Lifestyle intervention after kidney transplantation

1. Lifestyle intervention after kidney transplantation Drs. Dorien M. Zelle Health and movement scientist Working group Lifestyle and the Kidney: Dr. S.J.L. Bakker (Internal Medicine) Dr. E. Corpeleijn (Epidemiology) Prof. G. Navis, (Nephrology) T. Kok (Dietitian) Groeps revalidatie nierpatiënten: Dr. E. van den Ham, (AZM)

2. ~Plato • “Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” 

3. The old times…

4. Modern time..

5. ? ? Problem • Poor cardio-metabolic risk profile RTR plays a main role in long-term outcome

6. BMI & Metabolic syndrome (Aalten et al, Transpl.Int. 2006) (de Vries et al, AJT 2004)

7. Muscle mass & Physical activity (Zelle et al, CJASN 2011) (Oterdoom et al, Transplantation 2008)

8. CKD and Hemodialysis Involuntary weight loss Fat-free mass (muscle mass) Muscle weakness and exercise intolerance Physical activity

9. After kidney transplant Low Fat-free mass (muscle mass) Exercise intolerance Low Physical activity Dietary pattern Prednisolone Low Fat-free mass (muscle mass) Increased Fat mass Exercise intolerance

10. Exercise capacity p < 0.01 200 p < 0.01 40 150 Wpeak (Watt) Strength (nM) 30 100 20 50 10 RTx HD CON RTx HD CON Quadriceps strength (Cybex) Peak work load (Cycle-ergometry) (van den Ham et al, AJT. 2005)

11. Fitness is low • In general, the fitness levels of RTR is very low, and ~50% of renal transplant patients could be classified as having functional limitations (VO2peak values <20 mL/min/kg BW) • Males (50-55 year) 33-36 VO2 max

12. Functional limitations

13. Functional limitations

14. Research question • Which factors determine changes in body weight and body composition after renal transplantation ?

15. Transplantatie 3 maand 6 week 6 maand 1 jaar Pilot study RTR • 29 RTR Lifestyle monitoring • Weight, fat%, diet, physical activity

16. Weight gain: 5.1 kg (7%) Follow-up (months) Follow-up (months)

17. Physical Activity 8000 Steps p/d 6000 Steps p/d

18. Physical Activity Nederlandse Norm gezond bewegen 10.000 stappen 8000 Steps p/d 6000 Steps p/d

19. Nutrition

20. Conclusion • Both physical activity and dietary habits are important targets for lifestyle intervention in the RTR.

21. Lifestyle Intervention ACT • Active Care After Transplantation • ACT- Groningen-Maastricht • Grant Nierstichting

22. Method • Lifestyle intervention: Exercise & Diet • AIM: Prevent the development of post-transplant adiposity and its metabolic complications. • 180 stable RTR • 3-9 months after transplantation

23. RCT N=60 N=60

24. Design Inclusion Baseline Training program 12 weeks Consolidation of New lifestyle by Coaching Second phase First phase Transplantation T=6 T=12 Time months T=3 T=0

25. Design Inclusion Baseline Training program 12 weeks Consolidation of New lifestyle by Coaching Second phase First phase Transplantation T=6 T=12 Time months T=3 T=0 Blood chemistry Body composition Exercise capacity Muscle strength Quality of life

26. First Phase: Exercise AIM: Improve physical fitness and improve dietary habits. • Supervised exercise program in rehabilitation centre • Twice a week • Groups of 8-12 RTR

27. Training Endurance Dynamic strenght Gymnastics Swimming

28. First Phase: Diet • Dietary advice ( every 2 weeks) • Food dairy, weight changes • Personal goal setting and education

29. Second Phase AIM: to implement changes in diet and physical activity in daily life • COACH program (4-12 months) • 4-6 sessions • Pedometer & goals setting • Personal goal setting and education • 4-6 sessions • Weight changes

30. Thanks Work group “Lifestyle and the Kidney” Drs. Dorien Zelle Dr.Stephan Bakker Dr.Eva Corpeleijn Prof. Gerjan Navis Trijntje Kok (Dietitian) Groeps Revalidatie Nierpatienten Dr. Eugénie van den Ham

31. Questions