title: The gap between clinically assessed physical performance and objective physical activity in liver transplant candidates.
abstract: Frailty with sarcopenia in cirrhosis causes liver transplant wait-list attrition and deaths. Regular physical activity is needed to protect patients with cirrhosis from frailty. We subjectively assess physical performance in selecting patients for transplant listing, but we do not know whether clinical assessments reflect the extent of activity patients actually perform. To investigate this question, 53 wait-listed patients self-assessed their performance of ordinary physical tasks using the Rosow-Breslau survey, and clinicians assessed their physical performance status with the Karnofsky index. We compared these assessments with actual activity measured using an accelerometer/thermal sensing armband worn from 4 to 7 days. We found that their measured activity was among the lowest reported in chronic disease, similar to that of patients with advanced chronic pulmonary disease or renal failure. Their percentages of waking hours spent in sedentary, light, and moderate-vigorous activity were 75.9% ± 18.9%, 18.9% ± 14.3%, and 4.9% ± 6.9%, respectively. Higher mean sedentary and lower mean moderate-vigorous activity was significantly associated with 9 wait-list deaths (P = 0.004). Compared with a range of 7000-13,000 steps/day in healthy adults, patients' mean steps/day were 3164 ± 2842. Both their activity percentage and step data were typical of other severely inactive populations. Neither their Rosow-Breslau scores (mean 2.3 ± 0.8, maximum 3.0) nor their Karnofsky scores (mean 79 ± 12, maximum 100) suggested major impairment or showed a correlation with patients' actual physical performance. In conclusion, physical activity in patients with cirrhosis wait-listed for transplantation is highly sedentary. Self-assessments and provider assessments of physical activity do not reliably indicate actual performance. Whether the gap between assessed and actual performance may be favorably modified by interventions to improve activity and ameliorate frailty merits further study. Liver Transplantation 22 1324-1332 2016 AASLD.
authors.affiliation: Center for Liver Diseases, University of Pittsburgh, Pittsburgh, PA. dunnma@upmc.edu.|Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA. dunnma@upmc.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dunn
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Josbeno
authors.affiliation: Center for Liver Diseases, University of Pittsburgh, Pittsburgh, PA.|Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Schmotzer
authors.affiliation: Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA.|Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Amit D
authors.initials: AD
authors.lastname: Tevar
authors.affiliation: Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA.|Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Andrea F
authors.initials: AF
authors.lastname: DiMartini
authors.affiliation: Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA.|Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Landsittel
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Delitto
mesh_terms: D056044:Actigraphy; D000368:Aged; D002908:Chronic Disease; D015444:Exercise; D005260:Female; D005762:Gastroenterology; D006801:Humans; D008099:Liver / Q000601:surgery*; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D055948:Sarcopenia / Q000503:physiopathology; D057185:Sedentary Behavior; D014850:Waiting Lists