Saturday, October 29, 2016

University Health Network, Toronto, Study on Pre/Post Lung Transplant Physical Rehabilitation

I am always on the lookout for solid information on post-transplant fitness and physical rehabilitation.  Yes, it has been almost 22 months since my transplant, but I still consider myself as "under construction". I am fitter and in better physical shape than I was in the previous decades pre-tx, but until I stop feeling 'it' in my chest, there is restoration to be done.

One of the best sources for information on how the transplant has affected my muscles is CAN-RESTORE, the Canadian Network for Rehabilitation and Exercise for Solid OrganTransplant Optimal Recovery.  I spoke about them in a previous article here

I follow a couple of the doctors that are involved with CAN-RESTORE, and they have published, from the,Toronto Lung Transplant Program, University Health Network, another informative study on physical rehab for lung transplant patients. What is way cool, is that once again this paper is published under Open Access.  I really appreciate their willingness to share this data with everyone.

Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach

From the abstract:
Physical rehabilitation of lung transplant candidates and recipients plays an important in optimizing physical function prior to transplant and facilitating recovery of function post-transplant. As medical and surgical inter­ventions in lung transplantation have evolved over time, there has been a demographic shift of individuals undergoing lung transplantation including older individuals, those with multiple co-morbidites, and and candidates with respiratory failure requiring bridging to transplantation. These changes have an impact on the rehabilitation needs of lung transplant candidates and recipients. This review provides a practical approach to rehabilitation based on research and clinical practice at our transplant centre. It focuses on functional assessment and exercise prescription...
I am not going to review the entire study, but do highly recommend you head on over and read it if you are at all interested in pre/post lung transplant rehab and physical fitness.

I will pull this one paragraph from the section discussing long term rehab:
The 6MWT is reassessed regularly post-transplant, to monitor changes in exercise capacity and exertional oxygen saturation, which may change over time. Although the majority of exercise training programs occur in the first three to four months following transplant, longer-term exercise training may provide additional benefits to exercise capacity and the management of long-term co-morbidities of hypertension, hyperlipidemia and diabetes are prevalent at one, three and five years post-transplant. A randomized trial found that lung transplant recipients who underwent rehabilitation in the first three months following transplant had higher physical activity levels, improved fitness and lower 24-h blood pressure one year post-transplant compared to recipients who did not participate in rehabilitation. Daily physical activity has been reported to be significantly reduced one year following transplantation as compared to healthy controls...
"Daily physical activity has been reported to be significantly reduced one year following transplantation..." This highlights the importance of making a habit of doing some sort of daily activity early on after a transplant. The article gives some great ideas on how we might accomplish that goal.
Medical and surgical advances continue to improve the availability of lung transplantation. Exercise training provides an essential role in optimizing functional capacity and fitness pre-transplant, as well as improving outcomes and quality of life post-transplant. Physiotherapists and clinical exercise specialists working with lung transplant candidates and recipients require expertise in general exercise training principles and specialized knowledge of pre- and post-transplant complications, oxygen titration, side effects of medications and a sound understanding of how to modify exercise programs during episodic illnesses/ exacerbations and/or change in lung function pre- and post-transplant...
I would really like to see more studies on post-transplant physical rehabilitation and fitness.  We have the technology to acquire and track all kinds of data.  Studies that look for any correlation between average activity levels and all cause mortality, lung function over time, and quality of life, would be a good place to start.  Changes in bone density, A1C levels, resting heart rates, blood pressure... would all be interesting data points to monitor in future studies involving post-tx activity levels.

Pro tip: The references cited (and linked to) in this study will keep you reading, and learning, for a good while.

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