Transplant Candidate and Recipient FREQUENTLY ASKED QUESTIONS

 

Below are answers to some exercise-related questions that are frequently asked by transplant candidates and recipients: 

 

  1. Is exercise difficult for transplant patients? 

  2. Why is exercise beneficial in transplant patients?

  3. Is exercise safe for me?

  4. How hard should I exercise? How often? What specific exercises should I do?

  5. How do I know if I'm overdoing it?

  6. I need to gain weight, but exercise will make me lose weight, won't it?  Why should I exercise? 

  7. I have no energy.  I don't want to waste the little energy that I have to exercise.  Shouldn't I be conserving my energy for the transplant? 

  8. Can I just go up/down the stairs for exercise? 

  9. I think I should try to walk without my walker more often.  I don't want to get too dependent on it.  Isn't that the best way to push myself? 

  10. Is it a good idea to walk with weights around my ankles to increase the workout? 

  11. I have a lot of lower extremity swelling.  My doctor told me to stay off my feet.  Isn't walking bad for the swelling? 

  12. On the treadmill or bike, is 10 minutes at a fast pace better than 20 minutes at a slow pace? 

  13. I spend the whole day alone at home while my spouse is at work.  Do I always need to be supervised by someone when I exercise? 

  14. Some days I feel great and I can walk forever or go through my whole exercise program in no time.  Other days I don't have the energy to get off the couch.  How do I know how to exercise on both of those days? 

  15. How do I know if my transplant centre offers an exercise program?

  16. I want to start exercising – what should I do next?

 

 

1. Is exercise difficult for transplant patients?

 

Yes, exercising can sometimes be more difficult in transplant patients due to some pre- and post-transplant limitations. Although each solid organ transplant has its own unique characteristics and challenges, many issues that affect the ability to exercise are common across the transplant types (heart, lung, liver, kidney, etc.). Studies have shown that the function of the ‘old’ and ‘new’ organ is often not the only cause of the exercise limitations pre- and post-transplant.

 

Patients that are waiting for a transplant usually have an impaired ability to exercise. This can be due to:

  • Severe chronic disease

  • Nutritional depletion

  • Low iron levels

  • Decreased activity levels

  • Muscle weakness

  • Shortness of breath

  • Fatigue

 

Patients that have received a transplant may also have an inability to exercise. This can be due to:

  • Long hospital stay

  • Long period of lowered activity level

  • Side effects of immunosuppressant medications

  • Episodes of infection and/or rejection after transplant

  • Other complications related to the transplant

 

Although it may be difficult, it is important for transplant patients to take part in appropriate physical activity and exercise pre- and post-transplant to stay active and healthy.

 
 
2. Why is exercise beneficial in transplant patients?

 

Taking part in aerobic, strength, balance and/ or flexibility (hyperlink to definition of these exercises on Transplant Patient page) exercises can have many benefits.  There are many well-known benefits of exercise in the general population that can apply to transplant patients as well.These include:

  • Stronger muscles and bones

  • Improved sleep

  • Increased cardiovascular fitness

  • Increased energy

  • Reduced stress and anxiety

  • Lower blood pressure

  • Better controlled blood sugar

  • Improved mood

  • Better memory

 

Studies have also shown that transplant patients who take part in exercise training experience many benefits. These include:

  • Stronger muscles

  • Increased ability to return to work and leisure activities

  • Increased exercise capacity

  • Lower blood pressure

  • Better quality of life

 

 
3. Is exercise safe for me?

 

Yes, exercise is usually safe for anyone who is waiting for or receives an organ transplant – it is key to staying healthy! To ensure safety, it is important that individuals have a medical check-up to ensure there are no specific limitations to exercise and follow recommended exercise guidelines for transplant candidates and recipients. Pre-transplant patients often need to be supervised when taking part in physical activity. Unwell or recent recipients may be followed by a physiotherapist post-transplant while in hospital (who could provide more information about exercise) or should visit an exercise specialist for a tailored exercise program after hospital discharge. Long-term recipients can follow a general exercise program that is introduced on the Transplant Patients and Caregivers page of this website. 

