Poor cardiorespiratory fitness is a risk factor for sepsis in patients awaiting liver transplantation
- Authors: Wallen, Matthew , Woodward, Aidan , Hall, Adrian , Skinner, Tina , Coombes, Jeff , Macdonald, Graeme
- Date: 2019
- Type: Text , Journal article
- Relation: Transplantation Vol. , no. 103(3) (2019), p.529-535
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- Description: Background Patients with advanced liver disease are at increased risk of infection and other complications. A significant proportion of patients also have poor fitness and low muscle mass. The primary aim of this study was to investigate if cardiorespiratory fitness and body composition are risk factors for sepsis and other complications of advanced liver disease. Methods Patients being listed for liver transplantation underwent cardiopulmonary exercise testing to determine ventilatory threshold (VT). Computed tomography was used to measure skeletal muscle and subcutaneous and visceral adipose tissue indexes. All unplanned hospital admissions, deaths or delistings prior to transplantation were recorded. Results Eighty-two patients [aged 55.1 (50.6–59.4) years, median (interquartile range); male 87%] achieved a median VT of 11.7 (9.7–13.4) mL[BULLET OPERATOR]kg-1[BULLET OPERATOR]min-1. Their median MELD-Na score was 18 (14–22); and 37 had hepatocellular carcinoma. There were 50 admissions in 31 patients; with 16 admissions for sepsis in 13 patients. Patients with sepsis had a significantly lower VT [sepsis 9.5 (7.8–11.9), no sepsis 11.8 (10.5–13.8) mL[BULLET OPERATOR]kg-1[BULLET OPERATOR]min-1; P=0.003]. No body composition variables correlated with sepsis, nor were there any significant associations between VT and unplanned admissions for other indications. Multivariate logistic regression demonstrated that VT was independently associated with a diagnosis of sepsis (P=0.03). Poisson regression revealed that VT was a significant predictor for the number of septic episodes (P=0.02); independent of age, MELD-Na score, hepatocellular carcinoma diagnosis, presence of ascites, and beta-blocker use. Conclusion Poor cardiorespiratory fitness is an independent risk factor for the development of sepsis in advanced liver disease.
Safety, adherence and efficacy of exercise training in solid-organ transplant candidates: A systematic review
- Authors: Wallen, Matthew , Skinner, Tina , Pavey, Toby , Hall, Adrian , Macdonald, Graeme , Coombes, Jeff
- Date: 2016
- Type: Text , Journal article
- Relation: Transplantation Reviews Vol. 30, no. 4 (2016), p. 218-226
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- Description: Background Patients awaiting solid-organ transplantation may be encouraged to undertake exercise training to improve pre- and post-transplant outcomes. However, the safety, adherence and efficacy of exercise training in this population remain unclear. Methods All randomized, non-randomized and non-controlled trials of exercise training interventions in solid-organ transplant candidates were included. The Cochrane risk of bias tool and a modified Newcastle–Ottawa scale were used to assess procedural quality. Safety was defined as the number of reported adverse events during exercise training. Adherence was evaluated from session attendance, and efficacy as changes in cardiorespiratory fitness (CRF), exercise capacity, muscular strength, health-related quality of life (HR-QoL) and lung function. Results Eleven studies involving 874 patients were included: four randomized controlled, one non-randomized controlled and six non-controlled trials. Six studies included heart transplant candidates and five involved patients awaiting lung transplantation. Three trials included aerobic-only training, one incorporated resistance-only exercise and seven combined modalities. Twelve adverse events were reported with four due to exercise, although methods to collect these data were often omitted. Exercise adherence ranged from 82.5% to 100%, but was poorly described. No significant between-group changes attributable to exercise training were demonstrated. However, significant within-group improvements in CRF, exercise capacity, muscular strength, lung function and HR-QoL were observed. Conclusions Patients awaiting heart or lung transplant appear to tolerate exercise training despite the larger number of adverse events compared to other high-risk populations. Exercise training demonstrated within-group benefits for several outcomes, with no significant between-group differences. Randomized controlled trials with sufficient statistical power are required for all solid-organ transplant candidates. © 2016 Elsevier Inc.
