## 4 Discussion  
The goals of this study were to determine the health status of a group of HTRs and their level of PA and to compare their health status with that of a group of S. This study's hypothesis was partially confirmed, as HTRH did not exhibit better data than the other groups of patients across all variables, nor did they demonstrate similar health status to S across all assessed variables. Overall, S and HTRH were very similar in terms of BP, HR, and blood analysis while HTRM and HTRL differed from both S and HTRH in these parameters. Regarding the cardiovascular, neuromuscular, functional mobility, and quality of life variables assessed in this study, HTRH showed the best results across all of them, followed by S, HTRM, and HTRL. Considering the cardiovascular function assessment, notably, all groups exhibited healthy BP values. Thus, it is suggested that the patients of the current study expressed healthy BP levels due to PA, since HTRs can improve their BP levels through PA [24]. The fact that the basal HR of both S and HTRs in the current study did not show any significant differences is a positive finding, since HTRs often experience elevated resting HR [25]. Thus, PA could serve as an effective tool in maintaining healthy basal HR levels for HTRs. Concerning the 2 MST, results suggest that the aerobic condition of S and HTRH are similar and that HTRH is better than the rest of patients. Consequently, the outcomes of this study underscore the potential of PA in aiding patients to attain and sustain aerobic fitness levels akin to those observed in S.  
Given the neuromuscular assessment, in terms of handgrip strength, HTRH and HTRM expressed the highest performance in the dominant and in the non-dominant hand. Observations in healthy individuals revealed a positive correlation between the PA levels and the handgrip strength levels [26]. The present study's findings align with this trend; a higher level of PA among patients corresponds to a higher level of handgrip strength. In the ACT, no disparities emerged between S and HTRs. This observation might stem from the fact that HTRs often experience reduced muscle mass and strength owing to their immunosuppressive treatment [27]. These findings deserve attention as they reflect a positive outcome; the patients' performance closely approximates that of healthy sedentary individuals. In the 30 SCST, HTRH achieved the highest scores. Therefore, it is suggested that PA holds the potential to contribute to the attainment and maintenance of robust lower extremity extension muscle strength and endurance in HTRs. In respect to the blood analysis, no differences among groups were expressed in the values of glucose, total cholesterol, HDL, triglycerides, or albumin. Given that all groups in this study exhibited healthy values for these variables, it can be hypothesized that exercise has a positive effect on these variables in HTRs. Although is needed to note that a healthy diet can also have a positive impact in these parameters, and the patient's diet was not considered in the current study's results. Additionally, it is important to note that one of the side effects of immunosuppressive medication in HTR is an increase in blood glucose levels, increasing the risk of developing diabetes [28], and the patients' groups of this study presented healthy levels in this variable. Regarding the rest of the blood variables (creatinine, uric acid, LDL, and total protein levels), all groups in this study also expressed healthy values of them, but significative differences between S and HTRs were observed. S showed healthier values than HTRs, which might be attributed to immunosuppressive' toxic effects (HTRs may exhibit elevated creatinine levels due to the immunosuppressive's toxic effects) [29]. Thus, it is suggested that PA could help to HTRs to maintain these markers in healthy levels. No differences were found among the patient's groups in the NT Pro-BNP levels.