Pulmonary rehabilitation in lung transplantation: Its effects on pulmonary function, physical fitness, and quality of life.

Lung transplantation (LTx) is the definitive therapy for patients with end-stage lung disease and improves survival. However, many recipients continue to experience exercise intolerance, reduced physical capacity, and limitations in daily activities despite improved postoperative lung function. These impairments are multifactorial and closely associated with quality of life (QoL) and long-term outcomes. Pulmonary rehabilitation (PR) is a multidisciplinary intervention aimed at improving exercise capacity, physical fitness, and QoL and has demonstrated benefits across various chronic lung diseases. This narrative review synthesizes current evidence on PR in LTx recipients. A literature review was conducted to summarize PR program characteristics, safety, and reported outcomes across lung function, functional capacity, muscle fitness, activity and participation, and QoL, considering heterogeneity in study design and intervention protocols. Across the reviewed studies, PR participation was consistently associated with improvements in cardiorespiratory fitness, muscle strength, functional capacity, and QoL. In contrast, changes in spirometric parameters were generally modest. Functional improvements appear to be largely mediated by peripheral adaptations, including enhanced oxygen utilization and neuromuscular performance. These findings highlight the potential role of PR as an important component of short- and long-term management in LTx recipients, particularly during pre-transplant conditioning and post-transplant functional recovery phases.