Systematic Reviews
Copyright ©The Author(s) 2016.
World J Transplant. Dec 24, 2016; 6(4): 774-789
Published online Dec 24, 2016. doi: 10.5500/wjt.v6.i4.774
Table 1 Electronic search strategy used in MEDLINE
Search #Keywords and number of records identified
Search #1Organ transplantation (110179)
Search #2Transplantation conditioning (7738)
Search #3Transplant recipients (195)
Search #4“Transplant recipient$” (27594)
Search #51 or 2 or 3 or 4 (122169)
Search #6Exercise/or Exercise Therapy/or exercise$ (192344)
Search #7Rehab$/or rehabilitation (151761)
Search #8Resistance training/or “physical education and training”/or training (181282)
Search #9“Physical activity” (47446)
Search #10Physical exertion (11451)
Search #116 or 7 or 8 or 9 or 10 (474657)
Search #125 and 11 (2399)
Search #13Heart or lung or kidney or pancreas or liver (1433618)
Search #1412 and 13 (2200)
Search #15Limit 14 to humans (2156)
Search #16Limit 14 to animals (76)
Search #1715 not 16 (2121)
Search #18Limit 17 to randomized controlled trial (60)
Table 2 Description of studies
Ref.CountryYearOrganTime-post transplant (wk)Treatment duration (wk)Randomized patients1Exercise interventionComparison
Braith et al[5]United States1996Heart> 82416Lumbar extension 1 d/wk; variable resistance exercises 2 d/wkUsual care
Braith et al[4]United States1998Heart> 824162Lumbar extension 1 d/wk; variable resistance exercises 2 d/wkUsual care
Kobashigawa et al[15]United States1999Heart> 22627Individualized cardiac rehabilitation (strengthening, flexibility, and moderate aerobic exercises) 1-3 d/wkUsual care (unstructured therapy at home)
Painter et al[16]United States2002Kidney4-848167Independent home-based exercise 4 d/wkUsual care
Mitchell et al[17]United States2003Lung> 82616Lumbar extension resistance exercise 1 d/wk and walking programUsual care (walking program)
Painter et al[18]United States2003Kidney> 44896Independent home-based exercise 4 d/wkUsual care
Braith et al[19]United States2005Heart> 82415Variable resistance exercises 2 d/wkUsual care
Juskowa et al[20]Poland2006Kidney> 0.54-569Strength exercise training 7 d/wkUsual care
Krasnoff et al[3]United States2006Liver> 840151Cardiovascular exercise training 3 d/wkUsual care
Bernardi et al[21]Italy2007Heart> 242426Stationary bicycle; 30 min/5 d per weekUsual care
Karapolat et al[22]Turkey2007HeartMean 14-17838Hospital-based exercise program (flexibility, stretching, aerobic, strengthening, breathing, relaxation) 3 d/wkHome-based exercise program (flexibility, stretching, aerobic, strengthening, breathing, relaxation) 3 d/wk
Braith et al[23]United States2008Heart> 81220Aerobic treadmill exerciseUsual care
Karopola et al[24]Turkey2008HeartMean 14-178383Hospital-based exercise program (flexibility, stretching, aerobic, strengthening, breathing, relaxation) 3 d/wkHome-based exercise program (flexibility, stretching, aerobic, strengthening, breathing, relaxation) 3 d/wk
Pierce et al[25]United States2008Heart> 81220Aerobic exercise trainingUsual care
Wu et al[26]Taiwan2008Heart> 52837Resistance and aerobic training 3 d/wkUsual care
Haykowsky et al[27]Canada2009Heart> 261223Aerobic 5 d/wk and strength training 2 d/wkUsual care
Mandel et al[28]United States2009Liver6-121250Targeted lower body resistance strengthening exercise 3-4 d/wkUsual care (walking program)
Hermann et al[29]Denmark2011Heart> 52827Aerobic interval training program 3 d/wkUsual care
Ihle et al[30]Germany2011Lung> 52460Inpatient rehabilitation (exercise training 4 d/wk and aerobic session 5 d/wk)Outpatient physiotherapy
Christensen et al[31]Denmark2012HeartMean 8484High-intensity aerobic interval training 3 d/wkUsual care
Langer et al[2]Belgium2012Lung1-61240Aerobic and resistance training 3 d/wkUsual care
