Physical function in lung transplant recipients: Clinical implications and rehabilitation strategies

Lung transplantation (LTx) is an established procedure that provides benefits in health-related quality of life (HRQL) and survival for individuals with advanced lung disease. However, recovery of physical function after LTx can be variable. This narrative review summarizes key elements of physical function, including skeletal limb and respiratory muscle function, frailty, exercise capacity, and physical activity, and provides an overview of how these parameters are associated with clinical outcomes, and their response to rehabilitation. In the early post-LTx period (< 6 months), a number of physical function parameters recover but levels remain lower than age-sex matched healthy adults. While limb muscle strength, mobility, respiratory muscle function, and frailty demonstrate early recovery, persistent limitations remain in the first year post-LTx. Exercise capacity typically improves in the first 6 months, while physical activity levels remain lower than healthy adults. These post-LTx impairments are clinically important, as low muscle mass, frailty, and physical inactivity are associated with worse HRQL, greater hospital readmission rates, and increased mortality. Rehabilitation interventions can improve strength, exercise capacity, and HRQL, though participation for some LTx recipients remains limited due to individual and system level barriers. Emerging home-based and hybrid approaches with in-person rehabilitation show promise in improving access and engagement. Future research should identify optimal rehabilitation strategies focusing on supporting an active lifestyle post-LTx.