Exercise and lung

transplantation in

cystic fibrosis:

A case study of pre-

operative exercise

training

Dr. Owen Tomlinson

University of Exeter & Royal Devon and Exeter Hospital

Cystic Fibrosis

• Genetic disease

• Primarily affects

lungs and

digestive system

• NO CURE

• Managed by

exercise, nutrition

and antibiotics

• ~11,000 people in

UK with CF

Lung Health in CF

Lung Health in CF

Transplant in CF

• Transplants occur in advanced disease, but

do not cure CF

• ~60 people will have transplant each year

50% 40% 30%

Discussions Monitoring Referral

“You’re preparing

for a call that you

know is coming…

…You just don’t

know when”

Our participant…

• 39-year old male

• Lung function < 30%

• Referred in June ‘14

• Joined waiting list in June ‘15

• Using 4 L/min O2 when exercising

• CF-diabetes, pulmonary hypertension, prone to

airway bleeds

Exercise Testing

• Cardio-

Pulmonary

Exercise

Test Sedentary

Light

Mod Vig

610 mins

MVPA/week

• Physical

Activity

monitoring

0

20

40

60

80

100

120

140

160

180

200

0.00

1.00

2.00

3.00

4.00

5.00

0 200 400 600 800 1000 1200 1400

VO2

VCO2

HR

Exercise Training

1. Home visit & explanation of programme

Example 1:

• Cycle 3mins 12-13 rpm HR 120

• Cycle 12mins 18-29rpm HR 150

• 3 mins active cool down followed by

stretches

Example 2:

• Squats x 10reps x 3 sets

• Seated row using blue theraband

• Push ups 10 reps x 3 sets

Example 3:

• Warm up

• Cardio

• Plank, squats, push ups, seated row

Exercise Training

2. Supervision of programme via Skype

• Real time monitoring allows adaptation – reflects changes in daily life

• Allows staff to perform multiple ‘back to back’ sessions

• Reduces patients burden of travelling

• Reduces cross-infection risk

The ‘other’ stuff

• Orkambi – March ‘16

• Nocturnal Non-Invasive Ventilation – March ’16

• Combined exercise sessions with airway

clearance techniques

• Exceptionally adherent to all medications &

therapies

July 2017 = Double Lung Transplant

Results

Feb 2017

VO2peak 0.34 L/min

4.5 ml/kg/min

12.6% predicted

FEV1 24%predicted

Feb 2018

VO2peak 1.71 L/min

23.2 ml/kg/min

65.5% predicted

FEV1 96%predicted

Takeaway Message

Exercise

Transplant

• People awaiting transplant should try and be active

• Exercise testing aids personalised exercise prescription

• Online delivery of exercise is feasible, accepted and beneficial

• Exercise may enhance post-operative success

“CPET-guided supervision and

training gave me a lot of

confidence to exercise when

otherwise I may have been too

concerned about complications”

Thank You

Thank you to all the staff at the Royal Devon & Exeter

Hospital and Harefield Hospital

QUESTIONS?

@TomlinsonOwen

O.W.Tomlinson@exeter.ac.uk