Formal Pulmonary Rehabilitation after Lung Transplantation Improves Six Minute Walk Distance

Abstract

We hypothesized that an intensive PR program after LT would improve 6-minute walk distance (6MWD) more than a conventional PR program. 78 consecutive LT recipients who survived >90 days were included. The intensive group (n=48) was prescribed supervised PR 5 days/wk for 10 wks. The conventional group (n=30) was prescribed supervised PR 3 days/wk for 8 wks with additional self-exercise on non-PR days for a total of 10 wks. Both groups completed 6MWD, Patient Health Questionnare-9 (PHQ-9), and Rating of Perceived Dyspnea (RPD) assessments on their initial and final visits. The primary outcome was change in 6MWD. Secondary outcomes were days required to achieve 30 min of continuous exercise and changes in PHQ-9 and RPD scores. Changes in 6MWD, PHQ-9, and RPD were assessed by paired Wilcoxon signed rank testing. Multivariable linear regression was used to control for age, type of LT, indication, and lung allocation score (LAS). The intensive PR group completed 42 supervised visits while the conventional group completed 24 supervised and 12 unmonitored visits (p<0.001 for supervised PR visits). The 6MWD significantly increased in both groups (p=<0.001): 680 ft (65%) in the intensive PR group and 515 ft (53%) in the conventional PR group (p<0.037). The median number of days needed to achieve 30 min of continuous exercise was 8 visits in the intensive group and 13 visits in the conventional group (p<0.001). PHQ-9 and RPD showed improvement in both groups. After controlling for age, LAS, indication for LT, and type of LT, patients in the intensive PR group significantly increased 6MWD more than the conventional group (median +231 ft, 95%CI 32-431 ft, p=0.023) (Figure). Formal PR after LT significantly improved 6MWD, PHQ-9, and RPD scores. Intensive PR achieved a clinically significantly greater improvement in 6MWD and required fewer PR visits to achieve 30 min of continuous exercise.