Pulmonary Rehabilitation in Patients Referred for Lung Transplantation
Effectiveness of pulmonary rehabilitation in patients with chronic obstructive lung diseases, cystic fibrosis, and interstitial lung disease is well documented but little is known about the results of pulmonary rehabilitation in patients referred for lung transplantation. The purpose of this study is to prospectively examine the efficacy of Nordic walking, a low cost, accessible, and proven beneficial form of physical exercise, as a form of pulmonary rehabilitation in patients referred for lung transplantation. Twenty-two male patients referred for lung transplantation at the Department of Lung Diseases and Tuberculosis in Zabrze, Poland, were invited to take part in the study. The rehabilitation program, which was conducted for 12 weeks, was based on Nordic walking exercise training with ski poles. Lung function tests (FVC, FEV1), mobility (6 min walking test (6MWT)), rating of dyspnea (Oxygen Cost Index, MRC and Baseline Dyspnea Index), and quality of life assessments (SF-36) were performed before and after the completion of the exercise program. No adverse events were observed after completing the pulmonary rehabilitation program in patients referred for lung transplantation. After 12 weeks of pulmonary rehabilitation with Nordic walking we observed a significant increase in the mean distance walked in the 6MWT (310.2 m vs. 372.1 m, p < 0.05). The results of lung function tests also showed improvement in FVC. There were no significant differences in the perception of dyspnea before and after completing the rehabilitation program. General health and quality of life questionnaire (SF-36) showed improvement in the domain of social functioning (p < 0.05). In conclusion, pulmonary rehabilitation with a Nordic walking program is a safe and feasible physical activity in end-stage lung disease patients referred for lung transplantation and results in improvements in patients’ mobility and quality of life.
KeywordsInterstitial lung disease Lung transplantation Pulmonary rehabilitation Nordic walking Six-minute walking distance
Supported by grant No. KNW-1-176/10 from the Medical University of Silesia, Poland.
Conflicts of Interest: The authors declare no conflicts of interest in relation to this article.
- American Thoracic Society Statement. (2002). Guidelines for the six-minute walk test. American Journal of Respiratory and Critical Care Medicine, 166, 111–117.Google Scholar
- Baddini Martinez, J. A., Martinez, T. Y., Lovetro Galhardo, F. P., & de Castro Pereira, C. A. (2002). Dyspnea scales as a measure of health-related quality of life in patients with idiopathic pulmonary fibrosis. Medical Science Monitor, 8, 405–410.Google Scholar
- Holland, A., & Hill, C. (2008). Physical training for interstitial lung disease. Cochrane Database of Systematic Reviews, 4, CD006322.Google Scholar
- International Nordic Walking Federation (INWA). INWA Nordic Walking Portal. http://inwa-nordicwalking.com. Accessed 20 May 2012.
- Jastrzebski, D., Kozielski, J., Banas, A., Cebula, T., Gumola, A., Ziora, D., & Krzywiecki, A. (2005). Quality of life during one-year observation of patients with idiopathic pulmonary fibrosis awaiting lung transplantation. Journal of Physiology and Pharmacology, 56(Suppl. 4), 99–106.PubMedGoogle Scholar
- Nici, L., Donner, C., Wouters, E., Zuwallack, R., Ambrosino, N., Bourbeau, J., Carone, M., Celli, B., Engelen, M., Fahy, B., Garvey, C., Goldstein, R., Gosselink, R., Lareau, S., MacIntyre, N., Maltais, F., Morgan, M., O’Donnell, D., Prefault, C., Reardon, J., Rochester, C., Schols, A., Singh, S., & Troosters, T. (2006). American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine, 173, 1390–1413.PubMedCrossRefGoogle Scholar
- Orens, J. B., Estenne, M., Arcasoy, S., Conte, J. V., Corris, P., Egan, J. J., Egan, T., Keshavjee, S., Knopp, C., Kotloff, R., Martinez, F. J., Nathan, S., Palmer, S., Patterson, A., Singer, L., Snell, G., Studer, S., Vachiery, J. L., & Glanville, A. R. (2006). International guidelines for the selection of lung transplant candidates: 2006 update-a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. The Journal of Heart and Lung Transplantation, 7, 745–755.CrossRefGoogle Scholar
- Ries, A. L., Bauldoff, G. S., Carlin, B. W., Casaburi, R., Emery, C. F., Mahler, D. A., Make, B., Rochester, C. L., Zuwallack, R., & Herrerias, C. (2007). Pulmonary rehabilitation: Joint ACCP/AACV pulmonary rehabilitation evidence-based clinical practice guidelines. Chest, 131, 4S–42S.PubMedCrossRefGoogle Scholar
- Ware, J. E., Kosinski, M., & Gandek, B. (2004). SF-36 health survey. Manual & interpretation guide. Lincoln: QualityMetric Incorporated.Google Scholar