Impact of beta-blockers on cardiopulmonary exercise testingin patients with advanced liver disease
- Authors: Wallen, Matthew , Hall, Adrian , Dias, Katrin , Ramos, Joyce , Keating, Shelley , Woodward, Aidan , Skinner, Tina , Macdonald, Graeme , Arena, Ross , Coombes, Jeff
- Date: 2017
- Type: Text , Journal article
- Relation: Alimentary Pharmacology and Therapeutics Vol. , no. (2017), p. 1-7
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- Description: Summary Background: Patients with advanced liver disease may develop portal hypertensionthat can result in variceal haemorrhage. Beta-blockers reduce portal pressure andminimise haemorrhage risk. These medications may attenuate measures of car-diopulmonary performance, such as the ventilatory threshold and peak oxygenuptake measured via cardiopulmonary exercise testing. Aim: To determine the effect of beta-blockers on cardiopulmonary exercise testingvariables in patients with advanced liver disease. Methods: This was a cross-sectional analysis of 72 participants who completed acardiopulmonary exercise test before liver transplantation. All participants remainedon their usual beta-blocker dose and timing prior to the test. Variables measuredduring cardiopulmonary exercise testing included the ventilatory threshold, peakoxygen uptake, heart rate, oxygen pulse, the oxygen uptake efficiency slope and theventilatory equivalents for carbon dioxide slope. Results: Participants taking beta-blockers (n = 28) had a lower ventilatory threshold(P <.01) and peak oxygen uptake (P = .02), compared to participants not takingbeta-blockers. After adjusting for age, the model of end-stage liver-disease score,liver-disease aetiology, presence of refractory ascites and ventilatory thresholdremained significantly lower in the beta-blocker group (P = .04). The oxygen uptakeefficiency slope was not impacted by beta-blocker use. Conclusions: Ventilatory threshold is reduced in patients with advanced liver dis-ease taking beta-blockers compared to those not taking the medication. This mayincorrectly risk stratify patients on beta-blockers and has implications for patientmanagement before and after liver transplantation. The oxygen uptake efficiencyslope was not influenced by beta-blockers and may therefore be a better measureof cardiopulmonary performance in this patient population.
Exercise and the gut microbiome : implications for supportive care in cancer
- Authors: Hart, Nicholas , Wallen, Matthew , Farley, Morgan , Haywood, Darren , Boytar, Alexander , Secombe, Kate , Joseph, Ria , Chan, Raymond , Kenkhuis, Marlou-Floor , Buffart, Laurien , Skinner, Tina , Wardill, Hannah
- Date: 2023
- Type: Text , Journal article , Review
- Relation: Supportive Care in Cancer Vol. 31, no. 12 (2023), p.
- Relation: http://purl.org/au-research/grants/nhmrc/1194051
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- Description: Purpose: Growing recognition of the gut microbiome as an influential modulator of cancer treatment efficacy and toxicity has led to the emergence of clinical interventions targeting the microbiome to enhance cancer and health outcomes. The highly modifiable nature of microbiota to endogenous, exogenous, and environmental inputs enables interventions to promote resilience of the gut microbiome that have rapid effects on host health, or response to cancer treatment. While diet, probiotics, and faecal microbiota transplant are primary avenues of therapy focused on restoring or protecting gut function in people undergoing cancer treatment, the role of physical activity and exercise has scarcely been examined in this population. Methods: A narrative review was conducted to explore the nexus between cancer care and the gut microbiome in the context of physical activity and exercise as a widely available and clinically effective supportive care strategy used by cancer survivors. Results: Exercise can facilitate a more diverse gut microbiome and functional metabolome in humans; however, most physical activity and exercise studies have been conducted in healthy or athletic populations, primarily using aerobic exercise modalities. A scarcity of exercise and microbiome studies in cancer exists. Conclusions: Exercise remains an attractive avenue to promote microbiome health in cancer survivors. Future research should elucidate the various influences of exercise modalities, intensities, frequencies, durations, and volumes to explore dose-response relationships between exercise and the gut microbiome among cancer survivors, as well as multifaceted approaches (such as diet and probiotics), and examine the influences of exercise on the gut microbiome and associated symptom burden prior to, during, and following cancer treatment. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.