Unsupervised Exercise Intervention vs. Adherence to a Mediterranean Diet Alone: The Role of Bioelectrical Impedance Vector Analysis and Cardiovascular Performance in Liver-Transplanted Recipients

(1) Background: Cardiovascular disease is one of the leading causes of mortality after liver transplantation. Body composition and cardiovascular performance assessment represent a potential approach for modulating lifestyle correction and proper follow-up in chronic disease patients. This study aimed to verify the additional role of an unsupervised physical activity program in a sample of male liver transplant recipients who follow the Mediterranean diet. (2) Methods: Thirty-three male liver transplant recipients were enrolled. Sixteen subjects followed a moderate-intensity home exercise program in addition to nutritional support, and seventeen received advice on the Mediterranean diet. After six months, bioelectrical vector impedance analysis (BIVA) and cardiopulmonary exercise testing (CPET) were performed. (3) Results: No differences in CPET (VO peak: exercise 21.4 ± 4.1 vs. diet 23.5 ± 6.5 mL/kg/min; = 0.283) and BIVA (Z/H: exercise 288.3 ± 33.9 vs. diet 310.5 ± 34.2 Ω/m; = 0.071) were found. Furthermore, the BIVA values of resistance correlate with the submaximal performance of the Ve/VCO slope (R = 0.509; < 0.05) and phase angle with the maximal effort of the VO peak (R = 0.557; < 0.05). (4) Conclusions: Unsupervised physical exercise alone for six months does not substantially modify liver transplant recipients' cardiovascular performance and hydration status, despite their adherence to a Mediterranean diet. The body composition analysis is useful to stratify the risk profile, and it is potentially associated with better outcomes in transplanted subjects.