 

To determine whether your transplant centre offers an exercise program, ask your transplant coordinator or doctor. You can also view our National Transplant Rehabilitation Program Directory, which includes many of the exercise programs in Canada.

 

 

4. How hard should I exercise? How often? What specific exercises should I do?

 

When exercising, it is important to be aware of your limits and gradually increase your activity level. A simple way of monitoring your exercise is the ‘talk-sing-gasp’ test: if you can talk in short sentences, then you are working out at the right intensity; if you are gasping for air and can only get a word or two out at a time, then you are working too hard; and if you can sing while exercising, then the intensity might be too low for you. 

 

A common scale used to judge your exercise intensity is the “Rating of Perceived Exertion” (click here to DOWNLOAD). You can use this scale to rate how hard you feel you are working, including your breathlessness and your muscle fatigue. During exercise, most people should be working between 3 to 5 out of 10, which is the “moderate to hard” training zone.

 

There are different types of exercise including aerobic, strength, balance and flexibility. It is good to mix up the types of physical activity that you take part in. To achieve maximum benefits, you should accumulate at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in sessions of 10 minutes or longer. It is also beneficial to add muscle-strengthening activities using major muscle groups, 2 to 3 days per week, with 1 day of rest in between to allow your muscles to recover. To increase your muscle strength, you should select a weight that you can lift 8 to 10 times and by the end of the set, your muscle feels tired. One set of each exercise is a good starting point for muscle strengthening. Once the weight lifting exercise becomes easy (your muscle no longer feels tired), you can increase the weight you are lifting or add a second set of the exercise.

 

 

5. How do I know if I'm overdoing it?
 
If you find that you are very tired for the rest of the day after you exercise and you are not able to keep up with your basic home activities, then you may have done too much. Also, if you are not able to sleep well after you have exercised, it is sign that you are working too hard. There are certain steps you can follow to make sure you are not pushing your body too far. If you are uncomfortably short of breath or feel very tired during any activity, slow down your activity level or take a rest. You should stop exercising and rest if you experience chest, neck or jaw pain, feel dizzy or lightheaded, have unexplained swelling or feel any other symptoms of concern. If the symptoms do not go away, you should contact your doctor.
 
 
6. I need to gain weight, but exercise will make me lose weight, won't it?  Why should I exercise? 
 
Exercise does burn calories, which can lead to weight loss. However, one of the benefits of exercise is that you will build muscle, which is important for your overall health. Building muscle can also help you gain weight and maintain a healthy weight. Exercise can also increase your appetite so you may feel like eating more than if you are inactive. It is important to work with a registered dietician to make sure you are getting enough calories from healthy food sources if you are using exercise to gain (or lose) weight.
 
 
7. I have no energy.  I don't want to waste the little energy that I have to exercise.  Shouldn't I be conserving my energy for the transplant? 
 

No, this is not the case.  In fact, exercise actually helps to build your endurance, which is important when you undergo the transplant procedure and for recovery. To minimize the issue of energy, you can practice “energy conservation”. This means, you do activities that require the most of your energy at the time of day when you feel the most energetic. If you are a morning person, you can exercise in the morning, then take a rest before doing your other activities. You can also take frequent rest breaks during your exercise or activity, rather than one long break at the end. 

 

Other tips for conserving energy throughout your day are:

  • Use good body mechanics – this can be done by maintaining good posture when sitting, standing and moving

  • Eliminate unnecessary steps – for example, if you are going to cook something, gather all of your ingredients on the counter from the fridge and pantry before you start so you don’t have to keep walking around the kitchen

  • Sit for certain activities instead of standing

  • Pace yourself throughout the day and have rest time scheduled

  • Exercise on alternate days

  • Use of assistance devices (walker, bath bench)

 

 

8. Can I just go up/down the stairs for exercise? 

 

Yes, stair climbing is a type of exercise – stepping up and down 2-3 steps slowly can be an alternate exercise but it is not recommended for some transplant candidates and recipients because of the risk of falls. Stair climbing is quite intense and may not be suitable for everyone. A simple exercise that does not require any specialized equipment is walking and is a good alternative option.

