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1st
appeared 25 June 1999
First Study of Fitness for Children with Liver
Transplants Launched at UCSF Picnic
"I have to keep moving and taking pictures (at
these reunions). If I sit still, I get so emotional." Christine Mudge, coordinator
for pediatric liver transplants, looked across the picnic ground at 60 families from all
over Northern California, whose children had received or were waiting for new livers.
"There are so many stories: Look at this couple. Their baby was 28 days old and we
had to tell them that he would die without a transplant -- that he had only a 50-50 chance
of surviving if he got one."
 That baby boy, now a
healthy, laughing eight-year-old, came running back to the picnic table trailed by his
six-year-old brother, to show their parents a candy coin that a magician had just pulled
out of the older boy's ear. The annual picnic for the UCSF Pediatric Liver Transplant
Service, part of UCSF Stanford Health Care, was full of such scenes. The mother of a
five-year-old chatted with UCSF transplant service chief John Roberts and Peter Stock, the
surgeons who operated on her son. A family from Oregon planned their trip to Disneyland
around a stop at the picnic, and a clinic checkup for their child with pediatric
hepatologist Philip Rosenthal, director of the UCSF pediatric liver transplant program.
The June picnic, held at McNear's Beach near San Rafael, was planned by Mudge, Diane
Valmossoi, Michelle Guidry, Maria Melko, and two San Francisco families whose children
have received liver transplants -- the Qares and the Wongs. In addition to the magician,
there were crafts, games, two pinatas and good food. "Also there was lots of time for
families to get together and talk about the experiences they've shared because of their
children's transplants," Mudge said.
This year's picnic also was the scene of a unique collaboration between the UCSF
transplant program and the Department of Exercise and Sports Science at nearby University
of San Francisco (USF). They staged the first fitness evaluation for children who have
received liver transplants. "We know that children have more energy and stamina after
liver transplant. But there is no data whatsoever on how well they can exercise relative
to others their age," Rosenthal said. When faculty from USF offered to set up a
series of games at the picnic to test children's fitness, Rosenthal and Mudge were
delighted. So, it turned out, were many of the kids and their parents.
"At this stage, this is a pilot study. Because there are no data on this population,
any facts we gather will help," said Vishwanath Unnithan, assistant professor in
exercise physiology at USF. He worked with visiting scholar Suzanne Veehof of the
University of Maastrict in the Netherlands to plan the fitness testing event.
Research at UCSF and elsewhere shows that rehabilitation programs that encourage adults to
exercise after transplant have a positive effect on the patients' overall health.
Unnithan, a specialist in pediatric fitness, would like to find out the effects of fitness
programs on children who have had transplants.
Every child at the picnic was invited to undertake the fitness tests, and 31 did, kids
with transplants and their siblings and friends, from toddlers to teens, running and
stretching and doing curl-ups to the loud encouragement of their parents and a team of 16
USF college students.
The students had come back after the end of their college term -- for several, after
graduation from USF -- to volunteer for intensive training before the picnic. The fitness
tests are part of a standard evaluation given to school children all over the US to
measure muscular endurance, flexibility and aerobic fitness. Unnithan trained the students
to perform six different evaluations at stations set up in the park. Their challenge was
to make the series fun for the children, yet still collect objective data that could be
compared with national fitness test results.
The final game, set up after the fitness clinic had run its course, was a soccer training
session organized by Jean-Paul Verhees, coach of USF's women's soccer team. Children and
grownups alike lined up for a skill test designed to test balance and coordination.
"These are self-esteem and skill-building exercises," he said. Little kids
especially delighted in swarming Verhees' team-building tool -- a giant three-foot-high
soccer ball, which he donated to UCSF's liver rehabilitation therapy program.
Unnithan said that it will take time to analyze the data gathered at the picnic. He said
he hopes this will be the beginning of a series of studies on physical fitness among this
group of children. In the future, it might be possible to develop an exercise
rehabilitation program for children recovering from transplant that builds confidence and
self-esteem through skills in a sport such as soccer -- since almost every girl and boy
returns to a community where they could continue playing the game. "We can show them
that you don't have to be a professional to play soccer -- it's a way to enjoy yourself
and get fit at the same time," he said.
UCSF's liver and kidney transplant program is one of the few in the country to offer a
post-transplant fitness rehabilitation program. So far the program primarily has focused
on adults, said its director, exercise physiologist Trish Painter. She and Rosenthal
approached Unnithan with plans for this and other pilot studies of post-transplant fitness
for children.
Over ten years, Painter's research has shown that fitness rehabilitation helps adults
maintain and improve their health after a transplant. An adult's exercise capacity
generally improves 20 percent after transplant -- but a year later, shows no further
improvement if the person has not adopted an exercise program. In contrast, patients who
receive exercise rehabilitation in the hospital and continue exercising afterwards show
exercise capacities similar to people without health problems. "Some of our patients
go on to become excellent athletes," Painter said.
The underlying diseases that cause kidney and liver disease also are risk factors for
heart disease, so exercise and diet are essential for maintaining long-term health,
Painter said. "This is a new life for these patients. If we don't address their
physical functioning after transplant, we're not doing our best to optimize their
outcomes. There are nationwide goals for increasing the levels of physical activity for
all Americans -- those goals are even more important for transplant recipients."
Exercise takes on an added significance for children, Painter said. "In order for
children to feel 'normal' as they grow up, they must become confident with their physical
abilities. That confidence will only come from encouraged participation in regular
activity."
Mudge said events like the pediatrics picnic, and the reunion held every winter for all
transplant patients, are beneficial for staff as well as families. They are a chance to
see children who once were gravely ill, growing up as normal kids.
Unnithan, Verhees and the USF students said they had a wonderful time, too. "All the
preparation was worth it," Unnithan said. "The tests went very well. And working
with these kids was truly inspirational for all of us."
Links:
UCSF Liver Transplant Program
Lucile Packard Children's Health Services
(UCSF Stanford Health Care)
Survivors Celebrate
Life-Saving Transplant Program
USF Department of Exercise and Sports Science
Source: Janet Basu, News Services |
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