Physical Therapy After Lung Transplantation

Before initiating any exercise program, consult with your physician and or physical therapist.

Airway Clearance

The Active Cycle of Breathing

Put one hand on the top part of your chest. Now put the other hand on your belly or abdomen. Breathe in through your nose. Don't let your chest move. Can you feel your abdomen go out like a balloon?

This way of breathing in (inhaling) is using the diaphragm. (That's the part right there, just below your chest). Now do it again. Be sure the hand on your chest is still as you breathe in through the NOSE. The hand on your abdomen moves up.

Before initiating any exercise program, consult with your physician and or physical therapist.

Breathing Exercises

  • Incentive spirometer
  • Diaphragmatic breathing
  • PNF D2 flexion/extension with deep breathing

Cardiovascular Exercises

Home walking program/cycle ergometer program (to be started in house)

Walking is a good form of cardiovascular exercise. The walking program is designed to help you increase your endurance gradually and to strengthen your heart and lungs. Consider the following guidelines in establishing your walking routine:

  • Pick a convenient time to walk. Stick to that time.
  • Walk on level ground.
  • Walk continuously (without rests) if possible. 
    Walk at an even pace.
  • Let your arms swing. Don't carry anything.
  • Wear comfortable shoes and clothing.
  • If you experience exercise fatigue, shortness of breath, or dizziness, REST, and decrease the amount of walking the next day.
  • Avoid extremes of weather.
  • Avoid exercising right after a big meal.
  • Follow the recommended schedule.

How fast should I walk?

In the beginning, walk at a pace that you feel comfortable. When you reach 20 minutes per day, then start and end your walks with a five minute warm-up and cool-down, increasing your pace in between. If you use the Borg scale of breathlessness, walk at a perceived breathlessness of about 3 on a scale of 1 to 10. If you use the Borg scale of perceived exertion, walk at an intensity of 11–13 out of 20 for the first 6 to 8 weeks following surgery. After that, if you are not limited by breathlessness, you may walk at an intensity of 13–15.

What about outpatient pulmonary rehabilitation?

Outpatient pulmonary rehabilitation may be indicated following surgery. It is a good way to provide structure to your exercise program, to obtain further monitoring, education, and group support, and to begin a more vigorous strengthening and cardiovascular exercise routine. Proper strengthening is important in helping to overcome the effects of the immunosuppressive regimen and to improve your overall functioning in daily life. Ask your therapist about a pulmonary rehabilitation program near you, or call 212.305.0890, the outpatient pulmonary rehabilitation program at Columbia University Medical Center of NewYork-Presbyterian Hospital. Participation in pulmonary rehabilitation will require a doctor's prescription. And you should check your insurance to see if it covers such a program.

Before initiating any exercise program, consult with your physician and or physical therapist.

Strengthening Exercises: Lower Extremity Exercises

In bed: Knee to chest; Hip abduction/adduction (supine); Ankle pumps; Bridging; Straight leg raise; Hip abduction in sidelying

"Knee to Chest" 

  1. Lie on back
  2. Bend hip and knee, raising foot off bed as shown
  3. Slowly lower leg back to bed
  4. Repeat 10 times on each leg

"Scissors" 

  1. Lie on your back
  2. Spread one leg out to the side as far as is comfortable
  3. Slowly bring leg back to the center
  4. Repeat 10 times each leg

"Ankle Pumps" 

  1. Bend ankle up toward your body as far as possible
  2. Now point toe away from your body
  3. Repeat 10 times (can do both feet at once)

"Bridging" 

  1. Lie on back with legs bent as shown
  2. Lift buttocks
  3. Repeat 10 times

"Straight Leg Raise" 

  1. Lie on back with one knee straight and the other knee bent as shown
  2. Keep the leg completely straight, then raise it about 6–12 inches
  3. Slowly lower back down to bed
  4. Repeat 10 times each leg

"Sidelying Leg Lifts" 

