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Effects of pulmonary rehabilitation in lung transplant candidates: a systematic review
  1. Mariana Hoffman1,
  2. Gabriela Chaves1,
  3. Giane Amorim Ribeiro-Samora1,
  4. Raquel Rodrigues Britto2,
  5. Verônica Franco Parreira2
  1. 1Rehabilitation Sciences Program, Federal University of Minas Gerais, Belo Horizonte, Brazil
  2. 2Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
  1. Correspondence to Dr Verônica Franco Parreira; veronicaparreira{at} or veronica.parreira{at}


Objectives The 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.

Setting PR performed for inpatient or outpatient lung transplant candidates.

Intervention PR programme including aerobic exercise training and/or resistance exercise training.

Primary and secondary outcomes Quality 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.

Results This 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.

Conclusions Studies 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 number PROSPERO CDR42015025110.

  • Lung transplantation
  • Rehabilitation
  • Lung diseases
  • Physical therapy

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  • Contributors MH and GC were the main systematic reviewers and worked across all stages of the review from inception to completed draft. GAR-S is the statistical expert and provided advice on data analysis and commented on the final document content. RRB provided advice on data analysis and commented on the final document content. VFP provided advice throughout the project, and was involved in screening, selection and commenting on the analysis and the final document content.

  • Funding This project was partially supported by Pró-Reitoria de Pesquisa da Universidade Federal de Minas Gerais and by Conselho Nacional de Desenvolvimento Científico e Tecnológico (grant numbers: 309494/2013-3 and 442973/2014-4), Brazil.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.