Lung transplantation is a crucial surgical intervention aimed at increasing survival rates in patients with end-stage lung diseases such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, idiopathic pulmonary fibrosis, and pulmonary hypertension. One of the most important determinants of health outcomes before and after lung transplantation is exercise capacity. An increase in the 6-minute walking distance (6MWD), which serves as a measure of functional exercise capacity, is associated with lower mortality rates in both pre- and post-transplantation settings. Therefore, effective rehabilitation programs are needed to enhance the exercise capacities of lung transplant candidates. Pulmonary rehabilitation (PR) is a comprehensive program designed specifically for individuals with chronic respiratory diseases. PR aims to improve patients\' physical and psychological conditions through detailed assessments and personalized treatment plans. It can play a role in enhancing the preoperative exercise capacities of lung transplant candidates and improving their chances of successful health outcomes. However, lung transplant candidates often have more advanced lung disease and face greater challenges compared to typical patients undergoing PR, making the expected benefits more complex to achieve. The primary aim of this study is to investigate the effects of high-intensity interval training (HIIT) in lung transplant candidates with interstitial lung disease (ILD). The first objective is to compare the physiological responses and effectiveness of HIIT and moderate-intensity continuous training (MICT) within the same exercise volume. The secondary aim is to evaluate the impact of HIIT on body structure and function, activity, and participation levels using ICF-based assessments.
Research Design This study employs a randomized controlled prospective design. The exercise training protocol consists of two main groups: high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT). The HIIT protocol includes high-intensity efforts performed in 30-second intervals, while the MICT protocol involves longer-duration, moderate-intensity exercise. The total training duration for both groups is planned for 8 weeks. Participants will include individuals with interstitial lung disease who are on the waiting list for lung transplantation. They must agree to participate regularly in the exercise program. Power analysis indicated that a minimum of 17 participants per group is needed, leading to a total target of 34 participants. Parameters to be Assessed The study will assess various parameters before and after the exercise training. These parameters include demographic information, exercise capacity, respiratory function, comorbidities, daily living activities, and quality of life. Exercise capacity will be evaluated using the 6-minute walk test (6MWT). Respiratory functions will be measured through pulmonary function tests (PFT), capturing values such as forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and carbon monoxide diffusion capacity (DLCO). Comorbidities will be assessed using the Charlson Comorbidity Index, while daily living activities will be measured using the London Chest and St. George questionnaires. Quality of life will be evaluated through various scales. For instance, the Tampa Kinesiophobia Scale will assess fear and anxiety levels in patients. Additionally, the FRAIL Scale will evaluate frailty, sarcopenia levels, and muscle strength. Hypotheses This study has four main hypotheses: There is a significant difference between HIIT and MICT regarding the effects on body structure and function impairments, activity, and participation levels. HIIT has a positive effect on respiratory function, exercise capacity, and quality of life. HIIT has an effect on sarcopenia and frailty levels. HIIT impacts body structure and function impairments, activity, and participation levels. Conclusion This study aims to evaluate the effects of high-intensity interval training in lung transplant candidates. The findings may contribute to optimizing pre-transplant rehabilitation processes and improving the overall health status of these patients. Furthermore, the applicability and effectiveness of such exercise protocols may lead to significant changes in clinical practice. The results of the research will shed light on the development of exercise rehabilitation programs and the treatment processes for lung disease patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
34
30-sec intervals at 85-100% peak workload, 30-sec rest at 40%, total 20-30 min.
Continuous cycling at 60-80% peak workload for 20-30 min.
Electronically Ergometer cycle custo ec5000, CustoMed used for all exercise sessions. Calibrated before each trial.
Ankara Bilkent City Hospital
Ankara, Ankara, Turkey (Türkiye)
RECRUITINGCardiopulmonary exercise capacity
Peak Work Rate (PWR) PWR is determined through a symptom-limited incremental bicycle ergometer test. Patients pedal at 10 W, increasing by 10 W each minute until fatigue or a workload of 50 W is reached, or a fatigue level of 9 on the modified Borg scale. Workload and heart rate are monitored, with maximum workload (Wpeak) and heart rate recorded at the end.
