- Email: [email protected]
Alpine Skiing and Anaerobic Performance in Solid Organ Transplant Recipients
Alpine Skiing and Anaerobic Performance in Solid Organ Transplant Recipients G.S. Roi, G. Mosconi, I. Capelli, V. Cuna, E. Persici, M. Parigino, D. Pisoni, P. Todeschini, A. Nanni Costa, and S. Stefoni ABSTRACT Limited information has been published about sporting activities in solid organ transplant recipients. The aim of this study was to assess “in the field” performance capacities of a group of transplant recipients involved in an alpine skiing competition. We studied 16 transplant recipients (13 men and 3 women) who had undergone transplantations (11 kidney, 4 liver, and 1 heart) at 89 ⫾ 68 months prior while participating in an alpine skiing race. The patients performed a countermovement jumping test to measure the explosive power of the lower limbs. In all patients blood lactate concentrations (La) were measured at the end of a giant slalom race. The maximum displacement of the center of mass during the jumping test was 22.4 ⫾ 9.3 cm; the time to complete the giant slalom was 75.5 ⫾ 16.5 seconds and La was 3.5 ⫾ 0.8 mmol/L. We observed significant linear relationships between race time and La (R2 ⫽ 0.4733; P ⬍ .01) and between race time and performance in the jumping test (R2 ⫽ 0.3655; P ⬍ .05). This study indicated that recovery of anaerobic and technical sporting activities is possible in organ transplant recipients. Muscular power and anaerobic performances among a selected group of solid organ transplant recipients were similar to those of the general untrained population. OLID organ transplantation is now a recognized treatment for end-stage organ failure. Transplantation leads to physical and social recovery. Physical activity and muscular capacity in the pretransplantation period are significantly impaired by the underlying diseases, thus patients affected by end-stage organ insufficiency show impaired muscular exercise capacity.1–3 Several studies have investigated the development of physical activity after solid organ transplantation.4 It is well known that some solid organ recipients restart professional sport activities after surgery. For these patients there are no data on the recovery of physical fitness necessary to compete in anaerobic events such as alpine skiing. Therefore, the aim of this study was to assess, “in the field,” the performance capacities of a group of transplant recipients involved in an alpine skiing competition.
S
MATERIALS AND METHODS After signing informed written consents, 16 solid organ transplant recipients—1 heart, 4 livers, and 11 kidneys—participated in an alpine skiing (giant slalom) competition during the Italian National Championship organized by the Sports Section of the Hemodialysis and Transplant Patients National Association.
They were 13 men of mean age 52 ⫾ 15 years with a body mass of 71.8 ⫾ 11.2 kg, body mass index of 24.0 ⫾ 2.1 kg/m2, and body fat of 19 ⫾ 3%. The 3 women had a mean age of 34 ⫾ 12 years with a body mass of 63.3 ⫾ 4.0 kg, body mass index of 24.2 ⫾ 3.0 kg/m2, and body fat of 27 ⫾ 11%. They had undergone transplantation 89 ⫾ 68 months prior. The average serum creatinine level of the patients was 1.7 ⫾ 1.3 mg/dL, and the average hemoglobin value was 12.9 ⫾ 1.3 g/dL. Table 1 shows the characteristics of the examined population, including immunosuppressive therapy and the eventual presence of diabetes. The race started at an altitude of 1600 m above sea level. There were 42 gates and a gradient of about 160 m. The air temperature was ⫺8°C. The day before the competition, after 10 minutes of warming up, all patients performed 3 countermovement jumps with the upper limbs free, with 30 seconds of rest in between, to assess the vertical displacement of the center of mass from the fly time, as an index of the From the Isokinetic Medical Group (G.S.R., M.P., D.P.), Education and Research Department, Bologna; Nephrology, Dialysis and Renal Transplant Unit (G.M., I.C., V.C., E.P., P.T., S.S.), S. Orsola University Hospital, Bologna; and Italian National Transplant Center (A.N.C.), Rome, Italy. Address reprint requests to Giulio Sergio Roi, Isokinetic Medical Group, Education & Research Department, Via Casteldebole 8/4, 40132 Bologna, Italy. E-mail: [email protected]
© 2010 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/–see front matter doi:10.1016/j.transproceed.2010.03.094
Transplantation Proceedings, 42, 1029 –1031 (2010)
1029
1030
ROI, MOSCONI, CAPELLI ET AL Table 1. Characteristics of the Study Population
Patient No.
