Exercise rehabilitation to treat sarcopenia in pediatric transplant populations
Amber Hager
Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorYuxin Guo
Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorYiqi Wang
Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorVera Mazurak
Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorSusan M. Gilmour
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
Division of Pediatric Gastroenterology & Nutrition/Transplant Services, The Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
Search for more papers by this authorCorresponding Author
Diana R. Mager
Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
Correspondence
Diana R. Mager, Clinical Nutrition, 2-021D Li Ka Shing Centre for Research Innovation, Clinical Research Unit, Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, AB T6G 0K2, Canada.
Email: [email protected]
Search for more papers by this authorAmber Hager
Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorYuxin Guo
Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorYiqi Wang
Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorVera Mazurak
Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorSusan M. Gilmour
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
Division of Pediatric Gastroenterology & Nutrition/Transplant Services, The Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
Search for more papers by this authorCorresponding Author
Diana R. Mager
Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
Correspondence
Diana R. Mager, Clinical Nutrition, 2-021D Li Ka Shing Centre for Research Innovation, Clinical Research Unit, Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, AB T6G 0K2, Canada.
Email: [email protected]
Search for more papers by this authorAbstract
Background
In adult transplant (Tx) populations, exercise rehabilitation strategies may improve sarcopenia components (muscle mass [MM], strength [MS], and physical performance [PP]). Limited data are available regarding exercise rehabilitation therapy in pediatric Tx populations.
Methods
The purpose of this review is to critically evaluate the feasibility and impact of exercise programs (EP) that include resistance exercise (RE) on markers of sarcopenia in pediatric Tx populations. Literature searches in SCOPUS and WEB OF SCIENCE were conducted to identify studies applying EP with a RE component in pediatric populations in the Tx setting.
Results
Twelve articles (2008–2022) met inclusion criteria. The exercise interventions varied in length (3 weeks–12 months), intensity (low to moderate), time pre/post Tx (0 days-5 years post Tx), age of participants (3–18 years), adherence (63%–94%), and methodologies to measure components of sarcopenia. No studies measured all three components of sarcopenia concurrently. Approximately, 60% of studies found positive effects on MS and PP. Only one pediatric study measured body composition, therefore, the effect of exercise programs with RE components on MM is unknown.
Conclusions
Exercise programs may be a beneficial treatment for sarcopenia in Tx populations, particularly in components of MS and PP. Studies measuring all three aspects of sarcopenia together in response to RE training in pediatrics remains an important gap. Studies that include body composition measurements in response to exercise are needed. Special considerations for the development of RE programs in pediatrics Tx populations are safety, supervision, engagement through family/peer involvement and incorporation of game/play-based elements.
CONFLICT OF INTEREST STATEMENT
None to report.
Open Research
DATA AVAILABILITY STATEMENT
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
Supporting Information
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Table S1. |
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REFERENCES
- 1Ooi PH, Mazurak VC, Siminoski K, et al. Deficits in muscle strength and physical performance influence physical activity in Sarcopenic children after liver transplantation. Liver Transpl. 2020; 26(4): 537-548.
- 2Ooi PH, Mazurak VC, Bhargava R, et al. Myopenia and reduced subcutaneous adiposity in children with liver disease are associated with adverse outcomes. JPEN J Parenter Enteral Nutr. 2020; 45: 961-972.
- 3Woolfson JP, Perez M, Chavhan GB, et al. Sarcopenia in children with end-stage liver disease on the transplant waiting list. Liver Transpl. 2021; 27(5): 641-651. doi:10.1002/lt.25985
- 4Wei C, Thyagiarajan MS, Hunt LP, Shield JP, Stevens MC, Crowne EC. Reduced insulin sensitivity in childhood survivors of haematopoietic stem cell transplantation is associated with lipodystropic and sarcopenic phenotypes. Pediatr Blood Cancer. 2015; 62(11): 1992-1999.
- 5Mager DR, Hager A, Ooi PH, Siminoski K, Gilmour SM, Yap JYK. Persistence of sarcopenia after pediatric liver transplantation is associated with poorer growth and recurrent hospital admissions. JPEN J Parenter Enteral Nutr. 2019; 43(2): 271-280.
- 6Patterson C, So S, Rogers A, Ng VL. Motor outcomes in young children pre-and one-year post-liver transplant. Pediatr Transplant. 2022; 26(3):e14200.
- 7Ando T, Fujisawa S, Teshigawara H, et al. Computed tomography-defined sarcopenia: prognostic predictor of nonrelapse mortality after allogeneic hematopoietic stem cell transplantation: a multicenter retrospective study. Int J Hematol. 2020; 112(1): 46-56.
- 8Ooi PH, Hager A, Mazurak VC, et al. Sarcopenia in chronic liver disease: impact on outcomes. Liver Transpl. 2019; 25(9): 1422-1438.
- 9Raghu VK, Sico R, Rudolph JA, Mazariegos GV, Squires J, Squires JE. Sarcopenia prevalence in pediatric intestinal transplant recipients: implications on post-transplant outcomes. Pediatr Transplant. 2022; 26(4):e14256.