  1. Lie on side
  2. Bend lower leg slightly
  3. Raise to leg straight up, without letting it come forward
  4. Lower back to starting position
  5. Repeat 10 times. Roll onto other side to do opposite leg 
In the chair: Hip flexion; Ankle pumps; Knee extension; Sit to stand

"Marching in Sitting" 

  1. Sit comfortably
  2. Lift one leg up towards chest
  3. Slowly lower foot back down to floor
  4. Repeat 10 times (may alternate legs)

"Knee Straightening" 

  1. Sit with your thighs fully supported
  2. Straighten one knee fully
  3. Slowly lower
  4. Repeat 10 times each leg (may alternate)

"Ankle Pumps" 

  1. Bend ankle up toward your body as far as possible
  2. Now point toe away from your body
  3. Repeat 10 times (can do both feet at once)

"Sit to Stand" 

  1. Sit on edge of chair, feet flat on floor
  2. Stand upright
  3. Repeat 10 times 
Standing: Standing calf lift; Mini-squat (wall squat)

"Calf Lifts" 

  1. Hold something sturdy for balance
  2. Slowly raise up onto toes
  3. Return to floor
  4. Repeat 10 times

"Mini-Squats" 

  1. Stand with back to the wall, feet hip distance apart
  2. Slowly bend knees to do mini-squat
  3. Slide back up wall to standing position
  4. Repeat 10 times

Strengthening Exercises: Upper Extremity Exercises

In bed (on the mat)

"Biceps Curl"

  1. Start with arm down at side, palm up
  2. Lift weight up by bending elbow
  3. Upper arm should be motionless
  4. Slowly lower arm to starting position
  5. Repeat 10 times each side

"Triceps Curls"

  1. Hold weight in hand
  2. Lie on back with elbow bent and pointing directly upward
  3. Support the arm with the other hand as shown
  4. Straighten the elbow
  5. Repeat 10 times each side

"Bench Press"

  1. Lie on back with weight in hand
  2. Place arm out to side with elbow bent as shown
  3. Straighten elbow lifting weight towards ceiling
  4. Repeat 10 times, may do both arms at once
Anterior arm lift

"Forward Arm Lifts"

  1. Stand with arms at side (holding weights if applicable)
  2. Raise arm(s) up to shoulder level
  3. Slowly lower
  4. Repeat 10 times

"Thumbing a Ride"

  1. Begin with arm resting across lap as shown
  2. Open your hand, turn out, and lift up and out
  3. Close your hand, turn in, and pull down to starting position
  4. Eyes on your hand
  5. Breathe in as you lift your arm
  6. Breathe out as you lower your arm
  7. Perform 3 – 5 times slowly on each arm

Strength/Postural Exercises

  1. Neck and trunk: Shoulder circles; Cervical range of motion; Trunk lateral flexion
  2. Lower extremities: Hamstring stretch; Calf stretch
  3. 6 weeks post surgery
    • Shoulder flexion overhead
    • Shoulder abduction and horizontal abduction standing against wall.
    • Elbows out into sides with fingers locked behind neck.

"Shoulder Circles"

  1. Begin with shoulders in a relaxed position
  2. Slowly lift shoulders upward, around, and back
  3. Return to starting and repeat 5 times in each direction

"Neck Rolls"

  1. Sit or stand with good posture
  2. Bend head to one side and slowly rotate towards the other side and around
  3. Repeat 5 times in each direction

"Side Bends"

  1. Place hands on hips as shown
  2. Lean to one side until you feel a stretch
  3. Hold 3 – 5 seconds
  4. Repeat 5 times each side

"Hamstring Stretch"

  1. Sit with leg propped as shown
  2. Relax, letting the leg straighten
  3. Lean forward, keeping the back straight
  4. Hold 30 – 60 seconds, repeat each leg

"Calf Stretch"

  1. Hold wall or counter for balance 
  2. Position one foot behind with heel down and knee straight
  3. Feet should be pointing directly forward 
  4. Hold 30 – 60 seconds, repeat each leg

Before initiating any exercise program, consult with your physician and or physical therapist.