Nytrøen et al[32]Norway2012Heart52-4165252High-intensity aerobic interval training 3 d/wkUsual care
Rustad et al[33]Norway2012Heart52-4161252High-intensity aerobic interval training 3 d/wkUsual care
Kawauchi et al[34]Brazil2013Heart< 1to hospital discharge2210-phase incremental exercise program (breathing, active resistance exercises, aerobic exercises, stretching)Institution exercise routine (breathing, stretching walking) 5 d/wk
Kouidi et al[35]Greece2013Kidney> 522624Aerobic exercise and strength training 4 d/wkUsual care
Nytrøen et al[36]Norway2013Heart52-41652525High-intensity aerobic interval training 3 d/wkUsual care
Dall et al[37]Denmark2014Heart> 5212 (5 mo washout)17High-intensity aerobic interval training 3 d/wkModerate biking exercise 3 d/wk
Monk-Hansen et al[38]Denmark2014Heart> 52830High intensity training 3 d/wkUsual care
Pascoalino et al[39]Brazil2015Heart> 521242Endurance exercise training 3 d/wkUsual care
Pooranfar et al[40]Iran2013Kidney104-1561044Aerobic and resistance training 3 d/wkUsual care
Riess et al[41]Canada2013Kidney> 261231Endurance and strength training 2 d/wkUsual care
Tzvetanov et al[42]United States2014Kidney> 45217Resistance exercise training 2 d/wk (as well as behaviour and nutrition)Usual care
Dall et al[43]Denmark2015Heart> 5212 (5 mo washout)176High-intensity aerobic interval training 3 d/wkModerate biking exercise 3 d/wk
Greenwood et al[44]England2015Kidney< 521260Home-based aerobic training and resistance training 3 d/wkUsual care
Karelis et al[45]Canada2015Kidney6-81624Resistance training 3 d/wk (once a week in hospital and 2 × /week at home)Usual care (no exercise)
Table 3 List of outcome measures by study
Ref.YearOrgan groupPrimary outcome measuresSecondary outcome measures
Braith et al[5]1996HeartBone mineral density (body and regional: Femur neck, lumbar vertebra)Bone mineral content Total bone calcium Acute rejection episodes
Braith et al[4]1998HeartBody mass Fat-free mass Fat mass Muscle strength (upper and lower body)Percent body fat Acute rejection episodes
Kobashigawa et al[15]1999HeartBlood pressure (peak and resting) Heart rate (peak and resting) Anaerobic threshold Exercise duration (to exhaustion) Peak ventilation Peak VO2 Peak workload Ventilatory equivalent for carbon dioxide and oxygenMuscle strength (lower limb)
Painter et al[16]2002KidneyBody mass index Body weight Fat mass/body fat Lean tissue mass Percent body fat Blood pressure (peak) Muscle strength (quadriceps) Peak ventilation Peak VO2 SF-36Self-reported activity level (frequency, type, length, and intensity of exercise) Blood creatinine Blood urea nitrogen levels Hematocrit Hemoglobin Bone mineral density Peak workload Rating of perceived exertion (Borg) Peak respiratory exchange ratio Immunosuppression use (type, dose)
Mitchell et al[17]2003LungBone mineral density (lumbar spine)Acute rejection episodes Muscle strength (lumbar extensor)
Painter et al[18]2003KidneyCholesterol (TC, HDL) Body mass index Total CVD risk (Framingham) Blood pressure Peak workload (METs)Blood lipids Incidence of diabetes Smoking status
Braith et al[19]2005HeartMuscle composition (fiber types) Muscle metabolic enzyme activityMuscle strength (upper and lower body)
Juskowa et al[20]2006KidneyBlood lipids Cholesterol (TC, HDL, LDL) Body mass indexBlood calcium level Blood creatinine Blood electrolytes Blood glucose Blood phosphorus Blood protein levels (albumin, fibrinogen, total protein level) Enzyme levels (alanine transferase, alkaline phosphatase, aspartate aminotransferase) Folate concentrations Hemoglobin Interleukin-18 Total-homocysteine Vitamin B12 Blood pressure Muscle strength (upper limbs) Peak expiratory flow
