Physical function, physical activity, muscle strength, and body composition: Clinical practice recommendations in pediatric intestinal failure and transplantation-position statement of the International Intestinal Rehabilitation and Transplant Association Allied Health Committee

Background: Pediatric survival rates in intestinal failure (IF) and transplant (ITx) have improved over time.However, surgery and prolonged hospitalization can impact motor function and levels of physical activity (PA), which is an essential health behaviour for physical, social, and mental health.This position paper provides clinical recommendations to optimize PA, strength, and exercise in children with IF and ITx.Methods: A working group of the IIRTA Allied Health committee conducted a literature review, identifying relevant articles between 2000 and 2023.Key recommendations were based on scientific evidence and expert-informed opinion.Results: Research indicates children with IF have altered body composition and lower physical function, PA, and muscle strength compared to healthy peers.They also have a higher prevalence of motor delays and an increased risk of sarcopenia pre-and post-ITx.Although exercise can potentially improve these outcomes, parents report unique barriers to PA including central lines and medical appliances.Key recommendations include: 1) Early intervention with rehabilitation specialists in hospital and on discharge to the community.2) Education related to PA guidelines including aerobic intensity and strengthening activities.3) Provision of individualized exercise plans with communication and support in school/community settings.4) Ongoing screening at out-patient visits to monitor body composition, strength, and PA and address potential barriers and safety issues.5) Prioritizing multi-center research on PA benefits and effective interventions.