Exercise Training After Lung Transplantation Improves Participation in Daily Activity: A Randomized Controlled Trial

Abstract

The effects of exercise training after lung transplantation have not been studied in a randomized controlled trial so far. We investigated whether 3 months of supervised training, initiated immediately after hospital discharge, improve functional recovery and cardiovascular morbidity of patients up to 1 year after lung transplantation. Patients older than 40 years, who experienced an uncomplicated postoperative period, were eligible for this single blind, parallel group study. Sealed envelopes were used to randomly allocate patients to 3 months of exercise training (n = 21) or a control intervention (n = 19). Minutes of daily walking time (primary outcome), physical fitness, quality of life and cardiovascular morbidity were compared between groups adjusting for baseline assessments in a mixed models analysis. After 1 year daily walking time in the treated patients (n = 18) was 85 ± 27 min and in the control group (n = 16) 54 ± 30 min (adjusted difference 26 min [95%CI 8-45 min, p = 0.006]). Quadriceps force (p = 0.001), 6-minute walking distance (p = 0.002) and self-reported physical functioning (p = 0.039) were significantly higher in the intervention group. Average 24 h ambulatory blood pressures were significantly lower in the treated patients (p ≤ 0.01). Based on these results patients should be strongly encouraged to participate in an exercise training intervention after lung transplantation.Key words: Activities of daily living, exercise, lung transplantation, rehabilitation Abbreviations: 6MWD, six-minute walking distance; BE, bronchiectasis; BMI, body mass index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in the first second; ICU, intensive care unit; MET, metabolic equivalent; PF, pulmonary fibrosis; QF, quadriceps force; RCT, randomized controlled trial; SSLTx, bilateral lung transplantation; VO2, max, peak oxygen consumption; Wmax, peak work rate.

Sarcopenia of thoracic muscle mass is not a risk factor for survival in lung transplant recipients

“…with poor post-transplantation outcomes in liver and renal transplant recipients (6,7), therefore, we hypothesize that it may negatively impact survival following LTx. Previous studies on sarcopenia have focused on physical activity and rehabilitation in LTx patients, and the quadriceps muscle is mainly used in the context of skeletal muscle assessment (3,(30)(31)(32). Thoracic muscles and major respiratory muscles have been surgically dissected; nevertheless, sarcopenia of thoracic muscles in LTx patients has not been fully evaluated.…”

“…Computed tomography (CT) (10), magnetic resonance imaging (MRI) (11), bioelectrical impedance (BIA) (12), anthropometry (13), and dual-energy X-ray absorptiometry (DXA) (14) have been used to assess muscle mass, while handheld and computerized dynamometry have been used to measure hand grip and quadriceps strength (3,15). Short Physical Performance Battery and usual gait speed can assess functional status (16)(17)(18).…”

“…The 6-minute walk test is the most commonly used modality to assess functional status but it cannot index isolated muscle function as part of the sarcopenia definition (5). Some studies of LTx patients have focused on low muscle mass and the importance of rehabilitation after LTx (3,4), but the clinical effect of sarcopenia on LTx outcome has not been studied until now. In this study, we hypothesized that thoracic skeletal muscle mass measured by analyzing the CSA from a chest CT image could be a predictor of early outcomes and survival after LTx, and can also be used to assess the suitability of lung transplant candidates.…”

“…Many candidates for LTx suffer from chronic disease and two thirds of them have reduced muscle mass (1). Maintaining skeletal muscle mass and strength seems to be essential for patients to recover after LTx (2)(3)(4).…”

Quality of Life After Thoracic Surgery

“…Yapılan çalış-malarda akciğer transplantasyonundan sonra 3 ila 12 hafta süreyle uygulanan hastane ve ev temelli egzersiz eğitim programlarının YK'nde anlamlı gelişme sağladığı rapor edilmiştir (73,(77)(78)(79). Akciğer transplantasyonunu takiben taburculuktan hemen sonra başlanan ve 3 ay boyunca gözetim altında uygulanan egzersiz eğitim programının etkilerinin araştırıldığı randomize kontrollü çalışmada; egzersiz eğitimi uygulanan hastalarda transplantasyondan sonra 1. yılın sonunda YK'nin fiziksel fonksiyon alanında egzersiz eğitimi uygulanmayan kontrol grubuna göre anlamlı gelişme görüldüğü bildirilmiştir.…”