Krasnoff et al[3]2006LiverBody mass index Body weight Bone mineral content Bone mineral density Fat mass/body fat Lean tissue mass Percent body fat Muscle strength (quadriceps) Peak VO2 SF-36 Peak respiratory exchange ratio Nutritional intake (Block-95 - calories/day; protein, carb and fat calories)Rating of perceived exertion (Borg)
Bernardi et al[21]2007HeartBaroceptor control of blood pressure Baroceptor control of heart rateBlood pressure; Heart rate Neck pressure RR interval Anaerobic threshold CO2 production Exercise duration (to exhaustion) Peak ventilation Peak VO2; Peak workload Ventilatory equivalent for CO2 and oxygen
Karapolat et al[22]2007HeartPeak VO2 Beck depression inventory SF-36 State-trait anxiety inventory
Braith et al[23]2008HeartEndothelial function (flow-mediated dilation)Blood glucose Blood lipids Cholesterol (TC, HDL, LDL) Oxidative stress-induced lipid peroxidation Plasma norepinephrine Serum metabolic and hematologic indicators Body mass Acute rejection episodes Blood pressure (resting and peak) Brachial artery diameter Exercise duration (to exhaustion) Peak VO2
Karapolat et al[24]2008HeartChronotropic response index Heart rate recovery Heart rate reserve Peak VO2Duke Treadmill Score
Pierce et al[25]2008HeartC-reactive protein Interleukin-6 Serum metabolic profile Soluble cell adhesion molecules (sICAM-1) Tumour necrosis factor-alpha Muscle vasodilation (forearm and calf)Blood glucose Cholesterol (TC, HDL, LDL) Cytomegalovirus IgG status White blood cell levels Acute rejection episodes Blood pressure (resting) Heart rate (peak and resting) Exercise duration (to exhaustion) Rating of perceived exertion (Borg) Peak respiratory exchange ratio
Wu et al[26]2008HeartMuscle endurance (quadriceps) Muscle strength (quadriceps) Peak VO2 World Health Organization Questionnaire on Quality of Life - BREFDaily physical activity Blood pressure Heart rate (resting and peak) Nutritional intake (caloric intake questionnaire) Peak ventilation Peak workload Rating of perceived exertion (Borg)
Haykowsky et al[27]2009HeartPeak VO2Lean tissue mass (total and leg) Blood pressure (peak) Endothelial function (endothelial-dependent vasodilation, endothelial-independent vasodilation, reactive hyperemia index) Heart rate (peak) Left ventricular systolic function Muscle strength (upper and lower body) Peak power output Peak respiratory exchange ratio
Mandel et al[28]2009Liver6MWD Muscle strength (lower body) Chronic liver disease questionnaire (CLDQ) SF-36 (physical function/limitations)
Hermann et al[29]2011HeartPeak VO2Blood creatinine Blood glucose; Blood lipids Blood protein levels (adiponectin, MR-proANP, NT-proBNP, provasopressin/copeptin) Cholesterol Hemoglobin High sensitive C-reactive protein Interleukin-6 Serum insulin Tumour necrosis factor-alpha Body mass index; Body weight Hip-waist ratio Blood pressure (resting) Brachial artery diameter Endothelial function (flow-mediated vasodilation, nitroglycerin-induced vasodilation) Heart rate (resting) Peak power output
Ihle et al[30]2011Lung6MWD Peak VO2 SF-36 St. George’s Respiratory QuestionnaireHeart rate (peak and resting) Anaerobic threshold Oxygen uptake at anaerobic threshold Peak workload Peak respiratory exchange ratio Ventilatory reserve and capacity
Christensen et al[31]2012HeartHospital Anxiety and Depression ScalePeak VO2
Langer et al[2]2012LungSF-36 Daily walking time (time spend in different postures: sedentary, standing, walking)Daily steps Movement intensity Time spent in moderate intense activities Blood lipids Body weight Bone mineral density Blood pressure 6MWD Muscle strength (quadriceps and handgrip) Peak workload Mood status SF-36 Forced expiratory volume Respiratory muscle force Incidence of morbidity (diabetes, hyperlipidemia, hypertension, osteoporosis)
