Health-related fitness is markedly below average in patients who have undergone orthotopic liver transplantation (OLT). The effect of exercise and dietary intervention on health-related fitness and health-related quality of life (HRQOL) after OLT has not been evaluated in randomized, controlled trials.OBJECTIVE
To evaluate the effect of exercise and dietary intervention on health-related fitness and HRQOL in patients who have undergone OLT.DESIGN AND INTERVENTION
This prospective, randomized, controlled study included patients who had undergone OLT 2 months previously. Exclusion criteria included contraindications to exercise. At baseline (2 months after OLT) the exercise capacity, muscle strength, body composition, HRQOL and nutrition of eligible patients were assessed. HRQOL was assessed by the SF-36 questionnaire, and nutrition by the Block 95 full-length dietary questionnaire, both of which patients completed independently. Body composition was evaluated with X-ray absorptiometry. Exercise capacity was determined as a measure of oxygen consumption (VO2). After the study group was stratified for hepatitis C status, patients were randomly allocated to exercise and dietary intervention, or usual care. Baseline assessment was repeated at 6 and 12 months post-OLT. Patients in the exercise and dietary intervention group received counseling for home-based cardiovascular exercise training and diet modification. Each patient completed an exercise log and a food diary. Patients were followed up bimonthly and received a biannual newsletter that contained exercise and nutrition tips. Adherence was assessed by reviewing patient exercise logs, nutrition diaries and follow-up data. Adherence to intervention was defined as following the exercise prescription and nutritional recommendations ≥50% of the time.OUTCOME MEASURES
The main outcome measures were exercise capacity, HRQOL, muscle strength, body composition, and adherence to intervention.RESULTS
In total, 151 patients were randomly allocated to treatment: 65 to exercise and diet intervention and 86 to usual care. The 6 and 12 month assessments were completed in 119 patients: 49 patients from the exercise and dietary intervention group and 70 patients from the usualcare group. Significantly greater increases in exercise capacity (peak VO2) and HRQOL between baseline and end of follow-up were shown in the exercise and dietary intervention group compared with the usual-care group: P = 0.036 and P = 0.038, respectively. Muscle strength was significantly increased in both groups between baseline and end of follow-up, P < 0.001 for both comparisons. Body weight, lean body mass, fat mass and percentage fat significantly increased between baseline and end of follow-up for both groups, P < 0.001 for all comparisons. At 1 year, the BMI of the exercise and diet intervention group and usual-care group had increased from 24.5 ± 4.4 kg/m2 to 29.0 ± 10.6 kg/m2, and from 25.3 ± 4.6 kg/m2 to 26.8 ± 5.8 kg/m2, respectively. In total, 18 patients (37%) in the intervention group adhered to intervention ≥50% of the time.CONCLUSION
Exercise and dietary intervention improve exercise capacity, body composition and HRQOL after OLT.