Gender M/F
Current Therapy
Type of Transplant
Months after Transplantation
Creatinine (mg/dL)
Hemoglobin (g/dL)
DM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
F M M M F M M F M M M M M M M M
CSA, MMF CSA RAD FK FK CSA, RAD, St CSA, MMF CSA, MMF CSA, St RAD, MMF, St FK FK, MMF, St FK, MMF, St FK, MMF, St FK, MMF, St FK, MMf, St
Heart Liver Liver Liver Liver Kidney Kidney Kidney Kidney Kidney Kidney Kidney Kidney Kidney Kidney Kidney
135 255 118 34 42 35 137 185 42 32 100 142 39 89 36 6
0.74 1.25 1.33 6.34 1.44 1.05 3.40 2.20 1.39 1.60 1.50 0.90 1.40 1.36 1.53 1.24
12.6 14.2 14.3 12.4 11.0 12.0 13.3 12.2 12.7 14.0 11.0 14.3 11.5 15.8 13.2 11.9
No Yes Yes No No No No No No No No No No No No No
Abbreviations: M, male; F, female; CsA, cyclosporine A; FK, tacrolimus; RAD, everolimus; MMF, mofetil mycofenolate; St, steroids; DM, diabetes mellitus.
power of the lower limbs.5 The fly time was measured using a system of transmitting and receiving bars that detected interruptions in communication between the bars and calculated their duration with an accuracy of 1/1000 s (Optojump, Microgate, Bolzano, Italy). Between 3 and 5 minutes after the end of the competition, each patient was asked to give a sample of capillary blood from the ear lobe. Each blood sample was analyzed by a hand-held lactate analyzer (Lactate Pro; Arkray KDK, Kyoto, Japan), which measures lactate concentrations (La) on 5 L of whole blood using a single-use reagent strip of an enzyme-coated electrode and a small meter.6 The results are shown as mean values ⫾ SD. Correlations using linear regression analysis were used to examine relationships between lactate and time of competition, and between the results of the jumping test and the time of competition. A value of P ⬍ .05 was considered statistically significant.
Fig 1. Relationship between La and time of competition; faster athletes have higher capacity to use anaerobic metabolism.
RESULTS
The maximum displacement of the center of mass during the jumping test was 22.4 ⫾ 9.3 cm; the time taken for completing the giant slalom was 75.5 ⫾ 16.5 seconds and La was 3.5 ⫾ 0.8 mmol/L. We found a significant linear relationship between time and La (R2 ⫽ 0.4733; P ⬍ .01; Fig 1) and between time and performance in the jumping test (R2 ⫽ 0.3655; P ⬍ .05; Fig 2). DISCUSSION
Alpine skiing is a leisure activity practiced by thousands of people. The competitions are a unique occasion to study this sporting activity practiced also by some solid organ transplant
ALPINE SKIING AND ANAEROBIC PERFORMANCE
1031
Fig 2. Relationship between countermovement jump and time of giant slalom competition; faster athletes have better power.
