Rehabilitation for Physical Frailty in Lung Transplant Candidates: A Systematic Review.

Thirteen of the 15 studies were before-and-after designs with no group that did not exercise, so improvements cannot be attributed to the intervention rather than to time, disease progression, or concurrent treatments. Only one randomised trial was included, and it was retained for completeness because it had not reported frailty outcomes; it does not contribute to the frailty evidence. Interventions varied widely in content, dose, duration (4 to 12 weeks), and delivery mode, making it impossible to identify which components or doses are effective. Four of the 15 studies were available only as abstracts, limiting the depth of quality assessment and data extraction. Most studies used completed-case analysis rather than intention-to-treat, and attrition reasons (transplant, delisting, death, drop-out) were often unexplained. There is no agreed core outcome set for exercise studies in this population, so studies measured different frailty and surrogate measures, limiting comparability. Vote counting captures the direction of effect but not its magnitude or clinical importance.

Several authors held part-time positions or fellowships funded by the NIHR Applied Research Collaboration Greater Manchester. No industry body, device manufacturer, or treatment vendor funded, designed, or wrote the study. The authors state that the views expressed are their own and not necessarily those of the NHS, NIHR, or the Department of Health and Social Care.

Do not read the consistent improvements in walking speed and sit-to-stand time as proof that exercise reduces frailty in lung transplant candidates. Thirteen of the fifteen studies compared patients to themselves before and after exercise with no group that did not exercise, so the changes could reflect time, disease course, or other treatments. The outcomes that would matter most for a transplant decision (post-operative hospital stay, quality of life) showed no significant benefit in the three studies that measured them.