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Exercise training after lung transplantation: A systematic review

https://doi.org/10.1016/j.healun.2009.12.008Get rights and content

Background

Lung transplant recipients experience persistent impairments in exercise capacity and skeletal muscle function despite a vast improvement in lung function after transplantation. Exercise training may be beneficial in improving exercise capacity in lung transplant recipients. A systematic review was undertaken to examine the evidence for exercise training on functional outcomes in lung transplant recipients.

Methods

Studies were identified by searching electronic databases and scanning reference lists. Only randomized controlled trials, controlled trials, and prospective cohorts were included in the review. Seven studies met the inclusion criteria. Study quality was assessed using the Physiotherapy Evidence Database, Jadad, and Downs scales.

Results

The overall quality of studies was fair to moderate in assessing the effect of exercise training on maximal and functional exercise capacity, skeletal muscle function, and lumbar bone mineral density. Every study reported significant improvements in these outcomes. Some studies lacked randomization and/or a control group, so it was not possible to separate the effects of training with the natural recovery process after lung transplantation.

Conclusion

Some evidence was found to support that a period of structured exercise training could improve maximal and functional exercise capacity, skeletal muscle strength, and lumbar bone mineral density in lung transplant recipients. Further studies are needed to determine the potential for exercise training to optimize these functional outcomes and to develop optimal guidelines for exercise prescription in the lung transplant population.

Section snippets

Search strategy

A search of electronic databases, including Cochrane Central Registrar of Controlled Trials, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and Excerpta Medica Database (EMBASE), was performed from inception to May 2009 for articles that evaluated the effects of exercise training after lung transplantation. The keywords used included organ transplantation, lung transplantation, transplantation, exercise, exercise training,

Results

Of the 1754 articles retrieved, only 8 met the inclusion criteria.15, 19, 20, 21, 22, 23, 24, 25 One article25 was further excluded because it involved a mixed sample of heart, heart-lung, lung, kidney, and liver transplant recipients. One abstract reporting a RCT of early rehabilitation after lung transplantation26 was ongoing at the time of this study and did not have sufficient data to be included in this review.

The 7 studies included in the review are summarized in Table 1. There were a

Discussion

This evidence shows that lung transplant recipients demonstrate impairments in exercise capacity, skeletal muscle function, and BMD. Preliminary data from 7 studies on exercise training shows positive effects on maximal and functional exercise capacity, skeletal muscle function, BMD, and HRQOL in lung transplant recipients. Exercise should therefore be included in the regular management of the patient before and after lung transplantation to address deconditioning and the side effects of

Disclosure statement

The authors acknowledge John Tagg and Sachi O'Haski from West Park Healthcare Centre, Toronto, Ontario, Canada, for their assistance with the electronic search and article retrieval.

Lisa Wickerson is supported in her graduate studies by fellowships through the Ontario Respiratory Care Society and the Canadian Lung Association. Dina Brooks holds a Canadian Research Chair in Rehabilitation in COPD.

None of the authors has a financial relationship with a commercial entity that has an interest in

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