Bootcongres

Background: Exercise capacity and muscle function remain below normal post lung transplantation and physical activity levels at one year post transplantation are considerably lower compared to healthy controls. Factors contributing to this deficiency in submaximal exercise have not been studied in a longitudinal manner before. Objectives: analyze the longitudinal change in 6-minute walking distance from pre-lung transplantation to 12 months post transplantation and identify factors contributing to this change. Methods: historical cohort analyses of data collected as a part of routine clinical evaluation in lung transplantation recipients (aged ≥18) transplanted between September 2003 and September 2013. Linear mixed model and logistic regression analyses on 6-minute walking distance were performed with data on patients’ characteristics, diagnosis, waiting list time, lung function and peripheral muscle strength. Results: 108 Recipients met the inclusion criteria (mean age [SD] at transplantation 51.5 [11.3] years, 49 [45%] male, median waiting list time 505 days [IQR 191-861], double lung transplantation in 90 [83%] recipients). Factors predicting 6-minute walking distance included measuring moment, diagnosis, gender, quadriceps and grip strength, forced expiratory volume in 1 second (% pred.) and total lung capacity (% pred.). A considerable decrease in improvement of 6-minute walking distance between 6 and 12 months post- lung transplantation was observed. At 12 months post-lung transplantation, 58% of recipients did not reach the cutoff point of 82% of the predicted 6-minute walking distance. Logistic regression demonstrated that values at discharge of forced expiratory volume in 1 second combined with quadriceps or grip strength were predictive for reaching this criterion. 

Conclusion: This first longitudinal analyses on 6-minute walking distance in lung transplant recipients showed that peripheral muscle strength is predictive of performance. Quadriceps strength training should at least be included in physical training to increase functional exercise capacity. However, it is reasonable to assume that a combination of cardiopulmonary and strength training program would have a larger effect. Specific attention should be paid to further increasing 6-minute walking distance between 6 and 12 months post-lung transplantation.