BACKGROUND: Long-term survival of renal transplant recipients (RTR) has not improved over the past 20 yr. The question rises to what extent lifestyle factors play a role in post-transplant weight gain and its associated risks after transplantation.METHODS: Twenty-six RTR were measured for body weight, body composition, blood lipids, renal function, dietary intake, and physical activity at six wk, and three, six, and 12 months after transplantation.RESULTS: Weight gain ranged between -2.4 kg and 19.5 kg and was largely due to increase in body fat. RTR who remained body fat stable, showed more daily physical activity (p = 0.014), tended to consume less energy from drinks and dairy (p = 0.054), consumed less mono- and disaccharides (sugars) (p = 0.021) and ate more vegetables (p = 0.043) compared with those who gained body fat. Gain in body fat was strongly related to total cholesterol (r = 0.46, p = 0.017) and triglyceride (r = 0.511, p = 0.011) at one yr after transplantation.CONCLUSIONS: Gain in adiposity after renal transplantation is related to lifestyle factors such as high consumption of energy-rich drinks, high intake of mono- and disaccharides and low daily physical activity. RCTs are needed to investigate potential benefits of lifestyle intervention on long-term morbidity and mortality.
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Purpose of this longitudinal observational study was to (i) examine the change of daily physical activity in 28 adult kidney transplant recipients over the first 12 months following transplantation; and (ii) to examine the change in metabolic characteristics and renal function. Accelerometer-based daily physical activity and metabolic- and clinical characteristics were measured at six wk (T1), three months (T2), six months (T3) and 12 months (T4) following transplantation. Linear mixed effect analyses showed an increase in steps/d (T1 = 6326 ± 2906; T4 = 7562 ± 3785; F = 3.52; p = 0.02), but one yr after transplantation only 25% achieved the recommended 10 000 steps/d. There was no significant increase in minutes per day spent on moderate-to-vigorous intensity physical activity (T1 = 80.4 ± 63.6; T4 = 93.2 ± 55.1; F = 1.71; p = 0.17). Body mass index increased over time (T1 = 25.4 ± 3.2; T4 = 27.2 ± 3.8; F = 12.62; p < 0.001), mainly due to an increase in fat percentage (T1 = 30.3 ± 8.0; T4 = 34.0 ± 7.9; F = 14.63; p < 0.001). There was no significant change in renal function (F = 0.17; p = 0.92). Although the recipients increased physical activity, the majority did not meet the recommended levels of physical activity after one yr. In addition to the weight gain, this may result in negative health consequences. Therefore, it is important to develop strategies to support kidney transplant recipients to comply with healthy lifestyle recommendations, including regular physical activity.
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BACKGROUND: Exercise capacity, muscle function, and physical activity levels remain reduced in recipients of lung transplantation. Factors associated with this deficiency in functional exercise capacity have not been studied longitudinally.OBJECTIVE: The study aims were to analyze the longitudinal change in 6-minute walking distance and to identify factors contributing to this change.DESIGN: This was a longitudinal historical cohort study.METHODS: Data from patients who received a lung transplantation between March 2003 and March 2013 were analyzed for the change in 6-minute walking distance and contributing factors at screening, discharge, and 6 and 12 months after transplantation. Linear mixed-model and logistic regression analyses were performed with data on characteristics of patients, diagnosis, waiting list time, length of hospital stay, rejection, lung function, and peripheral muscle strength.RESULTS: Data from 108 recipients were included. Factors predicting 6-minute walking distance were measurement moment, diagnosis, sex, quadriceps muscle and grip strength, forced expiratory volume in 1 second (percentage of predicted), and length of hospital stay. After transplantation, 6-minute walking distance increased considerably. This initial increase was not continued between 6 and 12 months. At 12 months after lung transplantation, 58.3% of recipients did not reach the cutoff point of 82% of the predicted 6-minute walking distance. Logistic regression demonstrated that discharge values for forced expiratory volume in 1 second and quadriceps or grip strength were predictive for reaching this criterion.LIMITATIONS: Study limitations included lack of knowledge on the course of disease during the waiting list period, type and frequency of physical therapy after transplantation, and number of missing data points.CONCLUSIONS: Peripheral muscle strength predicted 6-minute walking distance; this finding suggests that quadriceps strength training should be included in physical training to increase functional exercise capacity. Attention should be paid to further increasing 6-minute walking distance between 6 and 12 months after transplantation.
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PURPOSE: To explore the underlying dimensions of the Barriers and Motivators Questionnaire that is used to assess barriers to and motivators of physical activity experienced by recipients of solid organ transplantation and thereby improve the application in research and clinical settings.METHOD: A cross-sectional study was performed in recipients of solid organ transplantation (n = 591; median (IQR) age = 59 (49; 66); 56% male). The multidimensional structure of the questionnaire was analyzed by exploratory principal component analysis. Cronbach's α was calculated to determine internal consistency of the entire questionnaire and individual components.RESULTS: The barriers scale had a Cronbach's α of 0.86 and was subdivided into four components; α of the corresponding subscales varied between 0.80 and 0.66. The motivator scale had an α of 0.91 and was subdivided into four components with an α between 0.88 to 0.70. Nine of the original barrier items and two motivator items were not included in the component structure.CONCLUSION: A four-dimensional structure for both the barriers and motivators scale of the questionnaire is supported. The use of the indicated subscales increases the usability in research and clinical settings compared to the overall scores and provide opportunities to identify modifiable constructs to be targeted in interventions. Implications for rehabilitation Organ transplant recipients are less active than the general population despite established health benefits of physical activity. A multidimensional structure is shown in the Barriers and Motivators Questionnaire, the use of the identified subscales increases applicability in research and clinical settings. The use of the questionnaire with its component structure in the clinical practice of a rehabilitation physician could result in a faster assessment of problem areas in daily practice and result in a higher degree of clarity as opposed to the use of the individual items of the questionnaire.
