Participation and Progression of Hybrid Rehabilitation following Lung Transplantation

Exercise training is recommended to improve physical recovery following lung transplantation (LTx). Since the COVID-19 pandemic, hybrid rehabilitation has emerged utilizing both in-person and home-based exercise. Little is known about exercise participation, progression and intensity with this delivery model.

A single center retrospective chart review of adult LTx recipients who undertook outpatient rehabilitation within the first 3 months after LTx between December 1, 2022 and February 29, 2024, was conducted. High participation was defined as ≥3 exercise sessions/week for at least 50% of the rehabilitation period. Progression of exercise volumes was examined and walking intensity (Borg leg fatigue scale) was compared between in-person and home rehabilitation.

A total of 166 LTx recipients were included (70% male, 64 [14] years, 71% interstitial lung disease). High rehabilitation participation was observed in 48% of participants over a mean of 8 ± 2 weeks. The median walking distance, biceps and quadriceps resistance training volumes increased between the first and last recorded rehabilitation sessions during both in-person (536 [538] vs. 1073 [650] m, 40 [20] vs. 60 [55] repxlbs, and 20 [10] vs. 40 [30] repxlbs) and home rehabilitation (968 [991] vs. 1556 [1019] m, 50 [70] vs. 100 [70] repxlbs, and 30 [32] vs. 40 [70] repxlbs), all p < 0.05. Leg fatigue was higher during in-person walking compared to home (3 [3-4] vs. 3 [2-3]), p < 0.001.

Half of LTx recipients had low participation in outpatient and home rehabilitation early after transplantation. Understanding barriers to home exercise participation and reporting will enhance hybrid rehabilitation delivery.