Exercise training following lung transplant is now evidence-based practice

Abstract

In patients immediately following lung transplant, does three months of supervised exercise training confer changes in physical activity during daily life, functional exercise capacity, muscle force, health-related quality of life (HRQL), or forced expiratory volume in one second (FEV(1))? Randomised, controlled trial with concealed allocation in which investigators responsible for collecting the outcome measures were blinded to group allocation. Out-patient department of a hospital in Leuven, Belgium. Patients aged between 40 and 65 years who had an uncomplicated single or double lung transplant. Randomisation of 40 participants allocated 21 to the intervention group and 19 to the control group. Participants in both groups received six individual counselling sessions of 15-30 minutes in duration, during which they were instructed to increase participation in daily physical activity. In addition, the intervention group attended supervised exercise training sessions three times a week for 3 months following discharge. Each training session was approximately 90 minutes and comprised cycle ergometry, walking, stair climbing, and leg press resistance exercises. Training was prescribed at moderate to high intensity and progressed according to symptoms. The primary outcome was time spent walking each day. Secondary outcomes included the six-minute walk distance (6MWD), peripheral muscle force, HRQL, and FEV(1). Data were available on 18 and 16 patients in the intervention and control groups, respectively. On completion of the intervention, between-group differences in favour of the intervention group were demonstrated in the average time spent walking each day (difference in means 14 min, 95% CI 4 to 24), 6MWD (differences in means 9% predicted, 95% CI 3 to 15) and quadriceps force (difference in means 17% predicted, 95% CI 9 to 24), but not HRQL or FEV(1). These between-group differences were maintained 12 months following discharge from hospital. At the 12 month assessment, between-group differences in favour of the intervention group were also demonstrated in two components of HRQL related to physical function. In patients following lung transplant, exercise training conferred immediate and sustained gains in physical activity during daily life and exercise capacity. Gains in HRQL also appear to be evident, but took longer to be realised.