Effects of pulmonary rehabilitation in lung transplant candidates: a systematic review

• Published in: BMJ open 2017-02, Vol.7 (2), p.e013445-e013445
• Main Authors: Hoffman, Mariana, Chaves, Gabriela, Ribeiro-Samora, Giane Amorim, Britto, Raquel Rodrigues, Parreira, Verônica Franco
• Format: Article
• Language: English
• Subjects: Candidates; Chronic Disease; Chronic illnesses; Chronic obstructive pulmonary disease; Cystic fibrosis; Evidence-based medicine; Exercise; Exercise Therapy - adverse effects; Exercise Therapy - methods; Exercise Therapy - psychology; Exercise Tolerance; Humans; Hypertension; Lung diseases; Lung Diseases - physiopathology; Lung Diseases - rehabilitation; Lung Diseases - surgery; Lung Transplantation; Lung transplants; Medical prognosis; Muscle strength; Musculoskeletal system; Participation; Patients; Physical therapy; Preoperative Period; Pulmonary fibrosis; Quality of Life; Rehabilitation; Rehabilitation Medicine; Resistance Training - adverse effects; Respiratory diseases; Respiratory Muscles - physiopathology; Society; Strength training; Surgery; Survival Rate; Systematic review; Transplants & implants; Waiting Lists; Walk Test
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-013445

ObjectivesThe aim of this systematic review of randomised controlled trials (RCTs), and quasi-experimental and retrospective studies is to investigate the effects of pulmonary rehabilitation (PR) in patients with advanced chronic disease on the waiting list for lung transplantation.SettingPR performed for inpatient or outpatient lung transplant candidates.InterventionPR programme including aerobic exercise training and/or resistance exercise training.Primary and secondary outcomesQuality of life and exercise capacity (primary outcomes). Survival rate after transplant surgery; pulmonary function; respiratory muscle strength; psychological aspects; upper and lower extremity muscle strength and adverse effects (secondary outcomes). Two review authors independently selected the studies, assessed study quality and extracted data. Studies in any language were included.ResultsThis was a systematic review and studies were searched on the Cochrane Library, MEDLINE, EMBASE, CINAHL and PEDro. Experimental and retrospective studies evaluating the effects of PR in candidates for lung transplantation (>18 years old) with any lung diseases were included. 2 RCTs, and two quasi-experimental and two retrospectives studies, involving 1305 participants were included in the review. 5 studies included an enhancement reported in quality of life using the Short Form 36 questionnaire and showed improvements in some domains. All studies included exercise capacity evaluated through 6 min walk test and in five of them, there were improvements in this outcome after PR. Owing to the different characteristics of the studies, it was not possible to perform a meta-analysis.ConclusionsStudies included in this review showed that PR is an effective treatment option for patients on the waiting list for lung transplantation and can improve quality of life and exercise capacity in those patients. Although individual studies reported positive effects of PR, this review shows that there is a need for more studies of a high methodological quality addressing PR effects in lung transplant candidates.Trial registration numberPROSPERO CDR42015025110.