Is Lifelong Physical Activity a Determinant of Lung Transplantation Outcomes?

Background: Habitual physical activity (PhA) may contribute to overall physiological reserve, yet its relevance for lung transplantation (LTx) remains unclear, as existing studies almost exclusively explore short-term exercise interventions. This study evaluates whether life-course PhA before LTx influences postoperative outcomes: functional capacity measured by 6 min walk test (6MWT), chronic lung allograft dysfunction (CLAD), and length of hospital stay (LOS). Methods: In this retrospective study, ninety-seven LTx recipients completed the Historical Adulthood Physical Activity Questionnaire (HAPAQ), assessing PhA from age 20 to transplantation. All participants were assessed within the same time frame, with varying time intervals since transplantation. Patients were classified into no/recreational/intensive sport groups based on regular participation. Statistical analyses examined sport group differences in 6MWT, CLAD, and LOS and interactions with sex, pulmonary disease type, and secondary pulmonary hypertension (PH). Results: Lifelong PhA did not significantly differentiate quantitative 6MWT, CLAD, or LOS, and no interaction effects were observed. A modest trend was noted in patients without secondary PH, among whom intensive PhA corresponded to more frequent within-norm qualitative 6MWT results. Outcomes were comparable between single- and double-lung (DLTx) recipients, although a moderate effect between sports groups suggested a possible DLTx compensatory advantage. Conclusions: This study provides the very first life-course assessment of PhA in LTx recipients, highlighting the value of HAPAQ for estimating pre-transplant physiological reserve. Despite postoperative outcomes being largely independent of lifelong PhA, and recovery appearing multifactorial, habitual PhA should not be overlooked in developing individualized prehabilitation strategies in transplant medicine.