 

 

9. I think I should try to walk without my walker more often.  I don't want to get too dependent on it.  Isn't that the best way to push myself? 

 

No!  It is best to use the walker until you don't need it any longer.  The walker helps with your balance and without it, a fall or fracture could delay a transplant or prolong post-transplant recovery. If you are using the walker to carry your oxygen, this is a good way to conserve your energy for your daily activities rather than getting tired by carrying it. Also, using a walker may help some people feel less short of breath and walk farther. It may boost your confidence, as you will always have a place to rest.

 

 

10. Is it a good idea to walk with weights around my ankles to increase the workout? 

 

No, this would not be a good idea because of the falls risk. If you want to increase the intensity of your exercise, you can wrap weights around your wrists instead.

 

 

11. I have a lot of lower extremity swelling.  My doctor told me to stay off my feet.  Isn't walking bad for the swelling? 

 

The key is to balance the activity of walking with elevating your feet throughout the day.  Walking helps the muscles in your legs pump the fluid back into circulation, and elevating your feet helps to reduce swelling. Both are important but too much of either one is not good.

 

 

12. On the treadmill or bike, is 10 minutes at a fast pace better than 20 minutes at a slow pace? 

 

When exercising, the goal should be to exercise at a pace that gets you "slightly short-of-breath but still able to talk" and to do that for as long as possible.  Walking at a slower pace for longer is the better way to improve cardiovascular endurance.

 

 

13. I spend the whole day alone at home while my spouse is at work.  Do I always need to be supervised by someone when I exercise? 

 

It depends! If you are waiting for a transplant, have recently received one or are not doing well, then it is better to have someone present just in case something goes wrong (you do not feel well or get injured). However, if you are a long-term recipient or stable transplant candidate and have participated in an exercise program for a number of weeks, you are comfortable exercising, and have been exercising for a while, then it may be okay to exercise alone. Exercising with a buddy is more fun and can provide additional motivation!

 

 

14. Some days I feel great and I can walk forever or go through my whole exercise program in no time.  Other days I don't have the energy to get off the couch.  How do I know how to exercise on both of those days? 

 

This is a natural thing to experience as a transplant patient. Sometimes the hardest thing to do is to start the exercise. Once you start it, you may be surprised that it actually make you feel better. If you are taught how to monitor yourself and how to exercise to a level that gets you "slightly short-of-breath but still able to talk", then your body will naturally adjust the level of activity that it can tolerate on any given day. 

 

 

15. How do I know if my transplant centre offers an exercise program?

 

To determine whether your transplant centre offers an exercise program, ask your transplant coordinator or doctor. You can also view our National Transplant Rehabilitation Program Directory, which includes many of the exercise programs in Canada.

 

 

16. I want to start exercising – what should I do next?

 

That’s great!! Your first steps in starting to exercise depend on what stage you are currently in. Pre-transplant patients often need to be supervised when taking part in physical activity. Unwell or recent recipients should visit an exercise specialist (such as a physiotherapist) for a tailored exercise program. Long-term recipients can undergo a general exercise program like the one that is introduced on the Transplant Patients and Caregivers page. Feel free to talk to anyone in your transplant healthcare team for additional assistance and resources on engaging in physical activity before or after transplant.

 

If you have any additional questions, please contact us at canrestore@cntrp.ca

 

Acknowledgements:

Special thanks given to the physiotherapists Nancy Howes (London Health Sciences Centre), Lisa Wickerson, Denise Helm (Toronto General Hospital) for contributing to the creation of this page.

 

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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