Key result
Greater physical activity was associated with a lower risk of clinical events (HR 0.45; 95% CI 0.24-0.84), whereas greater depressive symptoms were associated with a higher risk (HR 2.11).
Why the study?
Physical inactivity and depressive symptoms following cardiothoracic transplantation are potentially modifiable factors, but few studies have prospectively assessed them in ambulatory, outpatient transplant recipients.
Are physical activity levels and depressive symptoms associated with clinical events in ambulatory cardiothoracic transplant recipients?
Cohort (n=66)
No
Are physical activity levels and depressive symptoms associated with clinical events in ambulatory cardiothoracic transplant recipients?
Hazard Ratio: 0.45 (95% CI 0.24–0.84)
p-value: p=0.012
Physical inactivity and depressive symptoms at 6 months post-transplant are predictive of subsequent adverse clinical events in cardiothoracic transplant recipients.
Greater PA intensity and fewer depressive symptoms at 6 months post-transplant were associated with fewer events; hypothesis-generating for targeted interventions in heart/lung recipients.
BACKGROUND: Physical inactivity and depressive symptoms following cardiothoracic transplantation are recognized as potentially modifiable psychosocial factors to improve clinical outcomes. However, few studies have prospectively assessed these in ambulatory, outpatient transplant recipients. METHODS: We conducted a prospective, single-center study examining actigraphy-assessed physical activity (PA) levels over a 1-week period in heart or lung transplant recipients recruited at 6 months (range 4-9) post-transplant. Depressive symptoms (Centers for Epidemiologic Study of Depression [CESD]), quality of life (QoL), and clinical events (transplant-related hospitalization and death) were collected. Clustered Cox proportional hazards models were used to examine the associations between PA, psychological measures, and clinical events. RESULTS: Among 105 potentially eligible participants, 66 (63%) met inclusion criteria and were enrolled between July, 2016 and May, 2017, including 42 lung and 24 heart transplant recipients. The mean age of the population was 53 years, 41% were women and 18% were black. Participants tended to be sedentary, with the majority of activity spent within the "sedentary" level (61%) and an average daily step count of 7188 (SD = 2595). In addition, participants tended to exhibit subclinical depressive symptoms, (mean CESD = 9.4 [SD = 8]) with only a subset exhibiting levels suggestive of clinical depression (22%). Over a median follow-up of 1.4 years (1.14, 1.62), 21 participants (32%) experienced at least one transplant-related hospitalization, including two deaths. In adjusted survival models, greater intensity of PA (HR = 0.45 [0.24, 0.84] per 0.2 METs, P = .012) was associated with a lower risk of clinical events, whereas greater depressive symptoms (HR = 2.11 [1.58, 2.82] per 9 CESD points, P < .001) at 6 months were associated a higher likelihood of subsequent transplant-related hospitalization and/or death. CONCLUSIONS: Physical inactivity and depressive symptoms at 6 months post-transplant were predictive of subsequent adverse clinical events among ambulatory cardiothoracic transplant recipients. Future studies should examine whether improving these potentially modifiable post-transplant risk factors improves clinical outcomes.
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Smith et al. (2019) conducted a cohort in Heart or lung transplant recipients (n=66). Physical activity and depressive symptoms vs. Lower levels of physical activity and depressive symptoms was evaluated on Transplant-related hospitalization and death (HR 0.45, 95% CI 0.24-0.84, p=0.012). Greater physical activity was associated with a lower risk of clinical events (HR 0.45; 95% CI 0.24-0.84), whereas greater depressive symptoms were associated with a higher risk (HR 2.11).
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