Background: Frailty is a novel risk factor to potential lung transplant candidates and recipients associated with excess morbidity and mortality. Limited data is available on effective interventions to improve frailty. Frailty is often defined as the presence of 3 or more parameters of the frailty phenotype (FP)[mdash]wasting, slowness, low physical activity, exhaustion, and weakness. We sought to determine the impact of pulmonary rehabilitation (PR) on the FP.

Methods: This was a prospective, observational cohort study of consenting adult patients referred to PR. FP testing (hand grip strength, self-selected gait speed over 15 ft, physical activity level (PAL) as measured by a wearable activity monitor, Center for Epidemiologic Studies for Depression exhaustion questions, and self-reported unintentional weight loss of >10 lbs in the past year) occurred pre- and post-PR. PAL was considered frail when total energy expenditure/resting metabolic rate was less than 1.4. Other frailty parameters used standard definitions. Potential predictors of improvement (e.g. demographics, psychometrics) were also explored.

Results: 63 patients, median age 65 (60% male), were included. At baseline 36.5% of patients were frail by FP (53% weakness, 22% slowness, 34% wasting, 53% exhaustion, and 75% with low physical activity). Frail patients had significantly worse self-management skills as measured by CRQ Mastery (p=0.004). Impressively, 43.5% of patients frail at baseline improved following PR. In particular, PR significantly improved gait speed (p=0.008) and exhaustion decreased from 52% pre to 40% post-PR. There was no significant improvement in grip strength, wasting, or PAL. Those who improved FP had a significantly lower body mass index (median 26 vs 30.2 kg/m²; p=0.016) and were more likely post-transplant (p=0.02).

Conclusion: Our data suggest frailty is common in this population and, importantly, can be mitigated by PR. Improvements in components of frailty, including gait speed and exhaustion, could meaningfully impact functional capacity and quality of life. Additional research is needed to optimize PR and identify adjuvant therapies that may augment its impact on frailty.

CITATION INFORMATION: Kennedy C., Novotny P., Stevens E., Kirsch J., Garrett J., LeBrasseur N., Benzo R. Prospective Trial Using Pulmonary Rehabilitation to Treat Frailty Am J Transplant. 2017;17 (suppl 3).

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