Physiotherapy Before and After Transplant

Before Kidney Transplant

Renal failure and dialysis can affect the renal patient’s physical function.

Before transplantation, there is a window of opportunity to increase the success rate of their renal transplantation through prehabilitation.

If the doctor assesses a patient to be frail or to have problems with mobility, they may require an assessment by a physiotherapist. The physiotherapist will work closely with the patient to prescribe an individualized exercise programme to improve their function to help with their recovery after surgery.

Some simple exercises that will help strengthen their body before surgery can be as follows:

Immediately after Kidney Transplant

The doctor will refer you to the physiotherapist after transplantation.

The physiotherapist will start with some exercises to your lungs healthy and get their blood circulation going.

Deep Breathing Exercise

Deep breathing exercises and moving around will help to re-expand the lungs, making it easier to breathe.

Breathing exercises will also help to clear phlegm and reduce the risk of chest infections post-transplant.

It is normal to have more phlegm in the lungs after surgery and coughing can be uncomfortable due to pain. The physiotherapist will educate the patient on wound support and airway clearance techniques.

Heel slides and Ankle pumps

Exercises in bed (such as ankle pumps and heel slides) will help to improve circulation and maintain movement and strength. It is also important to maintain an upright position in bed as much as possible to prevent other complications.

Get moving and out of bed

Once permitted by the surgeon, walking is the best intervention to help with recovery after surgery. The physiotherapist will aim to facilitate walking after surgery when it is safe. The physiotherapist will also teach the proper techniques to get in and out of bed.

Post-transplant

During the immediate post-surgical period, you may feel tired easily, loss of appetite, swelling around the ankles and legs, difficulty in breathing and shortness of breath which could lead to physical inactivity. In addition, side effects of medications such as steroids may include weight gain, osteoporosis (loss of bone mass/decrease bone strength) and sarcopenia (loss of muscle mass).

Physical activity is important to mitigate many of these risk factors - if left untreated, this can lead to strokes and heart attacks.

Upon discharge from SGH, you will be reviewed at the outpatient clinic to address rehabilitation needs and progression of exercises. The physiotherapist conducts regular assessment of your physical function. Education and modification of the individualized exercise regimen will be provided to improve aerobic fitness and strength.

Weight Gain

Excessive weight gain is a common concern after transplantation and it affects two third of the renal transplant recipients. This weight gain can be due to the liberal diet post-transplant and the side effects of the immunosuppressant.

On top of a healthy diet, the recipient’s goal should be at least 30minutes of moderate intensity activity on most days of the week. You should start slow and gradually increase both the duration and intensity of the exercise program over time after discharge, especially for those who had avoided physical activity pre-transplantation.

Osteoporosis (loss of bone mass/decrease bone strength)

Bone loss post transplantation is more rapid in the first three to six months after transplantation with subsequent slowing, likely due to the reduction of immunosuppressant and steroids use. The fracture rate is also higher during this crucial period.

Besides medical therapy and supplements prescribed, you are encouraged to stop smoking and engaged in regular weight-bearing exercises (at least 30minutes, three times per week) and core strengthening exercises.

Enjoyment of the regimen is important to facilitate long term compliance.

Sarcopenia (loss of muscle mass and function)

Renal transplant recipients may present with an increased risk of sarcopenia due to factors related to the pre-transplant period such as dialysis therapy.

Numerous studies show progressive resistance training is effective in prevention and improvement of sarcopenia, together with appropriate nutrition.

With progressive resistance training, you will need to exercise your large muscle groups against an increasing external force two to three times a week for at least eight to 12 weeks. The program is progressive, meaning the number of repetitions, sets or load should increase gradually over time based on your capabilities and progress.

Changes in lifestyle for a successful kidney transplantation

Prevention and treatment of the above issues requires changes in lifestyle. Changing habits can be difficult. Talk to your healthcare providers about ways to get help to make these necessary changes. Remember, changes in lifestyle could make the transplantation an overall success.