Changes in 6‐minute walking distance in lung transplant candidates while participating in a home‐based pre‐habilitation program—A retrospective chart review

Abstract

Home‐based exercise programs may offer a less costly alternative to providing exercise pre‐transplant to a large number of patients. We describe the changes in 6‐minute walk distance (6MWD) in lung transplant candidates who participated in a home‐based exercise program and their relationship to post‐transplant outcomes. Retrospectively, we investigated 159 individuals while awaiting transplantation who performed the surgery between 2011 and 2015. Primary outcome was 6MWD at time of assessment for transplant, last test prior to transplant and one‐month post‐transplant. 6MWD decreased by 28 ± 93.9 m between the time of assessment and the last 6MWD prior to transplantation (P < .001). Forty‐one patients (25.8%) increased their 6MWD (mean + 85.8 ± 42.8 m); 72 patients (45.3%) decreased their 6MWD (mean −109.8 ± 71.2 m); and 46 patients (28.9%) had no change in 6MWD (−1.5 ± 15.7 m). There was a moderate correlation (r = .528; P < .001) between the last 6MWD prior to transplant and 6MWD post‐transplant. Change in 6MWD prior to transplant weakly correlated with length of time on mechanical ventilation (r = −.185; P = .034). When adjusted for covariates, change in 6MWD prior to transplant was not associated with length of time on mechanical ventilation, total hospital LOS, or intensive care unit LOS. The majority of the patients were able to either increase or maintain their 6MWD while participating in a home‐based pre‐habilitation program during the waiting list period. Prospective research is needed to evaluate the effects of home‐based pre‐habilitation program for lung candidates.

Relationship of Exercise Capacity, Physical Function, and Frailty Measures With Clinical Outcomes and Healthcare Utilization in Lung Transplantation: A Scoping Review

“…The relationship of performance-based measures of exercise capacity, physical function, and frailty with healthcare utilization in lung transplant candidates was studied in 8 studies. 10 , 14 , 45 , 51 , 53 , 60 , 63 , 64 Five studies examined the relationship of the 6MWT with hospital LOS 14 , 51 , 53 , 63 , 64 and 3 studies with ICU LOS. 51 , 63 , 65 Of those, 2 studies showed a significant relationship of a higher 6MWD with hospital LOS 51 , 64 and 1 with ICU LOS, 51 using similar cutoffs of 346 51 and 350 m 64 for the 6MWD.…”

“… 10 , 14 , 45 , 51 , 53 , 60 , 63 , 64 Five studies examined the relationship of the 6MWT with hospital LOS 14 , 51 , 53 , 63 , 64 and 3 studies with ICU LOS. 51 , 63 , 65 Of those, 2 studies showed a significant relationship of a higher 6MWD with hospital LOS 51 , 64 and 1 with ICU LOS, 51 using similar cutoffs of 346 51 and 350 m 64 for the 6MWD. Three studies examined the relationship between the SPPB and hospital LOS 10 , 14 , 60 and 2 studies with ICU LOS.…”

“… 14 One study 14 examined the relationship of the 5STS and 4MGS with hospital and ICU LOS with no significant relationship shown. Three studies examined the relationship of the 6MWT with time on mechanical ventilation‚ 14 , 45 , 63 and of those, only 1 study showed a significant relationship. 14 Mayer et al 14 also examined the relationship of SPPB, 5STS, and 4MGS with time on mechanical ventilation but showed no significant relationship.…”

Changes in Functional Outcomes After an Inpatient Rehabilitation Program for Solid-Organ Transplant Recipients

“…12 In a previous study where an exercise program was offered to lung transplant candidates, the mean change between the six-minute walk distance at a time for assessment for transplant and 1-month posttransplant was 37 m, which was slightly above the minimally important difference for adults with chronic lung disease (30 m). 23 The 30-STS or dynamometry has not been used to assess lower limb strength or biceps or quadriceps muscle strength, respectively, in transplant recipients participating in an inpatient rehabilitation program. However, Tarrant et al 24 used the 60-second sit-to-stand test in a sample of lung recipients in the acute care setting and found a mean of 13 repetitions.…”

Prehabilitation in Adult Solid Organ Transplant Candidates

“…The intervention consisted of warm-up exercises, aerobic training, and strength training. A moderate correlation was found between the 6-min walking distance prior to transplant and after transplant [ 61 ]. Overall, prehabilitation in lung transplant candidates seems to be effective.…”