Before undergoing a double-lung transplant, Teresa ran, cycled, played paddle tennis, racquetball and signed up for any getaway to go for a walk in the mountains. All that activity of hers stopped suddenly, when the cystic fibrosis that she suffers from affected her lungs. This agricultural engineer who is now 38 years old underwent surgery in 2009 and spent almost five months in the hospital without hardly moving. By the time she managed to return home, she had become very afraid of the sport and it was not until 2017 that she felt like trying again. Teresa has returned to running and she is already able to complete 10 kilometer races. Her next goal is to drop her 10K mark to under 60 minutes and someday run a half marathon.
Prescribing physical exercise: a pending issue in a country with 25% of people with obesity or overweight
“In my case I was very critical of the rehabilitation that Social Security gave me. When I managed to get up from the chair without using my arms, they discharged me. But I couldn’t put a spoon in my mouth or cross the street without help” , Explain. After a transplant, the most common thing is to be afraid of sports. The lack of information and guidelines for people who have been transplanted or who suffer from chronic diseases makes many choose to reduce their physical activity. “My doctor told me to be very careful. There is a lot of fear, lack of information, support and professionals who tell you what you have to do. I would have paid whatever it took to return to sports as soon as possible.”
Can you play sports after any transplant? The Transplant Coordinator of the Hospital 12 de Octubre, Amado Andrés Belmonte, explains that yes, provided that “the situation in which the person is left after a transplant is adequate”. “It’s not that they have to play sports,” says the doctor, “it’s that they have to lead an active life and sports is one more point.” The transplant aims to “restore the same physical and mental situation that the person has prior to the disease that led to the transplant,” says the specialist. Thus, if a person fully recovers, “sports activity can be normalized.”
The problem is that there are no guides to return to training after going through an operation of this type. This is one of the main demands and, at the same time, the way in which we are working from the Sport and Transplant Association Spain. “Newly transplanted people contact us to recover a physical activity they already had or to recover,” says its president Noelia Ortega, who received a kidney transplant nine years ago. “But there are no guidelines. We are working on a guide for transplant recipients when it comes to exercising and that will also serve doctors so that they can recommend it,” she adds.
“We can’t be in a crystal ball”
One of the main obstacles is fear. “Some are afraid and decide not to exercise again, and others in the hospital are already taking walks,” says the president of the association. “It’s not traditionally that doctors have encouraged it,” she says. “It is as if they wanted to put us in a crystal ball, but it has been seen that it comes in handy in the state of mind and it is also reflected in our analytics.”
“Doctors can advise. There is consensus on this: the patient can do all kinds of sports, as long as they are sports in which they are not going to have accidents such as trauma,” recalls Andrés Belmonte and comments that a person who has received a transplant kidney can play soccer, but there is an added risk that has to do with the placement of the kidney in the abdominal part, “much more exposed than the kidneys themselves”. “Trauma to that area can cause you problems,” he notes.
We are working on a guide for transplant recipients when it comes to exercising and that will also serve doctors so that they can recommend it
After the double-lung transplant, Teresa was unemployed for eight years. She lost most of her muscle mass and more than ten kilos. She believes that if she had had more information and more support, she would have started much sooner. Teresa came across the Sonsoles Hernández project, Trainsplant, on social networks and, after doing a sporting recognition, they started training. “Now we are working a lot on my breathing. When I run, I have to breathe normally and I am very agitated. We do strength exercises and the idea is to be able to run faster and further.”
“Remove the fear of being able to move”
Sonsoles Hernández, a trainer and doctor in Biomedicine with a line of research on physical exercise and kidney transplantation, launched her therapeutic training project in 2016. Sonsoles came up with the idea because her father had chronic kidney disease and because in At that time, there were no training sessions dedicated to people with chronic diseases or transplant recipients. “Although we are the first country in the world in donation and transplantation, in care, healthy lifestyle habits and exercise there is a lot to do. In the public sphere there is nothing,” says the specialist. “The idea was to apply all the information I collected for my doctoral thesis to transplanted people. I began to inform people. Now we have taken a bit of shape.”
“Many come because they don’t know what to do, because they don’t have information. Sometimes simply because of general fatigue,” says the coach.
Estela, a Physics and Chemistry teacher with a kidney transplant, trains every week with Sonsoles and her team. “I have been training since 2018, removing the months of the pandemic. I live in Madrid, but I work in Villanueva de la Cañada. I have a kidney problem and when I found them on social networks I had just been transplanted. I had the feeling that I had to do something of exercise and that’s why I called them,” he says while doing a stationary bike in a gym in the center of Madrid.
During the exercise session, Estela comments with the trainers on how she feels or the discomfort that accumulates in her back. In the room the words that describe the pains are intermingled with the explanations of the exercises. The fatigue continues and the weekend is approaching. “I’m better. This helps me focus. It also helps me to get rid of any pain I may have much sooner,” she says without stopping pedaling. “Dialysis takes me many hours and, apart from this, I only have time to go out for a walk. On the weekends I go out a little more. To get to the institute I have to go to bed around nine at night, and I get in the dialysis machine until six in the morning,” he says.
“Removing the fear of being able to move” is the first step, says her trainer. “When there is an intervention of these characteristics, the first thing is to think about doing nothing, to see if something is going to happen to me. From here, what we try to do is improve the physical condition, but also all the biochemical parameters that a person needs to be as healthy as possible. Because they take a lot of medication,” he says.
Sonsoles has also launched an application called Renal&Go that can be downloaded for free. With it, the user, with kidney disease or transplant, can select their clinical situation and receive training guidelines. “It is not a personalized training, but it is a guide of where you can do things, recommendations and contraindications”.
Therapeutic training is the bridge between the hospital and the return to sport. Something like what happens after a rehabilitation process, explains Sonsoles, who currently works with 50 patients. “The hospital only contemplates the disease, it does not contemplate health. And we are in that second part,” he concludes.