Original Articles
Maximal exercise capacity and peripheral skeletal muscle function following lung transplantation

https://doi.org/10.1016/S1053-2498(98)00027-8Get rights and content

Abstract

Background

There have been many suggestions that diminished exercise capacity in patients that have undergone lung transplantation is due, in part, to peripheral muscle dysfunction, brought on by either detraining or immunosuppressive therapy. There is limited data quantifying skeletal muscle function in this population, especially in those more than 18 months post-procedure. The present study sought to quantitate skeletal muscle function and cardiopulmonary responses to graded exercise in 19 lung transplant recipients, 15 of which were mostly more than 18 months post-procedure.

Methods

Ten single- (SLT) and 9 double-lung transplantation (DLT) underwent anthropometric measures and performed expiratory spirometry, whole body plethysmography to assess lung volumes, static maximal mouth pressures to assess respiratory muscle strength, progressive exercise testing on a cycle ergometer (with cardiac output measurements being performed every second workload) and isokinetic cycling to assess peripheral muscle power and work capacity.

Results

The DLT group was younger than the SLT group (23.0 [21.0–32.0] vs 47.5 [43.0–55.0] median [interquartile range], p < .05) with no differences in height, weight, or BMI. Despite the DLT group having significantly better spirometric values (FEV1: 86% vs 56.5% median) and less airtrapping (RV/TLC: 30% vs 53.5%), both groups were equally limited in exercise capacity (Wmax)(38.0 percent predicted [30.0–65.0] vs 37.5 percent predicted [30.0–44.0], SLT vs DLT), leg power (76.1 percent predicted [53.8–81.4] vs 69.0 percent predicted [58.3–76.0]) and leg work capacity (63.3 percent predicted [34.7–66.8] vs 38.4 percent predicted [27.5–57.3]). This lack of difference in performance persisted when the analysis was limited to those more than 18 months post-procedure. Respiratory muscle strength was also not different for the two groups, and was within normal limits. Wmax was best correlated with leg work capacity (r = .84), but also with leg power, RV/TLC, FEV1 (r = .49, −.52, .58). When normalized for age, height, and sex, percent predicted Wmax only correlated with percent predicted leg work capacity (r = .58). Cardiac output was appropriate for the work performed.

Conclusions

We conclude that peripheral skeletal muscle work capacity is reduced following lung transplantation and mostly responsible for the limitation of exercise performance. While the causes of muscular dysfunction have yet to be clarified, the preservation of respiratory muscle strength with the concomitant reduction in leg power and work capacity suggests that most of the muscular dysfunction post-transplantation is attributable to detraining.

Section snippets

Methods

Data for 19 subjects (10 males, 9 females), 37.5 (19.5–60.9) months (median [interquartile range]) post-transplantation was collected as part of their standard clinical care. These patients were grouped as either single- (SLT) or double lung transplantation (DLT). Fifteen of these subjects were more than 18 months post-transplantation. In each group, 2 subjects were less than 18 months (6–7 months and 12 months) post-transplantation. The SLT group consisted of 10 subjects with the following

Results

The DLT group was significantly younger than the SLT group (Table I). Both groups were mildly anemic as evidenced by their low hemoglobin values (11.0 [10.3–11.9] gm/dl and 10.6 [10.0–11.4] gm/dl for the SLT and DLT groups respectively, p > .5). The Body Mass Index (BMI) and lean body mass was similar for the two groups.

The whole blood trough cyclosporine A levels and daily prednisone dose for the SLT and DLT groups were found to be similar (279.5 mg [234.0–307.0] vs 265.0 mg [169.0–291.0] and

Discussion

Our patients, like those reported by other groups,1, 2, 3 demonstrated a marked reduction in exercise capacity, regardless of the type of surgical intervention. The major factor associated with this reduced exercise ability was a diminished peripheral skeletal muscle work capacity. Cardiac output was appropriate for the amount of work performed. In contrast to leg muscle weakness, respiratory muscle strength was preserved.

Despite having acceptable BMI’s, our patients demonstrated reduced leg

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    This study was funded in part by the Association Pulmonaire du Québec.

    1

    Dr. Lands is a chercheur-clinicien of the Fonds de Recherche en Santé du Québec.

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