recipients as a means of achieving physical and psychological recovery after the transplantation. Alpine skiing is characterized by particular technical skills that must be supported by the power of the lower limbs.7 This biomechanical characteristic of the muscular system is easy to assess by a jumping test.5 The patients examined in this study showed a vertical displacement of the center of mass in the jumping test similar to those of a matched sedentary population,8 indicating that the capacity to express their specific power output to perform anaerobic tasks was not impaired, despite the potential side effects of immunosuppressive therapy. Furthermore, expressed power is also related to muscular mass,8 which does not seem to be strongly affected by the potential deconditioning effects of the pathology, as indirectly suggested by analysis of the anthropometric characteristics of our patients. Obviously, as in sedentary nonpathological subjects, specific training may further improve the power capacity of the lower limbs. In professional alpine skiers, the contribution of anaerobic metabolism during a giant slalom race is about 46% of the total energy request.9 The La at the end of the competitions attained about 8 –10 times the resting values.7,9 Furthermore, La in alpine skiing postcompetition was inversely related to race time,10 indicating that glycolytic metabolism is crucial for performance and also that skilled and unskilled skiers differ with respect to glycogen use.7 In our study, transplant recipient skiers showed the same pattern as that observed in healthy subjects with a significant relationship between La and race time, despite the smaller increase in La after the race compared with healthy skiers.7,9,10 This observation suggests that transplant recipients may recover anaerobic metabolism to a level compatible with participation in anaerobic sport activities such as alpine skiing. The coefficients of variation of the race time (CV ⫽ 22%) and of the jumping test (CV ⫽ 42%) also indicated that skiing
performance among these patients was also related to individual technique and to the anaerobic power of the lower limbs (Fig 2), as previously observed in healthy athletes.7,9,10 In conclusion, this study indicated that recovery of anaerobic and technical sporting activity is possible in organ transplant recipients. Muscular power and anaerobic performances in a selected group of solid organ transplant recipients were similar to those of the general untrained population. REFERENCES 1. Capitanini A, Cupisti A, Mochi N, et al: Effects of exercise training on exercise aerobic capacity and quality of life in haemodialysis patients. J Nephrol 21:738, 2008 2. Dharancy S, Lemyze M, Boleslawski E, et al: Impact of impaired aerobic capacity on liver transplant candidates. Transplantation 86:1077, 2008 3. Jehn M, Schmidt-Trucksäss A, Schuster T: Daily walking performance as an independent predictor of advanced heart failure: prediction of exercise capacity in chronic heart failure. Am Heart J 157:292, 2009 4. Painter P: Exercise following organ transplantation: a critical part of the routine post transplant care. Ann Transplant 10:28, 2005 5. Bosco C, Luhtanen P, Komi PV: A simple method for measurement of mechanical power in jumping. Eur J Appl Physiol Occup Physiol 50:273, 1983 6. Shimojo N, Naka K, Harumi U, et al: Electrochemical assay system with single-use electrode strip for measuring lactate in whole blood. Clin Chem 39:2312, 1993 7. Andersen RE, Montgomery DL: Physiology of alpine skiing. Sports Med 6:210, 1988 8. Ferretti G, Narici MV, Binzoni T, et al: Determinants of peak muscle power: effects of age and physical conditioning. Eur J Appl Physiol Occup Physiol 68:111, 1994 9. Saibene F, Cortili G, Gavazzi P, et al: Energy surces in alpine skiing (giant slalom). Eur J Appl Physiol 53:312, 1985 10. Roi GS, Osgnach C: Post-competition blood lactate in elderly alpine skiers. In Müller E, Schwameder H, Zallinger G, et al (eds): Book of Abstracts. 8th Annual Congress of the European College of Sport Science, Salzburg, Austria; 251
S
MATERIALS AND METHODS After signing informed written consents, 16 solid organ transplant recipients—1 heart, 4 livers, and 11 kidneys—participated in an alpine skiing (giant slalom) competition during the Italian National Championship organized by the Sports Section of the Hemodialysis and Transplant Patients National Association.
