Misty Clyde ran up and down several sets of bleacher stairs at
Stanford University's Cobb Track before pausing to stretch against a
handrail. Her new lungs – or, as she sometimes refers to them, her
recycled lungs – were working fine. And she aimed to keep them that way.
It was the last Wednesday of March and the first warm day of spring.
Clyde, 28, who got her recycled lungs in 2008, was working out with a
half-dozen other organ recipients who meet every week for what they
call Transplant Boot Camp. Most had cystic
fibrosis, a genetic disease that causes thick mucus to build up in
the lungs and digestive tract. All had undergone transplant surgery at
Stanford Hospital. They said the boot camp motivates them to exercise.
Two decades ago, physicians were leery of recommending much physical
activity for new organ recipients. But their doubts have largely been
erased in the intervening years as study after study has shown that,
for most patients, exercising as soon as a few weeks after a
transplant operation can improve cardiopulmonary function and quality
of life, as well as counteract some of the side effects of medication.
A recent study by Dutch researchers, published online March 3 in the
Clinical Journal of the American Society of Nephrology, even
found that exercise is linked to increased longevity among
Stanford Hospital's David Weill,
MD, medical director of the Lung and Heart-Lung Transplant Program
and director of the Adult
Cystic Fibrosis Center, called himself a "huge
advocate" of exercise for his patients. "The lungs are the
body's oxygenator, if you will, and what exercise does is train your
muscles to use the oxygen that's available most efficiently,"
said Weill, who is also an associate professor of pulmonary and
critical care medicine at Stanford University School of Medicine.
"That's a huge benefit, whether or not you've had a transplant."
The first successful lung transplant was performed as part of a
combined heart-lung transplant at Stanford Hospital in 1981. The
hospital now performs as many as 50 lung transplants each year,
putting it in the top 10 percent of the most active lung-transplant
centers nationwide. At 94 percent, the hospital also has the highest
national one-year survival rate among lung-transplant patients – a
commonly used quality measure of lung-transplant programs.
The Transplant Boot Camp at Stanford began as an offshoot of workouts
attended by several athletes training for the 2008 U.S. Transplant
Games. Two competitors, identical twins Anabel Stenzel and Isabel
Stenzel Byrnes, decided last year to organize similar workouts open to
all members of the local transplant community. The sisters, who have
cystic fibrosis, understand the extra effort it takes for organ
recipients to exercise; all must adhere to a regimen of steroids,
immunosuppressants and other drugs that impair muscle health. Organ
recipients have to work harder than others to build muscle and gain
the aerobic benefits of exercise, said Anabel Stenzel, who has had two
lung transplants – the first in 2000 and the second 2007. (Her sister
had a lung transplant in 2004.) "We were always told that you
have to exert twice the effort for half the reward," she said.
But experts say the payoff is worth it.
Weill cited several studies showing that exercise benefits
transplant recipients’ quality of life and emotional health. He said
many other studies have shown that exercise both before and after
lung-transplant surgery tends to make cardiopulmonary function more
efficient; strengthen muscles, especially respiratory muscles; and
ensure good bone density. However, there is no statistically reliable
study showing that exercise can increase the longevity of lung
recipients, he said, because of the difficulty of isolating exercise
as a single factor influencing survival.
Still, Stenzel believes exercise is a key factor to enjoying a longer
life as a transplant patient. "Everyone I know who has lived 10
years post-transplant is an active exerciser," she said. "It
improves well-being, but maybe more importantly helps decrease the
side effects of the medication. I believe exercise is as important as
immunosuppression and is not stressed enough by transplant doctors."
The boot camp also gives organ recipients a chance to share stories
and check up on one another. "It's really about
camaraderie," Stenzel continued. "There are people who join
us with only 45 or 55 percent lung capacity, and they can do only so
much. But we're all in this together. We're here to do our best. We're
not as strong as healthy people, and hanging out with a group that
understands that is important. We also feel enormously lucky. Apart
from the birth of a baby, transplantation is one of the true miracles
that happen in a hospital."