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

Table 4 Guidelines for early post-transplant exercise prescription in stable outpatients

	Aerobic	Resistance	Flexibility
Frequency	3-5 d/wk	2-3 d/wk	3-5 d/wk
Intensity	50%-80% HR reserve or < 85% age-predicted HRmax[4,23] Leg fatigue > dyspnea: Moderate to hard (3-4 on Borg scale) SpO2 > 88% Continuous training: 75%-100% 6MWT speed for walking[24,25] 50%-80% peak workload for cycling[24,59,128]	60%-80% 1RM[24,26] 10-RM No upper extremity lifting/pulling/pushing > 10 lbs. first 3 month Extra restrictions if sternal instability	Hold stretches to point of tightness/slight discomfort
Type	Walking (treadmill, corridor) Cycling (leg); avoid arm ergometry in first 3 month to allow for incision healing	See pre-transplant Avoid abdominal muscle exercises for first 3 month	Major muscle groups of upper and lower body Thoracic cage and chest wall mobility Postural re-education
Time/ Training Volume	Continuous: 20-30 min	1-3 sets × 8-15 reps	Hold up to 10-30 s each, repeat 2-4 times
Progression	Progress time to 30 min, then progress speed on treadmill; increase incline after approximately 6 wk post-transplant (if tolerated) Increase Watts on cycle Walk: Run program for some high level patients (at least 6 wk post-transplant) 30-60 s running bouts interspersed with walking for 20-30 min	Start with sit-stands and when able to perform without arm support progress to squats with hand weights Weekly increase weights based on tolerance; (approximately 0.5 kg or 1 lb. per week, as tolerated) within lifting guidelines (e.g., < 10 lbs. for upper extremities for first 3 month) Body weight exercises: Can add hand or ankle weights (e.g., squats and stair climbing)	Hold stretches to point of tightness/slight discomfort Extra restrictions if sternal instability (e.g., avoid chest expansion stretches)

6MWT: Six-minute walk test; CPET: Cardiopulmonary exercise test; HR: Heart rate; HRR: Heart rate reserve; SpO₂: Oxygen saturation measured by pulse oximetry; RR: Respiratory rate; BP: Blood pressure; ISWT: Incremental shuttle walk test; ESWT: Endurance shuttle walk test.