Impaired exercise capacity after lung transplantation is related to delayed recovery of muscle strength

Walsh, James; Chambers, Daniel C.; Davis, Rebecca J.; Morris, Norman; Seale, Helen; Yerkovich, Stephanie T.; Hopkins, Peter

doi:10.1111/ctr.12163

Cited by 50 publications

(45 citation statements)

References 27 publications

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“…A similar degree of muscle atrophy of the rectus femoris has been reported in people with COPD using ultrasound and of the plantarflexors using magnetic resonance imaging (MRI) . Quadriceps strength of individuals with advanced ILD in our cohort was 77% of predicted, which is similar to previous studies in individuals with advanced ILD and lung transplant candidates with other diagnoses . Although quadriceps strength has been the main focus in characterizing peripheral muscle weakness in individuals with advanced lung disease, the distal lower limb muscles, which are key muscles for walking and balance, have not been explored in ILD.…”

Section: Discussionsupporting

confidence: 85%

Skeletal muscle atrophy in advanced interstitial lung disease

Mendes

Wickerson

Helm³

et al. 2015

Respirology

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Background and objective: A limited number of studies examine skeletal muscle dysfunction in individuals with interstitial lung disease (ILD). We compared upper and lower limb muscle size and strength in individuals with advanced ILD with healthy controls. Second, the relationships of muscle size to muscle strength and function were explored. Methods: Individuals with advanced ILD listed for lung transplant and healthy control subjects were studied. B-mode ultrasound was performed to assess cross-sectional area (CSA) of rectus femoris and thickness of gastrocnemius and soleus and biceps brachii. Subjects performed isometric muscle strength testing, Short Physical Performance Battery, Timed Up and Go, and Unsupported Upper Limb Exercise Test. Results: Twenty-six individuals with advanced ILD (61 ± 8 years; 73% males; forced vital capacity: 2 ± 0.8 L, 49 ± 13% predicted; diffusing capacity of carbon monoxide: 9.3 ± 4 mL/min/mm Hg, 51 ± 20% predicted) and 12 healthy age and gender-matched controls (56 ± 9.5 years; 50% males) were included. Compared with controls, people with ILD had a smaller CSA of rectus femoris (7.6 ± 2.1 vs 9.4 ± 2.4 cm

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Section: Discussionsupporting

confidence: 85%

Skeletal muscle atrophy in advanced interstitial lung disease

Mendes

Wickerson

Helm³

et al. 2015

Respirology

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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Background: In lung transplantation (LTx), patients with thoracic muscle sarcopenia may have to require longer to recovery. We measured thoracic muscle volume by using the cross sectional area (CSA) and assessed its effect on early outcomes after LTx.Methods: A retrospective analysis was conducted to evaluate the effect of thoracic sarcopenia in patients undergoing LTx between January 2010 and July 2015. The lowest CSA quartile (Q1) was defined as sarcopenia.Results: In total, 109 patients were enrolled. 50.8±37.2 days, P= ns) tended to be longer in Q1 than Q4, but the difference was not significant. However, the 1-year survival rate was better in Q1 compared with Q4 (66.6% vs. 46.0%, P=0.04).Conclusions: Although patients with thoracic sarcopenia seem to require a longer post-operative recovery time after LTx, this does not compromise their early outcomes. By contrast, patients with larger thoracic muscle volume (Q4) showed poorer survival times.Keywords: Lung transplantation (LTx); sarcopenia; thoracic muscles; cross sectional area (CSA) 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 (16-18). 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).SubmittedSome 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. Methods PatientsThis study was approved by the Severance Hospital Institutional Review Board (4-2016-0129). We retrospectively reviewed the medical records of 111 patients who underwent LTx at our institution between January 2010 and July 2015. Age, sex, underlying diseases, height and weight at the time of the operation, post-operative course and mortality data were collected for all patients; data on thoracic muscle CSA were available in 109 of the patients. Measurement of thoracic skeletal muscle CSAThe thoracic muscle CSA at the level of the carina was determined based on a study performed by Rozenberg et al. (19). The first single slice identifying at carina level on each patient's chest CT scan was selected. We then outlined the borders of the thoracic skeletal muscle (pectoralis, intercostal and paraspinal muscles) in the CSA, and the area was measured (Figure 1). These steps were completed semiautomatically using Aquarius iNtuition...

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“…The evaluation protocols of the analyzed studies (lung function, QoL, exercise capacity and quadriceps force) were similar to other studies in different patients (11,12,15,16) . Recent study (32) showed that the delay in the recovery of the exercise capacity after lung transplant is not associated with the delay in the improvement of the function of the transplanted organ but it results to the slow recovery of the muscular force. Thus, the authors reinforce the necessity of clinical trials to a better comprehension about the influence of the physical activity in the improvement of the exercise capacity after lung transplant.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary rehabilitation programs in lung transplant: a literature review

Pinto¹,

Vale²,

Rodrigues³

et al. 2015

RBPS

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To analyze, using a literature review, Pulmonary Rehabilitation (RP) Programs in lung transplant. Methods: A literature review in July 2014 in Ebsco Host, Periódicos Capes, BVS and Science Direct data bases using descriptors in English ("lung transplantation", "lung transplant" AND/OR "rehabilitation") and Portuguese ("reabilitação" AND/OR "transplante pulmonar"). The eligibility criterions were interventional studies of PR before and/or after lung transplant; participants who were candidates to lung transplant or lung transplant recipients; studies that applied any kind of PR program (hospital-based, homebased or outpatient) and articles published in English, Spanish or Portuguese. Literature reviews, guidelines and case reports were excluded. The search process yielded 46 articles of which two were duplicated. After title and abstract screening 13 articles remained for full text reading. Six studies met the inclusion eligibility and were included in the review. Results:The studies involved patients with Chronic Obstructive Pulmonary Disease, Cystic Fibrosis, Pulmonary Hypertension, Interstitial Lung Disease and Pulmonary Fibrosis. Pulmonary function, exercise capacity, quality of life (QoL) and quadriceps force were evaluated. Most interventions were outpatient programs with three months duration, three times a week and session with at least one hour. Protocols included physical training, educational approach and just one included nutritional, psychiatric and social assistant follow-up. The studies presented significant change in the six-minute walking distance, QoL and quadriceps force after PR programs. Conclusion: This review showed the benefits of the PR in the QoL and exercise capacity contributing to the Health Promotion of the patients. Descriptors

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Impaired exercise capacity after lung transplantation is related to delayed recovery of muscle strength

Cited by 50 publications

References 27 publications

Skeletal muscle atrophy in advanced interstitial lung disease

Skeletal muscle atrophy in advanced interstitial lung disease

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

Pulmonary rehabilitation programs in lung transplant: a literature review

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