Nytrøen et al[32]2012HeartPeak VO2Blood lipids Blood protein levels (NT-proBNP) C-reactive protein Interleukin-6, 8 and 10 levels Body mass index; Body weight; % body fat Chronotropic response index Glycemic control parameters Blood pressure (peak and resting) Heart rate (peak and resting) Heart rate recovery and reserve Stroke volume (O2 pulse; resting and peak) Anaerobic threshold Exercise duration (to exhaustion) Muscle strength (quadriceps and hamstrings) Peak ventilation Rating of perceived exertion (Borg) SF-36 Visual Analog Scale (subjective difference in HRQoL) Peak respiratory exchange ratio
Rustad et al[33]2012HeartEchocardiographic parameters (rest and during exercise; systolic and diastolic parameters) Peak VO2Biochemical parameters Blood pressure Cardiac allograft vasculopathy (coronary angiography) Cardiac output Heart rate (resting and peak) Stroke volume Peak workload Peak respiratory exchange ratio
Kawauchi et al[34]2013Heart6MWD Forced vital capacity Respiratory muscle force/strengthMuscle strength (upper and lower limbs) Maximum expiratory/inspiratory pressure
Kouidi et al[35]2013KidneyBaroreflex sensitivity Heart rate variability parameters (SDNN, rMSSD, pNN50, LF, HF, LF/HF)Baroreflex effectiveness index Blood pressure (peak and resting) Heart rate (peak and resting) Exercise duration (to exhaustion) Peak ventilation Peak VO2
Nytrøen et al[36]2013HeartCardiac allograft vasculopathy (intravascular ultrasound and virtual histology)Blood creatinine Blood glucose Blood lipids C-reactive protein Cholesterol (TC, HDL, LDL) Hemoglobin Interleukin-6, 8 and 10 levels Body mass index Body water (total) Body weight Bone mass Lean tissue mass Percent body fat Visceral fat scale Basal metabolic rate Glycemic control parameters Metabolic age Muscle strength (quadriceps and hamstrings) Peak VO2
Dall et al[37]2014HeartPeak VO2Body weight Blood pressure Heart rate (peak and resting) Heart rate recovery Heart rate reserve CO2 production Peak ventilation Peak workload Peak respiratory exchange ratio
Monk-Hansen et al[38]2014HeartEchocardiography parameters (systolic and diastolic function)Body mass index Blood pressure Heart rate (peak and resting) Peak VO2 Peak workload
Pascoalino et al[39]2015HeartArterial stiffness (carotid-femoral pulse wave velocity) Blood pressure (ambulatory; peak and resting)Plasma norepinephrine Heart rate (peak and resting) Anaerobic threshold CO2 production Exercise duration (to exhaustion) Peak VO2 Peak respiratory exchange ratio Respiratory compensation point
Pooranfar et al[40]2013KidneyBlood lipids Cholesterol (TC, HDL, LDL) Sleep quality and quantity questionnaire (self-report; Pittsburgh Sleep Quality Index)
Riess et al[41]2013KidneyPeak VO2Cholesterol (TC, HDL) Lean tissue mass Total CVD risk (Framingham) Arterial pressure (mean) Arterial stiffness (pulse wave velocity) Arteriovenous oxygen difference (a-vO2) Blood pressure (ambulatory; peak and resting) Cardiac output Heart rate (peak); Stroke volume Systemic vascular endurance Muscle strength (lower body) Peak workload SF-36 Peak respiratory exchange ratio
Tzvetanov et al[42]2014KidneyGlomerular filtration rate SF-36 Adherence to training and follow-up Employment statusBlood creatinine; Blood glucose; Blood lipids Cholesterol (TC, HDL, LDL) Hemoglobin Body mass index Body weight Bone mineral content Lean tissue mass Percent body fat Arterial stiffness (carotid-femoral pulse wave velocity Blood pressure Carotid intima-media thickness Muscle strength