They were 13 men of mean age 52 ⫾ 15 years with a body mass of 71.8 ⫾ 11.2 kg, body mass index of 24.0 ⫾ 2.1 kg/m2, and body fat of 19 ⫾ 3%. The 3 women had a mean age of 34 ⫾ 12 years with a body mass of 63.3 ⫾ 4.0 kg, body mass index of 24.2 ⫾ 3.0 kg/m2, and body fat of 27 ⫾ 11%. They had undergone transplantation 89 ⫾ 68 months prior. The average serum creatinine level of the patients was 1.7 ⫾ 1.3 mg/dL, and the average hemoglobin value was 12.9 ⫾ 1.3 g/dL. Table 1 shows the characteristics of the examined population, including immunosuppressive therapy and the eventual presence of diabetes. The race started at an altitude of 1600 m above sea level. There were 42 gates and a gradient of about 160 m. The air temperature was ⫺8°C. The day before the competition, after 10 minutes of warming up, all patients performed 3 countermovement jumps with the upper limbs free, with 30 seconds of rest in between, to assess the vertical displacement of the center of mass from the fly time, as an index of the From the Isokinetic Medical Group (G.S.R., M.P., D.P.), Education and Research Department, Bologna; Nephrology, Dialysis and Renal Transplant Unit (G.M., I.C., V.C., E.P., P.T., S.S.), S. Orsola University Hospital, Bologna; and Italian National Transplant Center (A.N.C.), Rome, Italy. Address reprint requests to Giulio Sergio Roi, Isokinetic Medical Group, Education & Research Department, Via Casteldebole 8/4, 40132 Bologna, Italy. E-mail: [email protected]
© 2010 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
0041-1345/–see front matter doi:10.1016/j.transproceed.2010.03.094
Transplantation Proceedings, 42, 1029 –1031 (2010)
1029
1030
ROI, MOSCONI, CAPELLI ET AL Table 1. Characteristics of the Study Population
Patient No.
Gender M/F
Current Therapy
Type of Transplant
Months after Transplantation
Creatinine (mg/dL)
Hemoglobin (g/dL)
DM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
F M M M F M M F M M M M M M M M
CSA, MMF CSA RAD FK FK CSA, RAD, St CSA, MMF CSA, MMF CSA, St RAD, MMF, St FK FK, MMF, St FK, MMF, St FK, MMF, St FK, MMF, St FK, MMf, St
Heart Liver Liver Liver Liver Kidney Kidney Kidney Kidney Kidney Kidney Kidney Kidney Kidney Kidney Kidney
135 255 118 34 42 35 137 185 42 32 100 142 39 89 36 6
0.74 1.25 1.33 6.34 1.44 1.05 3.40 2.20 1.39 1.60 1.50 0.90 1.40 1.36 1.53 1.24
12.6 14.2 14.3 12.4 11.0 12.0 13.3 12.2 12.7 14.0 11.0 14.3 11.5 15.8 13.2 11.9
No Yes Yes No No No No No No No No No No No No No
Abbreviations: M, male; F, female; CsA, cyclosporine A; FK, tacrolimus; RAD, everolimus; MMF, mofetil mycofenolate; St, steroids; DM, diabetes mellitus.
power of the lower limbs.5 The fly time was measured using a system of transmitting and receiving bars that detected interruptions in communication between the bars and calculated their duration with an accuracy of 1/1000 s (Optojump, Microgate, Bolzano, Italy). Between 3 and 5 minutes after the end of the competition, each patient was asked to give a sample of capillary blood from the ear lobe. Each blood sample was analyzed by a hand-held lactate analyzer (Lactate Pro; Arkray KDK, Kyoto, Japan), which measures lactate concentrations (La) on 5 L of whole blood using a single-use reagent strip of an enzyme-coated electrode and a small meter.6 The results are shown as mean values ⫾ SD. Correlations using linear regression analysis were used to examine relationships between lactate and time of competition, and between the results of the jumping test and the time of competition. A value of P ⬍ .05 was considered statistically significant.
Fig 1. Relationship between La and time of competition; faster athletes have higher capacity to use anaerobic metabolism.
