ABSTRACT
Lung transplantation is an established treatment for patients with end-stage lung disease. With increasing survival rates after lung transplantation, more attention has been directed towards the importance of improving exercise capacity, independent functioning and quality of life in these patients. While immunological and infectious challenges after transplantation are overcome with increasing success, the high incidences of morbidities linked to the metabolic syndrome (i.e. diabetes, obesity and cardiovascular disease) after solid organ transplantation are increasingly acknowledged as being of great importance. It has further been observed that despite important improvements in pulmonary function, exercise intolerance and reductions in quality of life often persist after lung transplantation. Several pre- and post-transplant factors that might be addressed by rehabilitation interventions are known to contribute to these persisting impairments. Physiological changes associated with severe and chronic lung disease, limb muscle dysfunction, inactivity, deconditioning, and nutritional depletion can affect exercise capacity and physical functioning in candidates for lung transplantation. Following transplant, extended hospital and intensive care stay, prolonged sedentary time, persisting inactivity, immunosuppressant medications and episodes of organ rejection may all impact the lung recipients’ recovery. Available evidence will be reviewed, and content will be proposed (both evidence and experience based) for rehabilitation interventions prior to transplantation, during hospitalization following transplantation, and in both the immediate (up to 12 months after hospital discharge), and long-term (longer than 12 months after hospital discharge) post-transplant phase. Well-designed outpatient rehabilitation programmes including supervised exercise training have been shown to be effective in improving limb muscle dysfunction, exercise capacity, and quality of life both pre- and post-transplant. Unmet research needs include the absence of sufficiently powered randomized controlled trials (RCTs) measuring effects of rehabilitation interventions on crucial long-term outcomes such as sustained improvements in quality of life (QOL), participation in daily activity, survival, incidence of metabolic and cardiovascular comorbidities, and cost-effectiveness. Rehabilitative exercise training and lifestyle interventions targeting regular participation in physical activities could play an important role in preventing or treating these important side effects of organ transplantation. Remotely monitored (telehealth) home-based exercise, or pedometer-based walking interventions might be interesting alternatives to supervised outpatient rehabilitation interventions in the short-, or long-term post-transplant phase that warrant further investigation.