Dall et al[43]2015HeartBlood glucose Blood protein levels (adiponectin, orosomucoid, YLK 40) Interleukin-6 Serum insulin Tumour necrosis factor-alpha Arterial stiffness (augmentation index) Endothelial function (reactive hyperemia index) Hospital Anxiety and Depression Scale SF-36Body weight Homeostasis model assessment Heart rate (peak) Peak VO2 Peak respiratory exchange ratio
Greenwood et al[44]2015KidneyMuscle strength (quadriceps)Arterial stiffness (pulse wave velocity) Blood pressure (peak and resting) Heart rate (peak and resting) STS-60 Peak VO2 Body mass index; Body weight Waist girth Glomerular filtration rate high-sensitivity C-reactive protein interleukin-6 Fetuin A Tumor necrosis factor-alpha tumor necrosis factor receptors 1 and 2 SF-36 Duke Activity Status Index
Karelis et al[45]2015KidneyWorld Health Organization-5 Well-Being Index Muscle strength index Adherence to training and follow-up (feasibility)Body weight Body height Body mass index Waist girth Hip girth Fat mass/body fat Lean tissue mass Cholesterol (TC, HDL, LDL) Blood glucose Blood pressure Peak VO2
Table 4 International Classification of Functioning, Disability and Health outcome classifications
ICF componentDomainCategoryOutcome measuresCount primary1Organ group
Body FunctionGlobal mental functionsb134Sleep quality and quantity1Kidney
b152Mood status0Lung
Functions of the cardiovascular system (heart functions)b410Cardiac output0Heart, kidney
b410Carotid intima-media thickness0Kidney
b410Echocardiographic parameters2Heart
b410Endothelial function2Heart
b410Left ventricular systolic function0Heart
b410RR interval0Heart
b410Stroke volume0Heart, kidney
b410Systemic vascular endurance0Kidney
Functions of the cardiovascular system (heart rate)b4100Heart rate1Heart, kidney, lung
b4100Heart rate recovery1Heart
b4100Heart rate reserve1Heart
b4100Heart rate variability1Kidney
Functions of the cardiovascular systemb410-429Baroceptor control of blood pressure1Heart
b410-429Baroceptor control of heart rate1Heart
b410-429Baroflex effectiveness index0Kidney
b410-429Baroflex sensitivity1Kidney
b410-429Chronotropic response index1Heart
b410-429Total CVD risk1Kidney
b410-429Cardiac allograft vasculopathy1Heart
Functions of the cardiovascular system (blood vesselb415Arterial stiffness3Heart, kidney
functions)b415Brachial artery diameter0Heart
Functions of the cardiovascular system (bloodb420Arterial pressure0Kidney
pressure functions)b420Blood pressure4Heart, kidney, lung
b420Neck pressure0Heart
Functions of the cardiovascular system (oxygen-carrying functions of the blood)b4301Arteriovenous oxygen difference0Kidney
Functions of the hematological and immunologicalb430-439Biochemical parameters0Heart
systemsb430-439Blood calcium level0Kidney
b430-439Blood creatinine0Heart, kidney
b430-439Blood electrolytes0Kidney
b430-439Blood glucose1Heart, kidney
b430-439Blood lipids2Heart, kidney, lung
b430-439Blood phosphorus0Kidney
b430-439Blood protein levels1Heart, kidney
b430-439Blood urea nitrogen levels0Kidney
b430-439C-reactive protein1Heart
b430-439Cholesterol3Heart, kidney
b430-439Folate concentrations0Kidney
b430-439Hematocrit0Kidney
b430-439Hemoglobin0Heart, kidney
b430-439High sensitive C-reactive protein0Heart
b430-439Interleukin levels2Heart, kidney
b430-439Plasma norepinephrine0Heart
b430-439Soluble cell adhesion molecules1Heart
b430-439Total-homocysteine0Kidney
b430-439Tumour necrosis factor-alpha2Heart
B430-439Tumor necrosis factor receptor0Kidney
b435Cytomegalovirus IgG status0Heart
b435White blood cell levels0Heart
b435Acute rejection episodes0Heart, lung
Functions of the respiratory system (respiration functions)b440Forced expiratory volume0Lung
functions)b440Forced vital capacity1Heart
b440Maximum expiratory/inspiratory pressure0Heart
