Featured Publication in Transplant International: Tania Janaudis-Ferreira
The CDTRP is happy to highlight the paper entitled “The effects of exercise training in adult solid organ transplant recipients: A systematic review and meta-analysis” that was published in Transplant International featuring CDTRP investigators Tania Janaudis-Ferreira, Sunita Mathur and Tom Blydt-Hansen. Our Research Manager, Katie Bain, asked Tania a few questions about it:
How do you think the research will advance the field?
Our systematic review showed that exercise training improves maximal exercise capacity, health-related quality of life, quadriceps muscle strength, and diastolic blood pressure in solid organ transplant (SOT) recipients compared to a control group who received no exercise. These findings are novel compared to previous reviews. Prior reviews were conducted on recipients of a single transplant type (i.e., organ-specific). In addition, they included fewer studies preventing the pooling of results or focused on a narrower list of outcome measures. For example, Didsbury et al. (2013) were only able to conduct a meta-analysis with data of VO2 peak while we had enough data to conduct meta-analysis using VO2 peak, SF-36, quadriceps muscle strength, and several other secondary outcomes. Our systematic review highlights the benefits of exercise training for all organ groups and that exercise training should be considered an essential part of post-transplant care.
Our systematic review also revealed that there is limited evidence that exercise training improves other cardiovascular risk factors, body composition, inflammatory markers, physical activity, physical function, return to work, depression and anxiety, immune and graft function, healthcare utilization, or survival in this population. However, these results must be interpreted with caution as fewer studies reported these secondary outcomes.
Future research in exercise training studies should focus on outcomes such as cardiovascular risk factors, immune and graft function, healthcare utilization, and survival. In addition, implementation projects would ensure that exercise training programs are available for all organ groups across Canada.
How has the CDTRP supported this project?
Our team used an integrated knowledge translation approach to ensure that the results of our systematic review would be relevant to key knowledge users and Canadian and international stakeholders. We engaged knowledge users in a pre and post-review phase by providing feedback on the research questions, protocol, and findings. The CDTRP was instrumental in helping our team identify key knowledge users and international stakeholders.
How could the CDTRP support the future directions of this work?
The CDTRP could continue to provide research funds for exercise trials to address the shortcomings of previous studies to strengthen the evidence, especially regarding the benefits of exercise on other cardiovascular risk factors, immune and graft function, and survival. In addition, CDTRP could provide research funds for implementation studies that would facilitate the adoption of exercise training programs in transplant or rehabilitation centers in Canada. There is a great potential for national collaboration through the CDTRP Exercise Hub.
Reduced exercise capacity can predispose solid organ transplant (SOT) recipients to higher risk of diabetes, cardiovascular complications, and mortality and impact their quality of life. This systematic review and meta-analysis investigated the effects of exercise training (versus no training) in adult SOT recipients. We conducted an electronic search of randomized controlled trials reporting on exercise interventions in SOT recipients. Primary outcomes were exercise capacity, quadriceps muscle strength, and health-related quality of life (HRQoL). Twenty-nine articles met the inclusion criteria. In 24 studies, there were either high risk of bias or some concerns about the potential risk of bias. There was an increase in exercise capacity (VO2 peak) (SMD: 0.40; 95%CI 0.22–0.57; P = 0.0) and quadriceps muscle strength (SMD: 0.38; 95%CI 0.16–0.60; P = 0.001) in the exercise vs control groups. There were also improvements in several domains of the SF-36. Diastolic blood pressure improved in the exercise group compared to controls (SMD: −0.22; 95%CI −0.41–0.03; P = 0.02). Despite the considerable variation in exercise training characteristics and high risk of bias in the included studies, exercise training improved maximal exercise capacity, quadriceps muscle strength, HRQoL, and diastolic blood pressure and should be an essential part of the post-transplant care.
About Transplant International
Transplant International aims to be the premier journal publishing the key basic science and clinical developments in organ replacement medicine, including all aspects of transplantation, organ reconditioning, cell therapy, regenerative medicine, bioengineering and artificial organs.