The Importance of Rehabilitation before and after Lung Transplantation.
Lung transplantation has gained widespread acceptance as a therapeutic option for end-stage pulmonary disease. LTx has been shown to improve quality of life and survival in individuals with various end-stage lung diseases. However, numerous studies have been demonstrated that LTx recipients experience persistent impairments in exercise capacity and skeletal muscle function despite a vast improvement in lung function after LTx.
Persistent limitations in exercise capacity and skeletal muscle function have been observed for more than 1 year after transplantation. Investigations of muscle function in LTx recipients reveal decreased muscle mass and strength, reductions in type 1 fiber proportion, decreased calcium uptake and release, decreased mitochondrial enzyme activity, and impaired oxidative capacity of the peripheral muscles.
Similarly, poor daily physical activity has been studied in heart and kidney recipients. Heart recipients were classified as very sedentary, based on accelerometer measurements. Children and adolescents with renal tranplants have severely impaired cardiorespiratory fitness and physical activity compared with their healthy counterparts.
In these patients, inactivity prior to transplantation and resulting pre-transplant deconditioning are likely to influence functional recovery after surgery. Repeated episodes of infection and rejection, use of anti-inflammatory and immunosuppressive drugs and a sedentary life style are possible post-transplant contributing to limitations in the physical fitness.
In LTx patients, pulmonary function is only patially related to participation in daily physical activities. For a given limitation in pulmonary function a considerable variability in daily physical activity was found.
Of all measured variables the six minutes walking distance showed the strongest association with participation in daily physical activity. Good correlations between 6MWD and both minutes in activities 2 METs and number of steps were
Pulm Res Respir Med Open J. 2017; 4(2): e3-e5. doi: 10.17140/PRRMOJ-4-e008