Comparison between Supervised and Unsupervised Exercise Program after Lung Transplantation

Abstract

Purpose: Rehabilitation plays a key role in the management of patients before and after lung transplantation (LTX). We aimed to compare the effects of supervised and unsupervised rehabilitation program after LTX on short and mid-term physical-functional outcomes. Methods and Materials: We retrospectively studied a group of 78 patients, aged 38.9 + 15.3 years, composed by patients with cystic fibrosis (28.2%), emphysema (23%), bronchiectasis (21.7%), pulmonary fibrosis (14,1%) and other diseases (12%), submited to LTX (single n=13 and double n=65) from 2004 to 2009. Patients underwent education, aerobic and resisted exercise one-hour sessions, two times a week. We compared a group of outpatients who completed 15 sessions (Group1) of supervised rehabilitation followed by 2 months unsupervised rehabilitation to another who completed 30 sessions of supervised rehabilitation (Group2). Physical-functional variables were obtained from measures at rest, maximal respiratory pressures (MIP and MEP) and six-minute walk test (6MWT). We collected data pre surgery (pre), one (1yr) and two years (2yr) after surgery. Results: Groups (Group1 n=33, Group2=n=45) showed similar age (Group1 41.5±15.6 x Group2 37.8±15.1, p=0.4, in years) and BMI (21.8±4.1 x 21.6±4.3, p=0.6, kg/m2). Both groups showed significant improvement in all parameters postoperatively. We could not determine significant differences between groups in Peripheral saturation of oxygen (pre-Group1 89.6±6.1 x pre-Group2 89.3±6.9, p=0.8; 1yr- 97.6±1.1 x 97.1±1.5, p=0.3; 2yr- 96.8±2.3 x 97.0±1.1,p=0.9,in %); MIP (pre-64.0±23.9 x 65.5±24.2, p=0.8; 1yr- 94.9±25.2 x 98.5±15.6, p= 0.7; 2yr- 93.4±26.6 x 101.3±12.6, p=0.7) and MEP (pre-92±29.1 x 86.5±27.1, p=0.5; 1yr 99.2±28.5 x 104.9± 16.4,p=0.9; 2yr 103.14±25 x 105.6±16.4, p=0.7,in cmH2O) and 6MWT (pre-428±137.4 x 411.2±113.9, p=0.5; 1yr 629.2±91.26 x 659.2±93.5, p=0.3; 2yr 645.9±91.5 x 686.6±98.6, p=0.2,in meters). Conclusions: Our findings indicate that unsupervised rehabilitation may represent an alternative in the management of post lung transplant patients.