant to say that physical rehabilitation should be a mandatory and integral part of the complex treatment of transplant recipients which is what they are suggesting, but I was glad to see that they are planning a larger study to take these very interesting observations further. Would the same apply to all recipients of a renal transplant? I suspect so but compliance and logistical support would be a major problem.
Data analysis
Per protocol analysis
Trial registration
Not reported.