Skeletal Muscle Force and Functional Exercise Tolerance Before and After Lung Transplantation: A Cohort Study

Abstract

We investigated the impact of lung transplantation and outpatient pulmonary rehabilitation after lung transplantation on skeletal muscle function and exercise tolerance. Skeletal muscle force (Quadriceps force, QF), exercise tolerance (six minute walking distance, 6MWD) and lung function were assessed in 36 patients before and after lung transplantation. Seventeen male and 19 female patients (age 57 ± 4) showed skeletal muscle weakness before the transplantation. A further 32 ± 21% reduction was seen 1.2 (interquartile range 0.9 to 2.0) months after LTX. The number of days on the intensive care unit was significantly related to the observed deterioration in muscle force after LTX. At this time point 6MWD was comparable to pre-LTX.Rehabilitation started 37 (IQR 29 to 61) days after LTX. 6MWD and QF improved significantly (140 ± 91 m, and 35 ± 48%, respectively; p < 0.05) with rehabilitation. QF remained below pre-LTX values. The evolution of the 6MWD with the transplantation and the subsequent rehabilitation was less in female compared to male subjects. We conclude that muscle strength deteriorates after lung transplantation, particularly in patients with long ICU stay. Outpatient pulmonary rehabilitation is feasible after lung transplantation and leads to recovery of skeletal muscle function. In female patients this recovery is significantly less compared to male recipients.TT and LD are Post-doctoral research fellows of the Scientific Foundation Flanders. DL is a research fellow of the Scientific Foundation Flanders.

Pulmonary rehabilitation programs in lung transplant: a literature review

“…The age of the investigated patients varied from 18 years (8) to more than 65 years (26) and it was identified almost the same number of man and woman when analyzing the total patients from the studies. The most prevalent diagnosis in the articles were the COPD (8,(23)(24)(25)(26) , the Cystic Fibrosis (8,(24)(25)(26) , the Pulmonary Hypertension (8,(24)(25)(26) , the Interstitial Pulmonary Disease (8,23,24) and the Pulmonary Fibrosis (9,25,26) . Three studies were realized with lung transplant recipients (8,24,25) and three with candidates to lung transplant (9,23,26) .…”

“…Six articles were included in this literature review (8,9,(23)(24)(25)(26) . The age of the investigated patients varied from 18 years (8) to more than 65 years (26) and it was identified almost the same number of man and woman when analyzing the total patients from the studies.…”

“…Table I presents the socio-demographics and clinical data from the patients of each study. The evaluation of the patients were principally through the pulmonary function (8,9,(23)(24)(25) , exercise capacity with the Six Minute Walking Test (6MWT) (8,9,(23)(24)(25)(26) and the QoL using the generic questionnaire Short-Form 36 (SF-36) in most studies (8,9,24,26) . Quadriceps force was also investigated in some researches (23,24) .…”

“…The evaluation of the patients were principally through the pulmonary function (8,9,(23)(24)(25) , exercise capacity with the Six Minute Walking Test (6MWT) (8,9,(23)(24)(25)(26) and the QoL using the generic questionnaire Short-Form 36 (SF-36) in most studies (8,9,24,26) . Quadriceps force was also investigated in some researches (23,24) . In most studies the PR program had 3 months duration (9,(23)(24)(25) with the sample varying from 19 (25) to 345 patients registered in one retrospective study (26) .…”

Rehabilitation in Patients Undergoing Lung Transplantation (LTx)

“…7 There are also reports that exercise training has improved exercise capacity in lung transplant recipients (Table 1). [8][9][10][12][13][14] There were a variety of study designs, including one controlled trial and five prospective cohort studies. Outcome measures included spirometry six-minute walk test (6MWT), 10,14 quadriceps and handgrips force (QF and HGF), 9,10 health-related QOL, 14 maximal oxygen consumption (VO 2max ), and VO 2peak , 8,9,12 peak power output, 8 endurance time, 13 and additional measures of hemodynamic responses 12 to exercise and mitochondrial bioenergetics.…”