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Dunn MA, Rogal SS, Duarte-Rojo A, Lai JC. Physical Function, Physical Activity and Quality of Life After Liver Transplantation: A Review. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2020 Mar 3.
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Abstract: Robust physical activity after liver transplantation is an important determinant of long-term health, similar in its importance to the value of pre-transplant activity for withstanding the immediate stress of transplantation. While transplantation normally enables rapid recovery of liver synthetic and metabolic functions, the recovery of physical capacity and performance to normal levels is delayed and often incomplete. Anatomic measurements of sarcopenia and the physical performance indicators of frailty both tend to improve slowly and may in fact deteriorate in the post-transplant period, especially when the common extrahepatic drivers of muscle loss, such as the elements of the metabolic syndrome, persist or intensify after transplantation. Post-transplant exercise improves fitness, based on 2 observational studies and 3 randomized trials that assessed endpoints of strength testing, energy expenditure in metabolic equivalents (METs), and peak or maximal oxygen uptake. Importantly, one controlled trial found that exercise also improved quality of life (QOL) measured by Standard Form 36 (SF-36) survey, consistent with multiple reports of the value of social support and engagement in sports activity for improving post-transplant QOL. Developing evidence-based standards for post-liver transplant physical activity baseline testing and sustainment of intensity and quality is a key unmet need in transplant hepatology. At present it is reasonable for transplant teams to assess fitness and design a tailored exercise program when a recipient is first discharged, to record and reinforce progress at all post-transplant visits, and to set realistic long term performance goals that will often achieve recommended standards for the healthy general population.

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