title: Fatigue after liver transplantation: effects of a rehabilitation program including exercise training and physical activity counseling.
abstract: BACKGROUND
  It is hypothesized that increasing physical fitness and daily physical activity can lead to a reduction in fatigue. However, standard medical care following liver transplantation seldom includes rehabilitation that focuses on physical fitness and physical activity.
  
  
  OBJECTIVE
  The aim of this study was to explore whether a rehabilitation program can reduce fatigue in recipients of liver transplants. Furthermore, effects on physical fitness, physical activity, and cardiovascular risk were studied, and adherence, satisfaction, and adverse events were assessed.
  
  
  METHODS
  This was an uncontrolled intervention study.
  
  
  METHODS
  The study took place in an outpatient rehabilitation clinic.
  
  
  METHODS
  Eighteen recipients of a liver transplant who were fatigued participated in a 12-week rehabilitation program including physical exercise training and counseling on physical activity. The primary outcome measure was fatigue. Other outcome measures were: aerobic capacity, muscle strength, body fat, daily physical activity, lipid profile, and glycemic control. All measurements were performed before and after the rehabilitation program. Adherence, satisfaction, and adverse events were registered.
  
  
  RESULTS
  After the program, participants were significantly less fatigued, and the percentage of individuals with severe fatigue was 22% to 53% lower than before the program. In addition, aerobic capacity and knee flexion strength were significantly higher, and body fat was significantly lower after the program. Participants were able to perform physical exercise at the target training intensity, no adverse events were registered, and attendance (93%) and mean patient satisfaction (8.5 out of 10, range=7-10) were high.
  
  
  CONCLUSIONS
  No control group was used in the study.
  
  
  CONCLUSIONS
  A rehabilitation program consisting of exercise training and physical activity counseling is well tolerated and seems promising in reducing fatigue and improving fitness among recipients of liver transplants.
authors.affiliation: R.J.G. van den Berg-Emons, PhD (Health Science), Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Rita J G
authors.initials: RJ
authors.lastname: van den Berg-Emons
authors.affiliation: B.T.J. van Ginneken, PhD (Health Science), Department of Rehabilitation Medicine, Erasmus University Medical Center.
authors.forename: Berbke T J
authors.initials: BT
authors.lastname: van Ginneken
authors.affiliation: C.F.J. Nooijen, MSc, Department of Rehabilitation Medicine, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands. c.nooijen@erasmusmc.nl.
authors.forename: Carla F J
authors.initials: CF
authors.lastname: Nooijen
authors.affiliation: H.J. Metselaar, Prof (Medicine), Department of Gastroenterology and Hepatology, Erasmus University Medical Center.
authors.forename: Herold J
authors.initials: HJ
authors.lastname: Metselaar
authors.affiliation: H.W. Tilanus, Prof (Medicine), Department of General Surgery, Erasmus University Medical Center.
authors.forename: Huug W
authors.initials: HW
authors.lastname: Tilanus
authors.affiliation: G. Kazemier, Prof (Medicine), Department of General Surgery, Erasmus University Medical Center.
authors.forename: Geert
authors.initials: G
authors.lastname: Kazemier
authors.affiliation: H.J. Stam, Prof (Medicine), Department of Rehabilitation Medicine, Erasmus University Medical Center.
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Stam
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D037001:Directive Counseling; D005081:Exercise Therapy / Q000379:methods*; D005221:Fatigue / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D010809:Physical Fitness / Q000502:physiology; D011183:Postoperative Complications; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult