The Importance of Exercise in Post-Transplant Kidney Patients

Everyone knows the vital role physical fitness plays in a healthy lifestyle. What the blogosphere doesn't need are more average joes like me either parroting well-known truths or adding to the endless stream of dubious claims circulating around countless gyms and Internet forums, myths commonly referred to as broscience. I vow to do my best to avoid this by presenting in this post what is hopefully enlightening and scientifically-backed information.

Four years ago this month I underwent renal transplant surgery, the kidney an unsolicited gift of life from my selfless and all-too-generous wife. While the post-transplantation care I have received from my doctors and nurses has been exceptional, their perspective is reactive and medicinal-centric, not necessarily preventive and holistic. Prescription pad in hand, they stand ready to intervene if my cholesterol gets too high or if my bones become too weak. And I thank God for their vigilence and intimate knowledge of medicine and the human body. But what to do in the meantime, while my cholesterol levels are normal and my bones relatively strong? Outside of the standard watch-your-weight-and-be-sure-to-eat-your-Wheaties pep talk, I never really had a deep conversation with my medical providers about what I could or should do to keep from slowly degenerating. As I soon discovered in my own research that as a transplant patient I am more susceptible to chronic conditions such as cardiovascular disease and osteoporosis, I began to wonder how many other transplant patients remain in the dark concerning the long-term ramifications of immunosuppresants and the actions necessary to mitigate their negative effects.

A March 3, 2011 American Society of Nephrology news release stating that kidney transplant patients are 4-6 times more likely to die from cardiovascular disease (CVD) than people in the general population was a real eye opener for me. I had never heard anything like that from my transplant team. I continued my research. Besides weight gain, I learned that prednisone (a corticosteroid I will be taking for life) is associated with osteopenia, or weakening of the bones, and osteoporosis, a serious disease that can cause spontaneous fractures. Worse yet, according to a 1998 University of Florida study, the usual treatment for osteoporosis, oral calcium supplements and hormone replacement therapy, does not work with transplant patients because the anti-rejection steroids we take are too powerful. Randy Braith, a UF associate professor of cardiology and physiology involved in the study, went on to report that almost 100% of heart transplant recipients develop osteopenia and half of these will develop osteoporosis.

So what's a transplant recipient to do? Our solutions don't always come in the form of miracle pills. Our best bet is to exercise. A National Institutes of Health artcle notes that "aerobic exercise is necessary to reduce the risks for CVD, minimize osteoporosis, and facilitate weight loss, whereas strength-based exercise is necessary to minimize sarcopenia," a degenerative loss of skeletal muscle mass and strength associated with age (and prednisone). Providing a bit of reassurance to the leery (and at the same time debunking the excuses of the sedentary crowd), the article goes on to state that "there are no documented adverse consequences attributed to physical activity in kidney transplant patients."

Because few medications can stop bone loss and even fewer effectively stimulate new bone growth, lifting weights is absolutely essential for those of us on prednisone. The 1998 UF study cited above showed that weight-lifting exercises can counteract rapid bone loss in patients after an organ transplant. And the rapidity of bone loss in transplant patients can be quite staggering. Mr. Braith reported that bone density in heart transplant patients after surgery showed up to 25% loss during the first two months alone. However, the good news is that those patients who began weight training two months after transplant surgery were able to recover and maintain bone density to the same level it was before the operation. That's right, bone loss and osteoporosis caused by prednisone is not only preventable, it is also reversible through weight-lifting exercises!

So, the takeaway for all of transplant recipients is to get active and stay active. We need to do cardio and we need to pump iron. We reap all the benefits of exercise that the general population does and more. We have more to lose, and thus more to gain. Have fun and be fit and, of course, check with your transplant team before engaging in any type of exercise regimen.