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Background Loss of bone mineral and skeletal muscle mass is common after lung transplantation (LTx), and physical activity (PA) may prevent further deterioration. We aimed to assess the effects of 20-week high-intensity training (HIT) on body composition, bone health, and PA in LTx recipients, 6–60 months after surgery. Methods In a randomized controlled trial, 51 LTx recipients underwent Dual-energy X-ray absorptiometry (DXA), and PA level and sedentary time were objectively recorded by accelerometers for seven consecutive days. Of these, 39 participants completed the study, including 19 participants in the HIT group and 20 participants in the standard care group. Results Following the intervention, ANCOVA models revealed a nonsignificant between-group difference for change in lean body mass (LBM) and bone mineral density (BMD) of the lumbar spine of 0.4% (95% CI = −3.2, 1.5) (p = .464) and 1.0% (95% CI=−1.3, 3.4) (p = .373), respectively. Trabecular bone score (TBS) of the lumbar spine (L1-L4), however, increased by 2.2 ± 5.0% in the exercise group and decreased by −1.6 ± 5.9% in the control group, giving a between-group difference of 3.8% (95% CI=0.1, 7.5) (p = .043). There were no between-group differences in PA or sedentary time. Conclusion High-intensity training after LTx improved TBS significantly, but not PA, LBM or BMD.

ObjectivesChronic obstructive pulmonary disease and silicosis are associated with exposure to crystalline silica. We determined the exposure to respirable crystalline silica and estimated exposure–response relationships between cumulative exposure and pulmonary function in outdoor rock drillers.Methods136 rock drillers and 48 referents were recruited from three heavy construction companies. 98 air samples were collected by personal sampling for determination of respirable particulate matter and crystalline silica. Information about individual job tasks, type of drilling equipment and years of exposure in different job categories was obtained by interview. Cumulative exposure to crystalline silica was calculated for all workers. Pulmonary function was assessed by spirometry. A subgroup of 39 subjects with high cumulative exposure to crystalline silica underwent high-resolution computed tomography (HRCT).ResultsCumulative exposure (mean (min–max)) to crystalline silica was 0.69 mg٠years m–3 (0.01–5.89) in the exposed group. Mean time of exposure among rock drillers was 10.7 years (1–42). Compared with referents, the rock drillers had a lower forced expiratory volume in one second/forced vital capacity ratio (79.4 vs 81.4, p–3/years. Silicosis was not detected in HRCT, but other patterns of fibrosis and emphysema were seen.ConclusionsOutdoor rock drillers exposed to crystalline silica had significantly lower pulmonary function than referents, and signs of airflow obstruction. Silicosis was not detected.

Background: Physical fitness after lung transplantation (LTx) is often severely reduced, despite improvement in lung function. Low physical fitness is associated with increased mortality. We hypothesized that high-intensity training (HIT) would improve peak oxygen uptake (VO2peak) and muscular strength after LTx. Methods: In a randomized controlled trial, 54 LTx-recipients were enrolled 6-60 months after surgery. The HIT group (n=25) followed a 20-week endurance and strength training program three times a week. The control group (n=29) followed the hospital’s general recommendations for physical activity. All patients completed a maximal cardiopulmonary exercise test, arm- and leg press pre- and post-intervention. The primary outcome was change in VO2peak as a measure of cardiorespiratory fitness. Secondary outcomes were change in one-repetition maximum (1RM) in arm- and leg press as measures of muscular strength. ANCOVA was used for per-protocol analyses based on ≥70% attendance of the prescribed sessions. Data are presented as mean±SD. Results: VO2peak at baseline was 71±14 and 68±14% of predicted in the HIT- and control group, respectively. No adverse outcomes related to HIT were reported. Conclusion: HIT improved VO2peak and muscular strength. HIT may represent an effective form of exercise therapy that improves physical fitness and health outcomes after lung transplantation.

Introduction: Cardiorespiratory fitness (VO2peak) remains low after lung transplantation (LTx) despite improvement in lung function. The extent and reasons for this are unclear. Aim: To evaluate the cardiopulmonary response during a maximal cardiopulmonary exercise test (CPET) in LTx recipients, and to detect exercise limiting factors. Method: Bilateral-LTx recipients (n=47, age 20-67 years, 23 men) underwent a treadmill CPET. Exercise limiting factors were classified as a breathing reserve (BR) Results: Median (range) time since LTx was 29 (6-59) months. The table shows the physiological response during CPET. Five patients had a VO2peak within normal range (VO2peak>80% predicted). Six patients had a small BR, which indicates ventilatory limitations, and 3 had exercise-induced hypoxemia. Thirty-five demonstrated a low VO2peak having none of the limitations above. Seventeen had inefficient ventilation, but did not desaturate. Conclusion: LTx recipients demonstrated low cardiorespiratory fitness. One-fifth had cardiorespiratory limitations, whereas a majority was deconditioned without such limitations. This may suggest a substantial need for exercise training after LTx.