EXERCISE AND DIET INTERVENTION AFTER LIVER TRANSPLANT

肝移植是终末期肝功能衰竭公认的治疗方法 与移植前相比，明显提高了身体功能 然而，移植受者继续经历显著的 身体功能受限，经常报告症状 与肌肉无力和疲劳有关，有过度运动的风险 体重增加。心血管疾病的风险也增加了。典型的病人 对他们的器官的功能进行医学上的跟踪，尽管很少 注意，没有任何干预措施，以改善身体状况 健身或将体重增加和心血管风险降至最低。在其他 移植受者运动训练提高身体机能 而饮食调整会改善血脂状况。不是这样的 已经在肝移植受者身上进行了研究。建议进行的研究 是一项针对肝移植受者的随机临床试验，以确定 身体健康、生活质量和心血管风险的差异 组间：日常护理(UC)和运动干预 训练加饮食调整(XD)。将启动干预措施 移植后3个月，分别在3、6和12个月进行检查 移植后几个月。这项练习将单独规定为 每天在家独立散步或骑车。饮食干预 将基于国家胆固醇教育项目 建议，目标是实现热量平衡，以保持 体重在理想体重正负10%以内。两者都有 将积极监测干预措施，以最大限度地遵守 记录日志，定期电话跟踪和定期就诊。 主要结果指标为：1)体能指标：a) 以最大摄氧量衡量的心肺适合性；肌肉 通过等速测试以峰值扭矩测量的强度；以及车身 组成(身体脂肪百分比和瘦身质量)由 双X射线吸收测量法；2)生活质量/幸福感 使用基于医疗结果研究的问卷进行测量 问卷；以及3)使用算法的心血管风险指数 基于弗雷明翰的数据。此外，移植的临床措施 将对功能和药物进行监测，以评估 干预措施。数据分析技术将测试 干预以及确定几个被测对象之间的关系 生活质量/幸福感的变量。这项研究是需要的 演示运动和饮食干预对优化的影响 身体健康和生活质量高于任何改善 可能仅由肝移植引起的，并减少 这一外科手术后的心血管风险。

Liver transplantation is an accepted therapy for end-stage liver failure and clearly increases physical functioning compared to pre transplant levels, however transplant recipients continue to experience significant limitations in physical functioning and frequently report symptoms related to muscle weakness and fatigue and are at risk for excessive weight gain. Cardiovascular risk is also elevated. Typically patients are followed medically for the functioning of their organ, however little attention and no interventions are incorporated to improve physical fitness or minimize weight gain and cardiovascular risk. In other transplant recipients exercise training increases physical functioning and dietary modification results in improved lipid profiles. No such study has been done in liver transplant recipients. The proposed study is a randomized clinical trial of liver transplant recipients to determine differences in physical fitness, quality of life and cardiovascular risk between groups: Usual Care UC) and an intervention of Exercise Training plus Diet Modification (XD). The interventions will be initiated 3 months after transplant and testing will be done at 3, 6 and 12 months post transplant. The exercise will be individually prescribed for daily independent walking or cycling at home. The dietary intervention will be based on the National Cholesterol Education Project Recommendations with the goal of achieving caloric balance to maintain body weight within ideal body weight plus/minus 10%. Both interventions will be aggressively monitored to maximize adherence using recording logs, regular phone follow-up and regular clinic visits. Primary outcome measures are: 1) measures of physical fitness: a) cardiorespiratory fitness as measured by maximal oxygen uptake; muscle strength as measured by peak torque by isokinetic testing; and body composition (body fat percentage and lean body mass) as measured by dual X-ray absorptiometry; 2) Quality of life/well-being which will be measured using questionnaire based on the Medical Outcomes Study questionnaire; and 3) Cardiovascular Risk Index using an algorithm based on Framingham data. Additionally, clinical measures of transplant function and medications will be monitored to assess the impact of the interventions. Data analysis techniques will test the effectiveness of the intervention as well as determine the relationship of several measured variables to quality of life/well-being. This study is needed to demonstrate the impact of exercise and diet interventions on optimizing physical fitness and quality of life over and above any improvements that may result from the liver transplant alone and to reduce cardiovascular risk following this surgical procedure.