b440Peak expiratory flow0Kidney
b440Peak respiratory exchange ratio1Heart, kidney, liver, lung
b440Respiratory compensation point0Heart
b440Ventilatory reserve and capacity0Lung
Functions of the respiratory system (respiration rate)b4400CO2 production0Heart
b4400Oxygen uptake at anaerobic threshold0Lung
b4400Peak ventilation2Heart, kidney
b4400Peak VO213Heart, kidney, liver, lung
b4400Ventilatory equivalent for carbon dioxide and oxygen1Heart
Functions of the respiratory system (respiratory muscle functions)b445Respiratory muscle force/strength1Heart, lung
Functions of the cardiovascular system (general physical endurance)b4550Rating of perceived exertion0Heart, kidney, liver
Functions related to the digestive, metabolism and the endocrine systemb530Body mass index4Heart, kidney, liver
endocrine systemb530Body weight/mass3Heart, kidney, liver, lung
b530Fat mass/body fat3Heart, kidney, liver
b530Fat-free mass1Heart
b530Hip girth0Kidney
b530Hip-waist ratio0Heart
b530Lean tissue mass2Heart, kidney, liver
b530Percent body fat2Heart, kidney, liver
b530Visceral fat scale0Heart
b530Waist girth0Kidney
General metabolic functions, unspecifiedb5400Basal metabolic rate0Heart
b5400Metabolic age0Heart
General metabolic functions, other, specifiedB5408Maximal metabolic units1Kidney
Functions related to metabolism and the endocrine systemb540-559Enzyme levels0Kidney
systemb540-559Fetuin A0Kidney
b540-559Oxidative stress-induced lipid peroxidation0Heart
b540-559Serum insulin1Heart
b540-559Serum metabolic and/or hematologic profile1Heart
b540-559Vitamin B120Kidney
b540-559Glycemic control parameters0Heart, kidney
b540-559Muscle metabolic enzyme activity1Heart
b545Body water0Heart
b545Homeostasis model assessment0Heart
Functions of the genitourinary and reproductive functions (urinary functions)b610-639Glomerular filtration rate1Kidney
Neuromusculoskeletal and movement-related functions (muscle power functions)b730Peak workload/power output1Heart, kidney, lung
b730Muscle strength7Heart, kidney, liver, lung
b730-b749Muscle vasodilation1Heart
b740Muscle endurance1Heart
Body structureStructures related to movement - additional musculoskeletal structures related to movement (bones)s7700Bone mass0Heart
s7700Bone mineral content1Heart, kidney, liver
s7700Bone mineral density3Heart, kidney, liver, lung
s7700Total bone calcium0Heart
s7702Muscle composition (fibre types)1Heart
Activities and participationMobility - walking and movingd410STS-600Kidney
participationMobility - walking and moving (walking)d450Daily steps0Lung
d450Daily walking time1Lung
d4506 Minute Walk Distance3Heart, liver, lung
d450Anaerobic threshold1Heart, lung
Mobility - walking and movingd450-469Daily physical activity0Heart
d450-469Movement intensity0Lung
d450-469Self-reported activity level0Kidney
d450-469Time spent in moderate intense activities0Lung
d450-469Duke Treadmill Score0Heart
d450-469Exercise duration1Heart, kidney
Managing diet and fitnessd5701Caloric intake0Heart
d5701Nutritional intake1Liver
Major life areas (work and employment)d840-859Employment status1Kidney
Environmental factorsProducts or substances for personal consumption, other specifiede1108Smoking status0Kidney
Drugse1101Immunosuppression use0Kidney
QuestionnairesDASI0Kidney
Quality of Life Profile for Chronic Diseases Questionnaire1Lung
SF-368Heart, kidney, liver, lung
St. George’s Respiratory Questionnaire1Lung
State-Trait Anxiety Inventory1Heart
Beck Depression Inventory1Heart
Hospital Anxiety and Depression Scale2Heart
Visual Analog Scale (change in HRQoL)0Heart
WHOQOL-BREF2Heart, kidney
Not covered by ICFChronic Liver Disease Questionnaire1Liver
Incidence of morbidity0Kidney, lung
Adherence to training and follow-up2Kidney