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Quadriceps Muscle Strength and Body Mass Index Are Associated With Estimates of Physical Activity Postheart Transplantation

Kelly, Rebecca L.1,2,3; Walsh, James R., PhD1,2,3; Paratz, Jennifer D., PhD2,4,5; Yerkovich, Stephanie T., PhD4; McKenzie, Scott C.2,4; Morris, Norman R., PhD2,5,6

doi: 10.1097/TP.0000000000002488
Original Clinical Science—General
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Background. Although exercise capacity improves postheart transplantation (HTx), it remains unclear if the level of physical activity (PA) shows similar improvement. The purpose of this study was to (1) describe PA levels and (2) identify factors which may be associated with levels of PA post-HTx.

Methods. A prospective observational cross-sectional study was conducted at a single center HTx outpatient clinic. Medically stable adult recipients 6 months or longer post-HTx were recruited. Physical activity level (PAL) and average daily time spent at least moderately active (≥3 metabolic equivalents) were estimated using a multisensor device. Factors investigated were demographic (age, sex, body mass index [BMI], time post-HTx, and reason for HTx), corticosteroid use, exercise capacity (6-min walk distance), and quadriceps muscle strength corrected for body weight (QS%).

Results. The mean post-HTx time of the 75 participants was 9.2 ± 7.0 years (0.5–26 y). Twenty-seven (36%) participants were classified as extremely inactive (PAL, <1.40), 26 (34.6%) sedentary (1.40 ≤ PAL ≤ 1.69), and 22 (29.3%) active (PAL, ≥1.70). Multivariable analysis showed greater QS% (β = 0.004 (0.002–0.006) P = 0.001) to be independently associated with increased PAL. For increased time, 3 or more metabolic equivalents both greater QS% (β = 0.0164 [0.003–0.029]; P = 0.014) and lower BMI (β = −0.0626 [−0.115 to −0.0099]; P = 0.021) were independently associated.

Conclusions. The degree of observed sedentary behavior post-HTx is surprising, with the majority of participants not reaching levels of PA recommended for health benefits. QS% and BMI were the only factors found to be independently associated with estimates of PA. Further quality trials are required to demonstrate the long-term benefits of regular PA and investigate ways of increasing adherence to PA post-HTx.

1 Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.

2 School of Allied Health Sciences, Griffith University, Gold Coast, Australia.

3 Advanced Heart Failure and Cardiac Transplant Unit, The Prince Charles Hospital, Brisbane, Australia.

4 School of Medicine, The University of Queensland, Brisbane, Australia.

5 Menzies Health Institute, Griffith University, Gold Coast, Australia.

6 The Prince Charles Hospital Allied Health Research Collaborative, Queensland, Australia.

Received 24 May 2018. Revision received 21 September 2018.

Accepted 29 September 2018.

The authors declare no conflicts of interest.

The Prince Charles Hospital Foundation New Investigator Grant (NR2013-229) was used to assist with conducting this research. Amount awarded was A$9498.64.

R.L.K. participated in research design, writing the article, and performance of the research and data analysis. J.R.W. participated in research design, writing the article, and data analysis. J.D.P. participated in writing the article. S.T.Y. participated in writing the article and data analysis. S.C.McK. participated in research design and writing the article. N.R.M. participated in research design, writing the article, and data analysis.

Correspondence: Rebecca Louise Kelly, Physiotherapy Department, The Prince Charles Hospital, Rode Rd, Chermside, 4032, Queensland, Australia. (francis_becky@hotmail.com; Rebecca.Kelly2@health.qld.gov.au).

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