Establishing and Maintaining
Health and Quality of Life Benefits
of Isometric and Isotonic Exercise
Programs for recipients through involvement of
the world transplant games
Daryl Wall AM, MBBS,
Chairman, WTGF Medical Committee,
Senior Liver Transplant Surgeon, Queensland,
Australia
Presented at the Vancouver Convention Centre for the XXIII International Congress
of the Transplantation Society, Vancouver, Canada, 2010
Introduction & Methods
Recipients undertaking isometric and isotonic exercises may gain
improvement in quality of life and possibly length of life. Although
evidence supporting physician directed exercise has appeared in the
medical literature over the past 30 years, recipients are rarely provided
with medically directed exercise programs for life. To increase the
awareness of transplant clinicians it will be necessary to demonstrate
widely and frequently the safety and the benefits of supervised and
individualised exercise programs.
Modern inactive lifestyles are associated with an increase in severity and
of frequency of co-morbidities (eg obesity) in patients awaiting and
undergoing transplantation. Consequently restoring exercise tolerance,
functional capacity, muscle strength and endurance is now even more
important to both the recipient and the transplant clinician. Delay in
transplantation is associated with more advanced muscle wasting which
correlates with increased post transplant mortality.
World Transplant Games
Federation
The World Transplant Games Federation
was established 25 years ago for
transplant recipients.
Games Objectives
1.
2.
3.
4.
5.
To encourage rehabilitation through sport.
To demonstrate quality of life after organ transplantation.
To promote organ donor awareness.
To recognise donors and donor families.
To celebrate life.
Material and Methods
Study Population
Data was prospectively collected on athletes participating in the World
Transplant Games Federation from 1985. Two studies were undertaken. The
first was a safety study identifying death or new death experiences of athletes.
The second study undertaken was a comparison between World Transplant
Games athletes compared with inactive recipients matched for age, type of
transplant, year of transplant and sex. Fifty members in each group. The end
points were death, loss of organ or return to dialysis.
Extreme Adverse Events and Loss
of Life over 31 years
1987 Innsbruck
- Cardiac sudden death in bed renal transplant - shot putt athlete
1995 Manchester
- Cardiac arrest whilst swimming, successfully
resuscitated –cardiac transplant athlete
(pre-existing rejection)
2003 France
- Cardiac arrest playing badminton renal transplant
athlete - died
2005 Canada
- Cardiac screening introduced for >40 years
-
No adverse events
- Swine flu threat(H1N1), but no adverse events
Comparison Study over 10 years
Jan 1999 to Dec 2008
Tx athletes (50)
Alive at 10 years
Tx non-athlete (50)
45
38
Organs lost through failure
8
14
Death after organ failure
5
6
Statistical Analysis
WTG Athletes v Inactive Recipients
Survival - No statistically significant difference, however
The trend (45 v 38 ) is favourable
WTG Athletes v Inactive Recipients
Loss of Organs - No statistically significant difference, however
The trend (8 v 14) is favourable
A selection bias may have contributed to this result – athletes may have
been fitter before transplant
Interpretation of Results
Involvement in W.T.G. activities
Prolongs organ function
- average 16 months/athlete
Reduces costs of care
Improves quality of life of athlete
World Transplant Games
Conclusion
W.T. Games activities are safe
Sporting activities for recipients of all ages presents benefits which far
exceed the risks
Safe W.T .Games require a fierce commitment to protocols of risk
management
Safe W.T. Games are expensive, as training expertise and experience of the
duty officers are paramount
On demonstrating the safety of the W.T. Games (500 events), it is now
possible to reassure Recipients and their medical teams and carers