Among patients with cystic fibrosis (CF), rehabilitation is prescribed both before and after lung transplantation in an effort to optimize fitness and expedite post-transplant recovery, according to findings from a study published in Chronic Respiratory Disease.

Evidence supports the use of exercise to improve pulmonary function, enhance health-related quality of life, and facilitate mucociliary clearance in individuals with CF. In fact, in individuals who are candidates for lung transplantation, higher exercise capacity is linked to decreased morbidity and mortality pre- and post-transplant.

The use of telerehabilitation provides patients with support closer to their homes, thus increasing their adherence and access to services. The use of telerehabilitation is extremely beneficial for individuals with CF, who are at risk of infection.

The current analysis utilized semistructured interviews with patients and healthcare providers. The researchers sought to acquire in-depth insight into the perceptions and experiences associated with receiving/prescribing rehabilitation care both prior to lung transplantation and in the initial post-transplant period among adults with CF.

The study was conducted at a single lung transplantation center—the University Health Network (UHN) in Toronto, Canada. Among outpatients with CF, rehabilitation services were delivered mainly at home, with in-person sessions that occurred once weekly to once monthly based on coronavirus disease 2019 (COVID-19) restrictions and patients’ state of health, level of conditioning, and access/adherence to home exercise. Among inpatients, rehabilitation took place at the adult CF center of Unity Health Toronto (UHT) prior to transplantation and at UHN following surgery.

Eligible study participants were divided into 2 groups:

  • Patients aged 18 or more years with CF who were awaiting lung transplantation or who had undergone the surgery between March 2020 and June 2021
  • Healthcare providers at UHN or UHT who delivered or rendered clinical decisions regarding post-lung transplantation rehabilitation.

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From February 2021 to October 2021, 11 individuals were interviewed, including 5 patients and 6 healthcare professionals. Four patients had undergone 1 or 2 lung transplantations and 1 was awaiting a retransplantation. The healthcare professionals included 4 physiotherapists, 1 physiotherapy assistant, and 1 respirologist.

In all patients, rehabilitation was delivered both in-person and virtually with the use of a remote monitoring app.

There were 6 key themes identified about experiences/perceptions of both receiving and prescribing rehabilitation services prior to and following lung transplantation:

  • Structured exercise benefits both physical and mental health pre- and post-transplantation.
  • CF-specific physiologic impairments were a major barrier to exercise.
  • Collaborative and supportive relationships, either in-person or virtually, facilitated exercise participation.
  • More CF-specific exercise evidence, guidance, and resources are needed.
  • Experience with telerehabilitation and e-health tools during the COVID-19 pandemic resulted in preferences for a hybrid model.
  • Virtual platforms and clinical workflows required additional optimization.

“Further evidence and resources to support inpatient, outpatient, and home-based rehabilitation in CF is needed,” the researchers concluded.


Wickerson L, Grewal R, Singer LG, Chaparro C. Experiences and perceptions of receiving and prescribing rehabilitation in adults with cystic fibrosis undergoing lung transplantation. Chron Respir Dis. Published online March 29, 2023. doi:10.1177/14799731221139293