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The gap between clinically assessed physical performance and objective physical activity in liver transplant candidates
Author(s) -
Dunn Michael A.,
Josbeno Deborah A.,
Schmotzer Amy R.,
Tevar Amit D.,
DiMartini Andrea F.,
Landsittel Douglas P.,
Delitto Anthony
Publication year - 2016
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24506
Subject(s) - medicine , cirrhosis , physical activity , chronic liver disease , sarcopenia , liver transplantation , physical therapy , transplantation
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 .