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Background: Short-term survival after solid-organ transplantation has substantially improved, and the focus has shifted to long-term survival, including the role of physical activity (PA). Knowledge about PA and sedentary time in recipients of solid-organ transplantation is limited, and identification of the levels and associated factors is necessary for intervention development.Objective: The objectives of this study were to investigate the level of PA and sedentary time in recipients of solid-organ transplantation and to identify factors associated with these behaviors.Design: The design consisted of a cross-sectional survey.Methods: Questionnaires on PA level, sedentary time, and potential associated factors were used for recipients of solid-organ transplantation (kidney, liver, lung, and heart [N = 656]). Multiple regression analyses with a variable selection procedure were used.Results: Fewer than 60% of the recipients fulfilled the PA guideline. Factors significantly associated with a lower level of PA included being a woman, younger age (nonlinear), not actively working or being retired, physical limitations, and low expectations and self-confidence. Factors significantly associated with less sedentary time included exercise self-efficacy and not actively working or being retired. Significantly associated with more sedentary time were a high education level, fear of negative effects, physical limitations, and the motivator "health and physical outcomes." The type of transplantation did not significantly influence either of the outcome measures.Limitations: The design did not allow for causal inferences to be made. The studied associated factors were limited to individual and interpersonal factors. Self-reported measures of PA and sedentary time were used.Conclusions: In intervention development directed at increasing the level of PA and reducing sedentary time in recipients of solid-organ transplantation, attention should be paid to physical limitations, fear of negative effects, low expectations and self-confidence, health and physical outcomes, and exercise self-efficacy.
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ABSTRACT: In a global society legal systems tend to become far more intertwined than they have been so far. Transplantation of legal arrangements from one legal system to another became an increasingly important issue as a consequence of growing interdependency among...
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BACKGROUND: Sufficient physical activity is important for solid organ transplant recipients (heart, lung, liver, kidney). However, recipients do not meet the recommended amount or required type of physical activity. The perceived barriers to and facilitators of physical activity in this population are largely unknown.METHODS: Semi-structured in depth interviews were conducted with solid organ transplant recipients in order to explore experienced barriers and facilitators. Qualitative methodology with thematic line-by-line analysis was used for analysis, and derived themes were classified into personal and environmental factors.RESULTS: The most important indicated barriers were physical limitations, insufficient energy level, fear, and comorbidities. The most frequently mentioned facilitators included motivation, coping, consequences of (in)activity, routine/habit, goals/goal priority, and responsibility for the transplanted organ. Neutral factors acting as a barrier or facilitator were self-efficacy and expertise of personnel. A comparison of barriers and facilitators between transplant recipient groups yielded no overt differences.CONCLUSION: Several personal and environmental factors were indicated that should be considered in intervention development to increase physical activity behavior in solid organ transplant recipients.
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Coastal flood managers seek to anticipate future flood risk and as a result consider the adaptation of flood defences. Instead of crest heightening, dikes can be adapted to include hydrodynamic reducing vegetated foreshores to form a nature-based hybrid flood defence, for instance; at managed realignments. In this study we investigated the potential of vegetated revetments as a natural continuous connection between the realigned dike and restored foreshore. We applied the historic grass sod transplantation technique with the aim to improve our understanding of the strength of a transplanted sod revetment. In Living Lab Hedwige-Prosperpolder, dikes were available for in-situ experiments during managed realignment preparations. We transplanted grass sods and studied erosion resistance after one growth season. Our results show transplanted sod vegetation continued to grow and started to attach to the clay layer. While erosion occurred under extreme wave impact and overflow, the sod pulling method revealed individual sod strength. In conclusion, sod transplantation is a good technique to source local material for green realigned dike revetments. A vegetated dike revetment can hereby create a natural continuous connection between the realigned dike and foreshore, which benefits flood protection as well as flora and fauna.
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Hematological malignancies and treatment with hematopoietic SCT are known to affect patients’ quality of life. The problem profile and care needs of this patient group need clarification, however. This study aimed to assess distress, problems and care needs after allo- or auto-SCT, and to identify risk factors for distress, problems or care needs. In this cross-sectional study, patients treated with allo-SCT or auto-SCT for hematological malignancies completed the Distress Thermometer and Problem List. Three patient groups were created: 0–1, 1–2.5 and 2.5–5.5 years after transplantation. After allo-SCT, distress and the number of problems tended to be lower with longer follow-up. After auto-SCT, distress was highest at 1–2.5 year(s). Patients mainly reported physical problems, followed by cognitive-emotional and practical problems. A minority reported care needs. Risk factors for distress as well as problems after allo-SCT included younger age, shorter time after transplantation and GVHD. A risk factor for distress as well as problems after auto-SCT was the presence of comorbid diseases. Up to 5 years after auto-SCT or allo-SCT, patients continue to experience distress and problems. Judged by prevalence, physical problems are first priority in supportive care, followed by cognitive-emotional and practical problems.
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