- 10Michou V, Davioti M, Syrakou N, Liakopoulos V, Deligiannis A, Kouidi E. Effects of a combined intradialytic exercise training program on functional capacity and body composition in kidney transplant candidates. J Funct Morphol Kinesiol. 2023; 8(1): 1-14.
- 11Senthil Kumar TG, Soundararajan P, Maiya AG, Ravi A. Effects of graded exercise training on functional capacity, muscle strength, and fatigue after renal transplantation: a randomized controlled trial. Saudi J Kidney Dis Transpl. 2020; 31(1): 100-108.
- 12Peterson MD, Sen A, Gordon PM. Influence of resistance exercise on lean body mass in aging adults: a meta-analysis. Med Sci Sports Exerc. 2011; 43(2): 249-258.
- 13Schiaffino S, Serrano A. Calcineurin signaling and neural control of skeletal muscle fiber type and size. Trends Pharmacol Sci. 2002; 23(12): 569-575.
- 14Beaudart C, Rolland Y, Cruz-Jentoft AJ, et al. Assessment of muscle function and physical performance in daily clinical practice. Calcif Tissue Int. 2019; 105(1): 1-14.
- 15 World Health Organization. Integrated Care for Older People: Guidelines on Community-Level Interventions to Manage Declines in Intrinsic Capacity. 2017.
- 16 National Institutes of Health. National Heart Lung and Blood Institute. U.S. Department of Health and Human Services. Accessed Aug 1, 2023, https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
- 17Deliva RD, Hassall A, Manlhiot C, Solomon M, McCrindle BW, Dipchand AI. Effects of an acute, outpatient physiotherapy exercise program following pediatric heart or lung transplantation. Pediatr Transplant. 2012; 16(8): 879-886.
- 18Deliva RD, Patterson C, So S, et al. The world transplant games: an incentive to improve physical fitness and habitual activity in pediatric solid organ transplant recipients. Pediatr Transplant. 2014; 18(8): 889-895.
- 19Chamorro-Viña C, Ruiz JR, Santana-Sosa E, et al. Exercise during hematopoietic stem cell transplant hospitalization in children. Med Sci Sports Exerc. 2010; 42(6): 1045-1053.
- 20Rossi F, Zucchetti G, Esposito M, et al. Rehabilitation in children and adolescents undergoing stem cell transplantation: a pilot study focused on motor performance. Eur J Cancer Care (Engl). 2022; 31(6):e13711.
- 21San Juan AF, Chamorro-Viña C, Moral S, et al. Benefits of intrahospital exercise training after pediatric bone marrow transplantation. Int J Sports Med. 2008; 29(5): 439-446.
- 22Yildiz Kabak V, Duger T, Uckan Cetinkaya D. Investigation of the effects of an exercise program on physical functions and activities of daily life in pediatric hematopoietic stem cell transplantation. Pediatr Blood Cancer. 2016; 63(9): 1643-1648.
- 23Chamorro-Viña C, Valentín J, Fernández L, et al. Influence of a moderate-intensity exercise program on early NK cell immune recovery in pediatric patients after reduced-intensity hematopoietic stem cell transplantation. Integr Cancer Ther. 2017; 16(4): 464-472.
- 24Senn-Malashonak A, Wallek S, Schmidt K, et al. Psychophysical effects of an exercise therapy during pediatric stem cell transplantation: a randomized controlled trial. Bone Marrow Transplant. 2019; 54(11): 1827-1835.
- 25Smith C, Farhat R, Fern-Buneo A, et al. Effects of an exercise program during pediatric stem cell transplantation: a randomized controlled trial. Pediatr Blood Cancer. 2022; 69(5):e29618.
- 26Bogg TFT, Broderick C, Shaw P, Cohn R, Naumann FL. Feasibility of an inpatient exercise intervention for children undergoing hematopoietic stem cell transplant. Pediatr Transplant. 2015; 19(8): 925-931.
- 27Chen AC, Ramirez FD, Rosenthal DN, et al. Healthy hearts via live videoconferencing: an exercise and diet intervention in pediatric heart transplant recipients. J Am Heart Assoc. 2020; 9(3):e013816.
- 28Rosenhagen A, Bernhörster M, Vogt L, et al. Implementation of structured physical activity in the pediatric stem cell transplantation. Klin Padiatr. 2011; 223(3): 147-151.
- 29Davis NL, Tolfrey K, Jenney M, et al. Combined resistance and aerobic exercise intervention improves fitness, insulin resistance and quality of life in survivors of childhood haemopoietic stem cell transplantation with total body irradiation. Pediatr Blood Cancer. 2020; 67(12):e28687.
- 30Van Der Heijden GJ, Wang ZJ, Chu Z, et al. Strength exercise improves muscle mass and hepatic insulin sensitivity in obese youth. Med Sci Sports Exerc. 2010; 42(11): 1973-1980.
- 31Yang S, Qiu L, Xiao J, Luo C. The effects of resistance training on children with burns: a meta-analysis. Pediatr Surg Int. 2021; 37(10): 1323-1332.
