Predictors of Long-Term Exercise Capacity in Patients Who Have Had Lung Transplantation

Mejia-Downs, Anne; DiPerna, Christen; Shank, Cori; Johnson, Rebecca P.; Rice, Danielle B; Hage, Chadi A.

doi:10.1177/1526924818781564

Cited by 12 publications

(9 citation statements)

References 22 publications

(49 reference statements)

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“…33,34 To test this hypothesis this intervention would need to be prospectively studied both in patients with early diagnosis and those who are waiting for a re-transplant, 35 in which the physical condition has been shown to be a predictor of survival. 3,32,36 The role of pre-LTx 6MWD as a predictor of BOS development after lung transplant is unclear, our results did not find a significant difference in 6MWD between BOS and NON-BOS groups. In addition there is also a lack of descriptive data on the impact of pulmonary and limb muscle function impairments on limitations in exercise capacity and participation in daily activity in these patients.…”

Section: Discussioncontrasting

confidence: 53%

Evolution of Functional Exercise Capacity in Lung Transplant Patients With and Without Bronchiolitis Obliterans Syndrome: A Longitudinal Case–Control Study

Iranzo

Vos

Verleden

et al. 2019

Archivos de Bronconeumología

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Introduction: Bronchiolitis Obliterans Syndrome (BOS) is a debilitating disease with limited treatment options that threatens both the quality of life and long-term survival of lung transplant (LTx) recipients. This retrospective longitudinal case-control study was performed to compare the long-term functional evolution of LTx recipients with and without BOS. Methods: Twenty-four LTx recipients with BOS (BOS=Cases) and 24 without BOS (NON-BOS=Controls) were selected and individually matched according to age, gender, diagnosis and LTx characteristics. Measurements of 6-minute walking distance (6MWD), symptoms of dyspnea (BORG CR-10 scale), and comprehensive pulmonary function testing were performed before LTx and at annual follow-up assessments after LTx. Results: Peak FEV 1 after LTx was similar in both groups [FEV 1 (% predicted) 101 ± 25 vs. 101 ± 31, p = 0.96] and BOS diagnosis in cases was established 3.6 ± 2.5 years after LTx. At the final follow-up assessment (6.5 ± 3.2 years after LTx) FEV 1 (% predicted) was 86 ± 34 in NON-BOS vs. 44 ± 17 in BOS (p < 0.001). Evolution of 6MWD was different between groups (group by time interaction: p = 0.002). Borg dyspnea scores were also significantly different between groups at the final evaluation (NON-BOS 3.3 ± 1.7 vs. BOS 5.0 ± 2.2; p = 0.024). Conclusions: We observed gradual reductions in functional exercise capacity and increasing symptoms of dyspnea in patients who developed BOS after LTx. As such, prospective studies seem warranted to explore whether rehabilitative interventions might be useful to improve symptoms and slow down deterioration of exercise capacity in these patients from the onset of BOS.

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Section: Discussioncontrasting

confidence: 53%

Evolution of Functional Exercise Capacity in Lung Transplant Patients With and Without Bronchiolitis Obliterans Syndrome: A Longitudinal Case–Control Study

Iranzo

Vos

Verleden

et al. 2019

Archivos de Bronconeumología

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“…Nevertheless, in this study [22] the improvement in 6MWT distance was significantly higher in the intervention group than the control group, both at 12 weeks and 1 year. This study scored well on the quality assessment, providing robust evidence that exercise training has a beneficial effect on functional exercise capacity, which reflects the capacity required to undertake activities of daily living [58]. However, this evidence is restricted to the participant age range of 40-65 years highlighting a need for future RCT's in younger lung transplant recipients [22].…”