Time frame: through study completion, an average of 1 year
Submaximal exercise capacity
-Minute Walk Test (6MWT) The 6MWT assesses exercise capacity in a 30-meter corridor by measuring the distance walked. It evaluates oxygen saturation, heart rate, and dyspnea using the Borg scale before and after the test. Participants walk at their own pace and can pause or use oxygen as needed.
Time frame: through study completion, an average of 1 year
Forced Expiratory Volume in 1 Second (FEV1) Measured by Spirometry (Liters)
FEV1 will be assessed via CosmedQuark PFT Q-Box, Italy following. Participants will perform ≥3 reproducible maneuvers; the highest value within 5% repeatability will be recorded and reported in liters. Values will be expressed as absolute liters and % predicted using equation.
Time frame: through study completion, an average of 1 year
Fragility
Frail Frailty Scale It is a scale that evaluates the patient\'s fatigue, resistance, mobility, weight loss and other diseases by questioning them. The FRAIL scale, which consists of 5 items, receives 0 or 1 points according to the answers given by the patients, and a total of 0 points is considered as non-frail, 1-2 points as pre-frail and \>2 points as frail.
Time frame: through study completion, an average of 1 year
Life Quality
St George Quality of Life Questionnaire It is a scale that measures the quality of life specific to respiratory diseases. It consists of a total of 50 items, 8 of which question the patient\'s symptoms, 16 of which question the activities, and 26 of which question the effects of the disease. While evaluating the symptoms, the patient\'s level of shortness of breath, cough, and sputum respiratory discomfort are questioned. While evaluating the activity component, physical activities that cause shortness of breath or are restricted due to shortness of breath are questioned. While evaluating the effects of the disease, it includes factors such as work, occupation, keeping health under control, and discomfort during daily living activities. The 3 sections of the test are calculated separately and the total score is calculated. A score of 0 indicates normal, a score of 100 indicates maximum disability
Time frame: through study completion, an average of 1 year
Kinesiophobia
The Tampa Scale for Kinesiophobia (TSK) is a validated 17-item questionnaire assessing fear of movement and reinjury in chronic pain patients, scored on a 4-point Likert scale (1=strongly disagree to 4=strongly agree). Total scores range from 17 (no kinesiophobia) to 68 (severe kinesiophobia), with scores ≥38 indicating clinically significant fear that may impair recovery.
Time frame: through study completion, an average of 1 year
Muscle strength
Hand Grip Strength Jamar (Jamar®, California, USA) brand hand dynamometer, which is valid in clinical studies, will be used to measure hand grip strength.
Time frame: through study completion, an average of 1 year
Balance
Timed-up and Go Test Test is a test performed to evaluate dynamic balance and functional mobility. A standardized chair, stopwatch and 3 meters of walking space are needed. The test begins while sitting in a chair, the individual gets up with the start command, walks 3 meters at normal walking speed, turns back and sits on the chair. Test completion time is recorded for scoring. Those who complete it in more than 15 seconds are considered to have impairment in daily living activities.
Time frame: through study completion, an average of 1 year
Sarcopenia
SARC-F The SARC-F questionnaire is a self-reported screening tool for sarcopenia risk, based on five components: Strength, Assistance in walking, Rising from a chair, Climbing stairs, and Falls. It takes its name from the initials of the components. Each item is scored from 0 to 2, with a total score of ≥4 indicating a high risk. In this study, SARC-F will be used to assess sarcopenia risk at baseline and follow-up.
Time frame: through study completion, an average of 1 year
Respiratory muscle strength
Maximum Inspiratory Pressure (MIP) (cmH₂O) Maximum Expiratory Pressure (MEP) (cmH₂O)
Time frame: through study completion, an average of 1 year
Respiratory Muscle Endurance
This test will be conducted at 60% of MIP for 10 minutes, with respiratory frequency and duration recorded.
Time frame: through study completion, an average of 1 year
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