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      Physical Exercise After Solid Organ Transplantation: A Cautionary Tale

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          Abstract

          An increasing body of randomized controlled trials suggests the safety of engaging in moderate to vigorous intensity exercise training following solid organ transplantation. Fueled by emerging sport events designed for transplant recipients and the ever-growing body of research highlighting the diverse health benefits of physical activity, transplant recipients are now increasingly participating in strenuous and occasionally competitive physical endeavors that largely surpass those evaluated in controlled research settings. This viewpoint article adopts a cautionary stance to counterbalance the prevalent one-sided optimistic perspective regarding posttransplant physical activity. While discussing methodological limitations, we explore plausible adverse impacts on the cardiovascular, immunological, and musculoskeletal systems. We also examine the physiological consequences of exercising in the heat, at high altitude, and in areas with high air pollution. Risks associated with employing performance-enhancing strategies and the conceivable psychological implications regarding physical activity as a tribute to the ‘gift of life’ are discussed. With a deliberate focus on the potential adverse outcomes of strenuous posttransplant physical activity, this viewpoint aims to restore a balanced dialogue on our comprehension of both beneficial and potentially detrimental outcomes of physical activity that ultimately underscores the imperative of well-informed decision-making and tailored exercise regimens in the realm of posttransplant care.

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          Most cited references140

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          World Health Organization 2020 guidelines on physical activity and sedentary behaviour

          Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.
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            Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association.

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              OUP accepted manuscript

              (2020)
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                Author and article information

                Contributors
                Journal
                Transpl Int
                Transpl Int
                Transpl Int
                Transplant International
                Frontiers Media S.A.
                0934-0874
                1432-2277
                13 February 2024
                2024
                : 37
                : 12448
                Affiliations
                [1] 1 Department of Respiratory Diseases, Pulmonary Rehabilitation , University Hospitals Leuven , Leuven, Belgium
                [2] 2 Nephrology and Renal Transplantation Research Group , Department of Microbiology , Immunology and Transplantation , KU Leuven , Leuven, Belgium
                [3] 3 Laboratory of Abdominal Transplantation , Department of Microbiology , Immunology and Transplantation , KU Leuven , Leuven, Belgium
                [4] 4 Exercise Physiology Research Group , Department of Movement Sciences , KU Leuven , Leuven, Belgium
                [5] 5 Department of Abdominal Transplant Surgery , University Hospitals Leuven , Leuven, Belgium
                [6] 6 Transplantoux Foundation , Leuven, Belgium
                [7] 7 Research Group for Rehabilitation in Internal Disorders , Department of Rehabilitation Sciences , KU Leuven , Leuven, Belgium
                [8] 8 Department of Nephrology and Kidney Transplantation , University Hospitals Leuven , Leuven, Belgium
                Author notes
                *Correspondence: Stefan De Smet, stefan.desmet@ 123456kuleuven.be
                Article
                12448
                10.3389/ti.2024.12448
                10898592
                38414660
                66bf6502-1445-4046-a61c-f7cdd5095594
                Copyright © 2024 Stylemans, Vandecruys, Leunis, Engelborghs, Gargioli, Monbaliu, Cornelissen, Van Craenenbroeck and De Smet.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 20 November 2023
                : 02 February 2024
                Funding
                This work was funded by the Research Foundation Flanders (FWO-SBO project number S006772N). SL and SDS were financially supported by C2-M (26M/21/001) KU Leuven grant. SE and SD were financially supported by B2023-Bijzonder Onderzoeksfonds 2023 KU Leuven research grant. DM is a senior researcher of The Research Foundation (FWO) Flanders and is recipient of a Centrale Afdeling Voor Fractionering chair for abdominal transplant surgery.
                Categories
                Health Archive
                Review

                Transplantation
                sot, solid organ transplant,exercise,adverse event,methodological appraisal,critical appraisal,physical activity,side effects

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