RESULTS
The maximum displacement of the center of mass during the jumping test was 22.4 ⫾ 9.3 cm; the time taken for completing the giant slalom was 75.5 ⫾ 16.5 seconds and La was 3.5 ⫾ 0.8 mmol/L. We found a significant linear relationship between time and La (R2 ⫽ 0.4733; P ⬍ .01; Fig 1) and between time and performance in the jumping test (R2 ⫽ 0.3655; P ⬍ .05; Fig 2). DISCUSSION
Alpine skiing is a leisure activity practiced by thousands of people. The competitions are a unique occasion to study this sporting activity practiced also by some solid organ transplant
ALPINE SKIING AND ANAEROBIC PERFORMANCE
1031
Fig 2. Relationship between countermovement jump and time of giant slalom competition; faster athletes have better power.
recipients as a means of achieving physical and psychological recovery after the transplantation. Alpine skiing is characterized by particular technical skills that must be supported by the power of the lower limbs.7 This biomechanical characteristic of the muscular system is easy to assess by a jumping test.5 The patients examined in this study showed a vertical displacement of the center of mass in the jumping test similar to those of a matched sedentary population,8 indicating that the capacity to express their specific power output to perform anaerobic tasks was not impaired, despite the potential side effects of immunosuppressive therapy. Furthermore, expressed power is also related to muscular mass,8 which does not seem to be strongly affected by the potential deconditioning effects of the pathology, as indirectly suggested by analysis of the anthropometric characteristics of our patients. Obviously, as in sedentary nonpathological subjects, specific training may further improve the power capacity of the lower limbs. In professional alpine skiers, the contribution of anaerobic metabolism during a giant slalom race is about 46% of the total energy request.9 The La at the end of the competitions attained about 8 –10 times the resting values.7,9 Furthermore, La in alpine skiing postcompetition was inversely related to race time,10 indicating that glycolytic metabolism is crucial for performance and also that skilled and unskilled skiers differ with respect to glycogen use.7 In our study, transplant recipient skiers showed the same pattern as that observed in healthy subjects with a significant relationship between La and race time, despite the smaller increase in La after the race compared with healthy skiers.7,9,10 This observation suggests that transplant recipients may recover anaerobic metabolism to a level compatible with participation in anaerobic sport activities such as alpine skiing. The coefficients of variation of the race time (CV ⫽ 22%) and of the jumping test (CV ⫽ 42%) also indicated that skiing
performance among these patients was also related to individual technique and to the anaerobic power of the lower limbs (Fig 2), as previously observed in healthy athletes.7,9,10 In conclusion, this study indicated that recovery of anaerobic and technical sporting activity is possible in organ transplant recipients. Muscular power and anaerobic performances in a selected group of solid organ transplant recipients were similar to those of the general untrained population. REFERENCES 1. Capitanini A, Cupisti A, Mochi N, et al: Effects of exercise training on exercise aerobic capacity and quality of life in haemodialysis patients. J Nephrol 21:738, 2008 2. Dharancy S, Lemyze M, Boleslawski E, et al: Impact of impaired aerobic capacity on liver transplant candidates. Transplantation 86:1077, 2008 3. Jehn M, Schmidt-Trucksäss A, Schuster T: Daily walking performance as an independent predictor of advanced heart failure: prediction of exercise capacity in chronic heart failure. Am Heart J 157:292, 2009 4. Painter P: Exercise following organ transplantation: a critical part of the routine post transplant care. Ann Transplant 10:28, 2005 5. Bosco C, Luhtanen P, Komi PV: A simple method for measurement of mechanical power in jumping. Eur J Appl Physiol Occup Physiol 50:273, 1983 6. Shimojo N, Naka K, Harumi U, et al: Electrochemical assay system with single-use electrode strip for measuring lactate in whole blood. Clin Chem 39:2312, 1993 7. Andersen RE, Montgomery DL: Physiology of alpine skiing. Sports Med 6:210, 1988 8. Ferretti G, Narici MV, Binzoni T, et al: Determinants of peak muscle power: effects of age and physical conditioning. Eur J Appl Physiol Occup Physiol 68:111, 1994 9. Saibene F, Cortili G, Gavazzi P, et al: Energy surces in alpine skiing (giant slalom). Eur J Appl Physiol 53:312, 1985 10. Roi GS, Osgnach C: Post-competition blood lactate in elderly alpine skiers. In Müller E, Schwameder H, Zallinger G, et al (eds): Book of Abstracts. 8th Annual Congress of the European College of Sport Science, Salzburg, Austria; 251