Liver Transplant Candidates More Sedentary than Doctors Notice


Patients who become frail while awaiting a liver transplant become less likely to survive. A Pittsburgh team found that physicians treating these patients often get over-optimistic assessments of how active patients are when they rely on the patients' accounts.

In patients who are on liver transplant wait lists due to having advanced cirrhosis, sarcopenia, and deteriorating physical fitness threaten survival.

Doctors know that, and generally ask patients about their fitness and daily exercise.

A team from the Thomas E. Starzl Transplantation Institute and the Department of Physical Therapy at the University of Pittsburgh, Pittsburgh PA, found that though patients reported being able to do certain physical tasks, they often overstated how active they were.

"Regular physical activity is needed to protect patients with cirrhosis from frailty," Michael Dunn, MD, and colleagues wrote in Liver Transplantation.

The team had 53 patients on wait lists self-assess their performance of ordinary physical tasks.

Clinicians assessed their physical performance status.

The researchers compared the two sets of assessments with actual activity measured using an accelerometer/thermal sensing armband that patients wore for four to seven days.

The found that measured activity was very low, "among the lowest reported i chronic disease, similar to that of patients with advanced chronic pulmonary disease or renal failure."

They spend about 76% of the their waking hours in sedentary activities, they found.

Only between 5% and 7% of their waking hours were spend in moderate to vigorous activity.

While on average healthy adults walk between 7,000 and 13,000 steps a day, these wait-listed patients were walking about 3,000 steps daily.

But the researchers did not attempt to determine whether getting these patients to exercise more would improve their health and keep them alive longer.

That question "merits further study," they concluded.

Hepatitis C infection leading to cirrhosis is the most common cause of liver failure leading to patients getting a liver transplant, or at least to getting on a wait list for these scarce donor organs.

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