Section: Discussionmentioning

confidence: 78%

Exercise training for lung transplant candidates and recipients: a systematic review

et al. 2020

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Exercise intolerance and impaired quality of life (QoL) are characteristic of lung transplant candidates and recipients. This review investigated the effects of exercise training on exercise capacity, QoL and clinical outcomes in pre- and post-operative lung transplant patients.A systematic literature search of PubMed, Nursing and Allied Health, Cochrane (CENTRAL), Scopus and CINAHL databases was conducted from inception until February, 2020. The inclusion criteria were assessment of the impact of exercise training before or after lung transplantation on exercise capacity, QoL or clinical outcomes.21 studies met the inclusion criteria, comprising 1488 lung transplant candidates and 1108 recipients. Studies consisted of five RCTs, two quasi-experimental and 14 single-arm cohort or pilot studies. Exercise training improved or at least maintained exercise capacity and QoL before and after lung transplantation. The impact on clinical outcomes was less clear but suggested a survival benefit. The quality of evidence ranged from fair to excellent.Exercise training appears to be beneficial for patients before and after lung transplantation; however, the evidence for direct causation is limited by the lack of controlled trials. Well-designed RCTs are needed, as well as further research into the effect of exercise training on important post-transplant clinical outcomes, such as time to discharge, rejection, infection, survival and re-hospitalisation.

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“…Our study found that age influenced change in 6MWD, whereas the study by van Adrichen et al 17 examined lung disease, but not age. Age and type of lung disease are often closely related, as noted in a study by Mejia-Downs et al 26 showing transplant recipients with CF, who were younger in age and had greater 6MWD at 6 months after surgery compared with recipients with chronic obstructive pulmonary disease (COPD). Our findings that younger age resulted in greater 6MWD improvement are likely similar to the study by van Adrichen et al given that they found patients with CF improved more than people with other types of lung diseases.…”

Section: Discussionmentioning

confidence: 99%

Condensed Outpatient Rehabilitation Early After Lung Transplantation: A Retrospective Analysis of 6-Minute Walk Distance and Its Predictors

Byrd

Smith

McHugh

et al. 2021

Cardiopulm Phys Ther J

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The objectives were to evaluate the effect of a condensed post-lung transplant outpatient rehabilitation program started immediately after hospital discharge on 6-minute walk distance (6MWD) and to explore predictors of change in 6MWD and time to complete rehabilitation. Methods: Data were retrospectively collected from July 2009 to February 2019 on recipients who completed physical therapy-based posttransplant outpatient rehabilitation (PTOR). Changes in 6MWD prerehabilitation to postrehabilitation were assessed using repeated measures, and predictors were assessed using multiple linear regression. Results: Participants (N 5 819, 61% men, 61 years) began PTOR 2 days (interquartile range [IQR] 1-3) after hospital discharge. The mean 6MWD of 324 m (SD 5 107) improved after rehabilitation to 488 m (SD 5 105). Factors associated with improvement were younger age (P 5 .003), higher baseline forced expiratory volume in 1 second (FEV 1 ) (P , .001), and lower baseline 6MWD (P , .001). Participants averaged 22 sessions in 41 days (IQR 35-50); with lower baseline FEV 1 (P 5 .002) and 6MWD (P , .001) associated with longer completion time. Conclusions: A condensed outpatient rehabilitation program early after lung transplantation was associated with a large, clinically meaningful improvement in 6MWD. Salient predictors of improvement included age, lung function, and starting 6MWD. These findings from a large cohort of lung transplant recipients who participated in PTOR can assist clinicians in tailoring strategies to optimize patient management.

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Predictors of Long-Term Exercise Capacity in Patients Who Have Had Lung Transplantation

Cited by 12 publications

References 22 publications

Evolution of Functional Exercise Capacity in Lung Transplant Patients With and Without Bronchiolitis Obliterans Syndrome: A Longitudinal Case–Control Study

Evolution of Functional Exercise Capacity in Lung Transplant Patients With and Without Bronchiolitis Obliterans Syndrome: A Longitudinal Case–Control Study

Exercise training for lung transplant candidates and recipients: a systematic review

Condensed Outpatient Rehabilitation Early After Lung Transplantation: A Retrospective Analysis of 6-Minute Walk Distance and Its Predictors

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