Upper Limb Exercise Capacity: Lung Transplant vs. Healthy Controls

Ankara City Hospital Bilkent60 enrolled

Overview

Lung transplantation is a surgical intervention for end-stage lung diseases (e.g., COPD, cystic fibrosis, idiopathic pulmonary fibrosis). While post-transplant pulmonary function improves, peak exercise capacity remains 40-60% lower than age-matched healthy individuals due to factors like muscle weakness, reduced aerobic capacity, and immunosuppressive therapy. Although lower extremity rehabilitation is common, upper extremity (UE) function is often overlooked despite its impact on quality of life (QoL) and activities of daily living (ADLs). The 6-Minute Pegboard and Ring Test (6PBRT) evaluates UE functional capacity but has not been studied in long-term lung transplant recipients (LTRs). Objectives: Primary: Compare UE exercise capacity between LTRs and healthy controls using 6PBRT. Secondary: Investigate correlations between 6PBRT performance and pulmonary function, fatigue perception, ADLs, and QoL in LTRs. Hypotheses: H0: No significant difference in UE exercise capacity between LTRs and healthy individuals. H1: Significant difference exists. Methods: Design: Cross-sectional study. Sample size calculated based on prior 6PBRT data (effect size: 1.10, power: 80%, α: 0.05). Assessments: Demographics: Age, sex, BMI, Charlson Comorbidity Index (CCI). 6PBRT: Measures UE endurance (total rings moved in 6 minutes). Vital signs (SpO₂, heart rate, Borg scale for fatigue) recorded. LTR-specific: Pulmonary function: FEV₁, FVC, FEV₁/FVC. Fatigue: Fatigue Severity Scale (FSS; scores ≥4 indicate severe fatigue). QoL: St. George's Respiratory Questionnaire (SGRQ; 0=best, 100=worst). ADLs: London Chest ADL Questionnaire (0-5 scale). Expected Outcomes: LTRs will show significantly lower 6PBRT scores vs. controls. 6PBRT performance will correlate with pulmonary function, fatigue, and QoL in LTRs.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Transplant Recipient

Eligibility

Medical Language ↔ Plain English

Inclusion Criteria: Inclusion Criteria for Lung Transplant Recipients: * Patients aged 18-70 years * At least 3 months post-lung transplantation with no major complications * Clinically stable with any comorbidities under control * Willing to participate in the study * No neurological or orthopedic conditions that may interfere with functional testing * Sufficient cognitive level to understand and perform required tests and questionnaires Inclusion Criteria for Healthy Controls: * Aged 18-70 years * Sufficient cognitive ability to understand and complete the tests * Willing to participate in the study Exclusion Criteria: Exclusion Criteria for Lung Transplant Recipients: * Single-lung transplant recipients * Patients with orthopedic limitations * Patients unable to cooperate or comply with study procedures * Patients with mental disorders Exclusion Criteria for Healthy Controls: * Presence of cardiovascular diseases, cerebrovascular disease, dementia, chronic pulmonary diseases, moderate-to-severe liver diseases, hemiplegia, moderate or severe kidney disease, or solid tumors * Orthopedic conditions that would prevent exercise testing Inability to cooperate or comply with study procedures

Outcomes

Primary Outcomes

Upper extremity functional exercise capacity

Upper Extremity Functional Capacity assessed by 6-minute pegboard and ring test (6PBRT). The 6-Minute Pegboard and Ring Test (6PBRT) assesses upper limb endurance and functional capacity. The participant moves rings between pegs on a board using alternating hands for six minutes. The total number of rings moved is recorded as the outcome

Time frame: Baseline only (single assessment, no follow-up)

Secondary Outcomes

Respiratory Function

Respiratory functions will be evaluated with Pulmonary function tests (PFTs). Pulmonary function tests (PFTs) assess lung function. Key parameters include FEV₁, FVC, and the FEV₁/FVC ratio to evaluate airflow and detect obstruction or restriction. TLC measures total lung capacity. Results will be reported in liters (L) and as a percentage of predicted normal values (based on age, sex, and height).

Time frame: Baseline only (no follow-up)