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Lung transplantation (LTx) has gained widespread acceptance as a therapeutic option for end-stage pulmonary disease. LTx has been shown to improve quality of life (QoL) and survival in individuals with various end-stage lung diseases.
PULMONARY RESEARCH AND RESPIRATORY MEDICINE Editorial The Importance of Rehabilitation before * *Corresponding author and after Lung Transplantation Masahiro Kohzuki, MD, PhD Professor Department of Internal Medicine and * Rehabilitation Science Masahiro Kohzuki, MD, PhD*; Yosuke Izoe, MD; Taku Harada, MD, PhD Tohoku University Graduate School of Medicine Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate 1-1, Seiryo-cho, Aoba-ku Sendai, Japan School of Medicine, Aoba-ku, Sendai, Japan Tel. 022-717-7351 Fax: 022-717-7355 E-mail: kohzuki@med.tohoku.ac.jp Lung transplantation (LTx) has gained widespread acceptance as a therapeutic option for end-stage pulmonary disease. LTx has been shown to improve quality of life (QoL) and Volume 4 : Issue 2 survival in individuals with various end-stage lung diseases.
Article Ref. #: 1000PRRMOJ4e008 However, numerous studies have been demonstrated that LTx recipients experience persistent impairments in exercise capacity and skeletal muscle function despite a vast im- Article History 1-7 th provement in lung function after LTx. Persistent limitations in exercise capacity and skeletal Received: September 5 , 2017 th muscle function have been observed for more than 1 year after transplantation. Accepted: September 5 , 2017 th Published: September 5th, 2017 Investigations of muscle function in LTx recipients reveal decreased muscle mass and strength, reductions in type 1 fiber proportion, decreased calcium uptake and release, decreased Citation mitochondrial enzyme activity, and impaired oxidative capacity of the peripheral muscles.1 Kohzuki M, Izoe Y, Harada T. The im- portance of rehabilitation before and Similarly, poor daily physical activity has been studied in heart and kidney recipi- after lung transplantation. Pulm Res Respir Med Open J. 2017; 4(2): e3- ents. Heart recipients were classified as very sedentary, based on accelerometer measurements. e5. doi: 10.17140/PRRMOJ-4-e008 Children and adolescents with renal tranplants have severely impaired cardiorespiratory fitness 10,11 and physical activity compared with their healthy counterparts.
In these patients, inactivity prior to transplantation and resulting pre-transplant decon- ditioning are likely to influence functional recovery after surgery. Repeated episodes of infec- tion and rejection, use of anti-inflammatory and immunosuppressive drugs and a sedentary life style are possible post-transplant contributing to limitations in the physical fitness. In LTx patients, pulmonary function is only patially related to participation in daily physical activities. For a given limitation in pulmonary function a considerable variability in daily physical activity was found. Of all measured variables the six minutes walking distance (6MWD) showed the strongest association with participation in daily physical activity. Good correlations between 6MWD and both minutes in activities 2 METs and number of steps were observed.12 A systematic review was undertaken to examine the evidence for exercise training on functional outcomes in LTx recipients.1 Some evidence was found to support that a period of structured exercise training could improve maximal and functional exercise capacity, skeletal muscle strength, and lumbar bone mineral density in LTx recipients.1 Rehabilitation is also important in the pre-operative management of patients.13 The importance of pre-transplant rehabilitation has been shown in the latest joint American Tho- Copyright racic Society (ATS)/European Respiratory Society (ERS) official statement on pulmonary re- ©2017 Kohzuki M. This is an open habilitation. Before LTx, while patients wait for surgery, rehabilitation was found to improve access article distributed under the Creative Commons Attribution 4.0 exercise tolerance and activities of living, without any significant change in respiratory func- International License (CC BY 4.0), tion.15 Pulmonary rehabilitation improves physical fitness of pulmonary failure patients who which permits unrestricted use, are on waiting list for lung transplantation, meanwhile some of the candidates could deviate distribution, and reproduction in from the LTx waiting patients list. Moreover, reduced cardiorespiratory fitness was associated any medium, provided the original work is properly cited. with the clustering of cardiovascular risk factors. Routine counseling for increased physical activities is strongly recommended.
Further studies are needed to determine the potential for exercise training to optimize these functional outcomes and to develop optimal guidelines for exercise prescription in the LTxs population.16 CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.