24 July 2024 : Review article
Optimizing Quality of Life in Kidney Transplant Recipients Through Structured Exercise: A Systematic Review and Evidence-Based Guidelines
Wushi Wang1F*DOI: 10.12659/MSM.943617
Med Sci Monit 2024; 30:e943617
Table 2 Table of articles. MSc in Nursing/Dip Leadership/PgD Social Studies – Evidence Based Professional Practice 47218/QUAL91000.
| # | Reference as per guidelines | Aim/purpose | Methodology | Sample | Intervention/tool | Findings | Limitations |
|---|---|---|---|---|---|---|---|
| 1 | Karelis AD, Hébert MJ., Rabasa-Lhore’t R and Räkel A. Impact of resistance training on factors involved in the development of new-onset diabetes after transplantation in renal transplant recipients: an open randomized pilot study. Canadian Journal of Diabetes, 2016; 40(5): 382–88. (Canada) | 1. To evaluate the feasibility of resistance training (RT) after renal transplantation.2. To evaluate the effect of the RT program on health-related quality of life (QOL) in patients with new-onset diabetes after renal transplantation. | Pilot RCT | A single transplant center recruited 24 patients age≥18 with new-onset diabetes, and the transplantation time was 6–8 weeks.And the patients were sedentary and the structural exercise time was no more than 2 hours per week.Finally:Exercise group: 10Control group: 10 | 1. Intervention: resistance training (RT)Patients assigned to the exercise group trained in the gym for 16 weeks, 3 times a week. Train once a week under the supervision of a sports student and twice a week at home. The 45–60 min hospitalization RT program.Each exercise is monitored separately to get the best progress. The RT program includes the following activities:1) leg pressure;2) chest pressure;3) lateral pull-down;4) shoulder pressure;5) arm bending;6) triceps extension; and7) sit-ups.2. Evaluation QOL tool:WHO-5 | 1. Patients in the exercise group showed a high score of well-being in the WHO-5 score.The results showed that the QOL of recipients improved after RT training.2. RT training is safe and feasible. | 1. In terms of analysis, the power of the pilot research is insufficient.2. There is no supervision in the 2/3 exercise, which affects the intensity of the exercise.3. The researchers did not accurately measure or intervene in nutritional factors.4. Patients with new-onset diabetes at higher risk were not quarantined. |
| 2 | Tzvetanov I, West-Thielke, P, D’Amico G, et al. A novel and personalized rehabilitation program for obese kidney transplant Recipients. Transplantation Proceedings, 2014; 46(10): 3431–37. (USA) | Testing the effectiveness of Multidisciplinary Rehabilitation Program (GH method) | Pilot RCT | A single transplant center recruited obese recipients (BMI>30) between the ages of 18–65 years.The transplant time is more than one month.Finally:Exercise group: 9Control group: 8 | 1. Intervention: resistance training (RT)The exercise group received 12-month one-on-one resistance training from coaches.Twice a week, 1 hour at a time.2. Evaluation QOL tool:SF-36 | 1. The employment rate of the exercise group was higher than that of the control group.2. The perceived health status of the exercise group was improved.3. Employment also makes the QOL of patients improve positively. | The limitation of the study was the lack of complete data on the control group. |
| 3 | Painter PL, Hector L, Ray K, et al. A randomized trial of exercise training after renal transplantation. Transplantation, 2002; 74(1): 42–48. (USA) | To study the effect of an exercise intervention on health-related physical fitness (exercise volume, muscle strength, body composition) and QOL in patients after renal transplantation. | RCT | A total of 167 renal transplant recipients were recruited in a single transplant center one month after the operation.Finally:Exercise group: 54Control group: 43 | 1. Intervention: aerobic training (AT)Personalized exercise program (family exercise, walking, cycling). Training time ≥4 times a week, each time ≥30 min.The training was unsupervised, and follow-up tests were performed at 1 month, 6 months and 12 months after the study.2. Evaluation QOL tool:SF-36 | 1. Compared with the control group, the QOL of the exercise group was significantly improved.2. The physical function (PF) score of the exercise group is higher, which may be the direct influence of the exercise intervention. | The prescribed movement is not supervised. |
| 4 | Riess KJ, Haykowsky, M, Lawrance, R, et al. Exercise training improves aerobic capacity, muscle strength, and quality of life in renal transplant recipients. Applied Physiology, Nutrition, and Metabolism, 2014; 39(5): 566–71. (Canada) | 1. The effects of endurance and exercise ability on renal transplant recipients were examined.2. The role of exercise in improving the QOL | RCT | A total of 31 renal transplant recipients were recruited in a single transplant center whose age ≥18 years and the transplantation time ≥6 months. Patients with hypertension and diabetes were excluded.Finally:Exercise group: 16Control group: 15 | 1. Intervention: aerobic training and resistance training (AT+RT)12 weeks of supervised endurance and strength training (EST and AT combined with RT).Among them, endurance training 3 days a week, 30–60 min each time; strength training 2 days a week, 10–15 times as a group, 2 groups each time.2. Evaluation QOL tool:SF-36 | 1. 12 weeks of aerobic combined with resistance training improved the QOL of the patients.2. In the SF-36 health status questionnaire, the patients had high scores in social function, comprehensive psychological score and overall quality of life. | 1. The sample size is small.2. No X-ray and MRI were used to observe the changes of lower limb muscles. |
| 5 | Greenwood SA, Koufaki P, Mercer TH, et al. Aerobic or resistance training and pulse wave velocity in kidney transplant recipients: A 12-week pilot randomized controlled trial (the Exercise in Renal Transplant [ExeRT] Trial. American Journal of Kidney Diseases, 2015; 66(4): 689–98. (UK) | Determine the potential difference in cardiovascular health between aerobic or resistance training and conventional care. And the impact on the quality of life. | Pilot RCT | Recruit kidney transplant recipients who are ≥18 years old and transplant time <12 months in multiple centers. Exclude patients with exercise contraindi-cations.Finally:RT group: 13AT group: 13Control group: 20 | 1. Intervention: aerobic training or resistance training (AT or RT)Exercise training lasts for 12 weeks, with AT or RT 3 days a week. Among them, aerobic training is a supervised, structured exercise twice a week. Resistance training is a 30-min personal home training once a week.2. Evaluation QOL tool:SF-36 | 1. Exercise training for recipients after kidney transplantation is acceptable.2. Aerobic training improved the patient’s arterial stiffness and maximum peak oxygen uptake.Resistance training improves arterial stiffness, maximum peak oxygen uptake, isometric muscle strength, etc.3. Exercise training improves the QOL of patients. | Small sample size |