Exercise and lung transplantation in cystic fibrosis: A ...€¦ · cystic fibrosis: A case study...
Transcript of Exercise and lung transplantation in cystic fibrosis: A ...€¦ · cystic fibrosis: A case study...
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