Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach

Table 2 Guidelines for pre-transplant exercise prescription in stable outpatients

	Aerobic	Resistance	Flexibility
Frequency	2-5 d/wk	2-3 d/wk	3-5 d/wk
Intensity	50%-80% HR reserve Dyspnea > leg fatigue: Moderate to hard (3-5 on modified Borg scale)[48] SpO2 > 85%-90% Continuous or intermittent training1: 60%-80% 6MWT speed for walking[41,49] 60% peak workload for cycling[39,43] or just above anaerobic threshold[40] Interval training2: 100%: 0% peak work rate (cycle)[39]	30%-80% 1-RM or use 8-15-RM[125]
Type	Walking (treadmill, corridor, Nordic poles)[42] Cycling (leg and/or arm ergometer)	Major muscle groups of upper and lower body (quadriceps, hamstrings, plantar flexors, gluteals, biceps, triceps, pectorals, latissimus dorsi) Training modalities: Free weights/dumbbells Elastic bands Pulleys Gym equipment Body weight (stairs, squats, heel raises, wall push-ups)	Major muscle groups of upper and lower body Thoracic cage and chest wall mobility
Time/ Training Volume	Continuous: 15-30 min Intermittent: 5-10 min × 2-3 bouts Interval2: 30 s exercise: 30 s rest (12-36 min)[39]	1-2 sets × 8-15 reps	Hold up to 10-30 s each, repeat 2-4 times
Progression	Progress time up to 20-30 min continuous Perform regular 6MWTs and adjust speed accordingly for treadmill training; and increase Watts on cycle Higher level patients may tolerate a treadmill incline of 1%-4%	Increase weights based on tolerance; (approximately 0.5 kg or 1 lb. per week, as tolerated)[41] Body weight exercises: Can add hand or ankle weights	Hold stretches to point of tightness/slight discomfort

¹Intermittent training is regular or irregular intervals of the same low to moderate intensity vs interval training, which involves pre-set, alternating, short intervals of high intensity to intervals of rest or lower intensity;

²There are several different interval training protocols described in chronic lung disease[126]. SpO₂: Oxygen saturation measured by pulse oximetry; HRR: Heart rate reserve; 6MWT: Six-minute walk test; ISWT: Incremental shuttle walk test; HR: Heart rate; BP: Blood pressure; RR: Respiratory rate; ESWT: Endurance shuttle walk test; reps: Repetitions; RM: Repetition maximum.