This emerges from the multicentre randomised controlled trial ‘Active Care after Transplantation’ coordinated from the University Medical Centre Groningen. The study shows not only that lifestyle intervention is safe and feasible in kidney transplant recipients, but also that it is effective. Despite being a complex, multimorbid patient group with an extensive disease history and subject to polypharmacy, lifestyle intervention consisting of supervised exercise therapy combined with lifestyle counselling results in improved physical functioning. The results were published today in The Lancet Healthy Longevity.
The researchers investigated the effects of two lifestyle interventions. A lifestyle intervention consisting of 3 months supervised exercise therapy combined with 15 months of lifestyle counseling, and a lifestyle intervention with an additional 15 months of dietary counseling. Several health benefits were found, including improved muscle strength and cardiorespiratory fitness, and beneficial effects on HDL cholesterol. Additionally, at the end of the supervised exercise therapy, patients reported an improvement in their physical functioning, an important domain of health-related quality of life.
Interestingly, the researchers identified that certain subgroups responded better to the lifestyle interventions than others. For example, the interventions were most effective in improving health-related quality of life among females and among older participants. This could partly be explained by the fact that they started out in a worse condition. This finding warrants further investigation, as studying the factors influencing responses to the intervention can help in further improving lifestyle interventions after kidney transplantation. Additionally, better prediction of who would benefit from the intervention can help clinicians in deciding whom to offer lifestyle interventions after transplantation and to support the development of a more personalized approach.
Just like in other groups, the importance of lifestyle after transplantation is becoming more and more recognized. Kidney transplant recipients are a unique group, often dealing with numerous medical challenges and taking various medications. Despite this, they can still benefit greatly from lifestyle changes. This is not only a significant step forward for kidney patients, but it also serves as a positive example for other patients with complex health conditions.
The study was funded by the Dutch Kidney Foundation, and involved a multidisciplinary collaboration between the department of Epidemiology and the department of Nephrology in the UMCG, and included the collaboration of nephrologists, physiotherapists practices, rehabilitation centers, dieticians and lifestyle coaches across six hospitals in the Netherlands. It used existing care facilities and showed that lifestyle intervention can be successfully implemented in study settings, paving the way for implementation in standard post-transplant care. Importantly, as rehabilitation after kidney transplantation is not yet imbursed by the health insurance in Netherlands, this study provides the evidence to implement it.
