Recovery after lung transplantation (LTx) may be complicated by prolonged mechanical ventilation (MV) and protracted intensive care unit (ICU) stay leading to immobilization and impaired health-related quality of life (HRQoL). In the critical care setting, diaphragm atrophy and weakness have been associated with difficulty weaning from MV, increased risk for readmission to hospital or ICU, and increased mortality. Increasing respiratory muscle strength by inspiratory muscle training (IMT) as part of pre-rehabilitation mitigates respiratory muscle dysfunction peri-operatively and may reduce the risk of post-operative complications. However, IMT is not widely used prior to LTx and the benefits of pre-operative IMT on post-transplant outcomes in LTx candidates have not been studied. Objectives: (1) To evaluate the feasibility of a multicenter randomized clinical trial of IMT in LTx candidates in terms of recruitment rate, retention, program adherence, and outcome ascertainment; (2) To establish the change in pre-transplant dyspnea perception, diaphragm structure and function, health related quality of life (HRQoL) and post-transplant intensive care unit (ICU), hospital and post-transplant 3-month outcomes with IMT relative to usual care group; and (3) To characterize the effect of pre-transplant IMT on peri-transplant diaphragm myofibrillar cross-sectional area (CSA), oxidative capacity, inflammatory markers and post-transplant diaphragm muscle thickness and function (UHN TGH site).
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Study Recruitment According to Research Team Records
Timeframe: Over study recruitment period (approximately 2 years)
Participant Retention in the Study According to Research Team Records
Timeframe: Over the study data collection period (from enrolment until 3 months post-transplant)
Self-Reported Adherence to Inspiratory Muscle Training According to Participant IMT Diary
Timeframe: Over intervention period (from randomization until time of transplantation, up to maximum of 24 months)
Adverse Events and IMT Training Side Effects Reported by Participants
Timeframe: Over intervention period (from randomization until time of transplantation, up to maximum of 24 months)
Inspiratory Muscle Training Satisfaction Questionnaire (IMT Group Only)
Timeframe: At 3 months post-transplant follow-up