Exercise Training-Based Pulmonary Rehabilitation Program Is Clinically Beneficial for Idiopathic Pulmonary Fibrosis

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, devastating, interstitial lung disease, with few therapeutic options. IPF is characterized by pulmonary restriction, dyspnea, hypoxemia, exercise intolerance and poor quality of life (QOL). Objectives: We aimed to examine the effect of exercise training (ET) on clinical outcomes in IPF patients. Methods: A randomized controlled study included thirty-two IPF patients (aged 68 ± 8 years) who were allocated either to the ET group (n = 15), participating in a 12-week, twice-weekly 60-min supervised ET-based pulmonary rehabilitation program, or to a control group (n = 17) continuing with regular medical treatment alone. Cardiopulmonary exercise test, 6-min walking distance (6MWD) test, 30-second chair-stand test, pulmonary function tests, dyspnea and QOL were assessed at baseline and at the end of the 12-week intervention. Results: Significant differences were observed between the ET and the control groups in raw mean deltas (Δ = post- - pre-intervention): Δ6MWD, 81 m, p < 0.001; ΔV<smlcap>O</smlcap>₂ peak, 2.6 ml/kg/min, p = 0.002; Δwork rate, 22 W, p < 0.001; Δanaerobic threshold, 3.1 ml/kg/min, p < 0.001, and ΔFVC % predicted, 6%, p = 0.038. Dyspnea, QOL and 30-second chair-stand were also improved significantly following the program. Conclusions: ET improves exercise tolerance, functional capacity, pulmonary function, dyspnea and QOL in patients with IPF, suggesting a short-term treatment efficacy for clinical improvement, and should be considered the standard care for IPF.

The Prognostic Role of Ventilatory Inefficiency and Exercise Capacity in Idiopathic Pulmonary Fibrosis

“…21 All subjects completed the tests without adverse events. Demographic, cardiopulmonary, and exercise data are presented in Table 1.…”

“…In the current study, subjects from our previous exercise training study 21 were followed up until 40 months from baseline. Thirty-eight IPF patients treated in the Pulmonary Institute were screened for eligibility to participate in the study.…”

“…22 According to 50-m improvement in 6-min walk distance, a power analysis before the recruitment revealed that a total of 30 participants were needed (15 in each group) to detect a significant difference between the groups. 21,22 Thirty-four subjects volunteered and were recruited based on a 10% expected dropout rate in a previous exercise training study in ILD. 23 Demographic characteristics were obtained from all subjects, and evaluation for dyspnea by the Modified Medical Research Council scale was made.…”

“…Sealed envelopes containing each subject's intervention allocation were randomly opened, and the subject was assigned to either an exercise training group (n ϭ 16), where the subject participated in a 60-min, twice weekly, supervised exercise program for 12 weeks, or a control group (n ϭ 18), where the subject continued with the usual care alone. 21 In the current study, baseline data of subjects in both groups (n ϭ 34) were used to determine the prognostic predictors of survival. Subjects were tested as described below and followed up for 40 months from baseline.…”

Respiratory Rehabilitation in Interstitial Lung Diseases

“…Then: How do we explain that patients increased the meters walked in the walk test? Although we are aware that the increase of the meters walked may have been due to multivariate variables such as increased patient motivation and training of the respiratory muscles and peripheral post intervention 27,28 we dare to say that this result may be due to improved oxygen performance, i.e. peripheral oxygen extraction increased in the muscle, when measuring the oxygen saturation with a pulse oximetry we are measuring the concentration of oxygen bound to hemoglobin, but unfortunately we do not know the oxygen concentration that would be attached to the myoglobin in a muscle level.…”