- 32Nakanishi N, Tsutsumi R, Okayama Y, et al. Monitoring of muscle mass in critically ill patients: comparison of ultrasound and two bioelectrical impedance analysis devices. J Intensive Care. 2019; 7(1): 61.
- 33Valla FV, Young DK, Rabilloud M, et al. Thigh ultrasound monitoring identifies decreases in quadriceps Femoris thickness as a frequent observation in critically ill children. Pediatr Crit Care Med. 2017; 18(8): e339-e347.
- 34Niewiadomski W, Laskowska D, Gąsiorowska A, Cybulski G, Strasz A, Langfort J. Determination and prediction of one repetition maximum (1RM): safety considerations. J Hum Kinet. 2008; 2008(19): 109-120.
10.2478/v10078-008-0008-8 Google Scholar
- 35Mager DR, Carroll MW, Wine E, et al. Vitamin D status and risk for sarcopenia in youth with inflammatory bowel diseases. Eur J Clin Nutr. 2018; 72(4): 623-626.
- 36Perito ER, Bucuvalas J, Lai JC. Functional status at listing predicts waitlist and posttransplant mortality in pediatric liver transplant candidates. Am J Transplant. 2019; 19(5): 1388-1396.
- 37Janaudis-Ferreira T, Mathur S, Deliva R, et al. Exercise for solid organ transplant candidates and recipients: a joint position Statement of the Canadian Society of Transplantation and CAN-RESTORE. Transplantation. 2019; 103(9): e220-e238.
- 38van Waart H, Stuiver MM, van Harten WH, et al. Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol. 2015; 33(17): 1918-1927.
- 39Kampshoff CS, Chinapaw MJ, Brug J, et al. Randomized controlled trial of the effects of high intensity and low-to-moderate intensity exercise on physical fitness and fatigue in cancer survivors: results of the resistance and endurance exercise after ChemoTherapy (REACT) study. BMC Med. 2015; 13: 275.
- 40Braith RW, Welsch MA, Mills RM Jr, Keller JW, Pollock ML. Resistance exercise prevents glucocorticoid-induced myopathy in heart transplant recipients. Med Sci Sports Exerc. 1998; 30(4): 483-489.
- 41Schroeder EC, Franke WD, Sharp RL, Lee D-C. Comparative effectiveness of aerobic, resistance, and combined training on cardiovascular disease risk factors: a randomized controlled trial. PLoS ONE. 2019; 14(1):e0210292.
- 42Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial. Ann Intern Med. 2007; 147(6): 357-369.
- 43Westergren T, Fegran L, Nilsen T, Haraldstad K, Kittang OB, Berntsen S. Active play exercise intervention in children with asthma: a PILOT STUDY. BMJ Open. 2016; 6(1):e009721.
- 44Zou Y, Liu S, Guo S, Zhao Q, Cai Y. Peer support and exercise adherence in adolescents: the chain-mediated effects of self-efficacy and self-regulation. Children (Basel). 2023; 10(2): 1-14.
- 45Yeh CH, Man Wai JP, Lin US, Chiang YC. A pilot study to examine the feasibility and effects of a home-based aerobic program on reducing fatigue in children with acute lymphoblastic leukemia. Cancer Nurs. 2011; 34(1): 3-12.
- 46Patterson C, So S, Schneiderman JE, Stephens D, Stephens S. Physical activity and its correlates in children and adolescents post-liver transplant. Pediatr Transplant. 2016; 20(2): 227-234.
- 47Patterson C, So S, DeAngelis M, Ghent E, Southmayd D, Carpenter C. Physical activity experiences in children post–liver transplant: developing a foundation for rehabilitation interventions. Pediatr Transplant. 2018; 22(4):e13179.
- 48Brosig C, Pai A, Fairey E, Krempien J, McBride M, Lefkowitz DS. Child and family adjustment following pediatric solid organ transplantation: factors to consider during the early years post-transplant. Pediatr Transplant. 2014; 18(6): 559-567.
- 49Zelle DM, Corpeleijn E, Klaassen G, Schutte E, Navis G, Bakker SJ. Fear of movement and low self-efficacy are important barriers in physical activity after renal transplantation. PLoS ONE. 2016; 11(2):e0147609.
- 50Petersen I, Noelle J, Buchholz A, Kroencke S, Daseking M, Grabhorn E. Fatigue in pediatric liver transplant recipients and its impact on their quality of life. Pediatr Transplant. 2019; 23(1):e13331.
- 51Miserachs M, Nicholas DB, Otley AR, Ng VL. Health-related quality of life after pediatric liver transplantation: a qualitative analysis of the perspectives of health care providers. Can J Gastroenterol Hepatol. 2017; 2017:5274923.
- 52Wickerson L, Rozenberg D, Janaudis-Ferreira T, et al. Physical rehabilitation for lung transplant candidates and recipients: an evidence-informed clinical approach. World J Transplant. 2016; 6(3): 517-531.
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