Long-term effect of pulmonary rehabilitation in idiopathic pulmonary fibrosis: a randomised controlled trial

Abstract

BackgroundIdiopathic pulmonary fibrosis (IPF) is characterised by worsening dyspnoea and exercise intolerance.Research questionDoes a long-term pulmonary rehabilitation improve exercise tolerance in patients with IPF treated with standard antifibrotic drugs, which are expected to reduce disease progression?MethodsThis open-label randomised controlled trial was performed at 19 institutions. Stable patients receiving nintedanib were randomised into pulmonary rehabilitation and control groups (1:1). The pulmonary rehabilitation group underwent initial rehabilitation which included twice-weekly sessions of monitored exercise training for 12 weeks, followed by an at-home rehabilitation programme for 40 weeks. The control group received usual care only, without pulmonary rehabilitation. Both groups continued to receive nintedanib. The primary and main secondary outcomes were change in 6 min walking distance (6MWD) and change in endurance time (using cycle ergometry) at week 52.ResultsEighty-eight patients were randomised into pulmonary rehabilitation (n=45) and control (n=43) groups. Changes in 6MWD were −33 m (95% CI −65 to −1) and −53 m (95% CI −86 to −21) in the pulmonary rehabilitation and control groups, respectively, with no statistically significant difference (mean difference, 21 m (95% CI −25 to 66), p=0.38). Changes in endurance time were significantly better in the pulmonary rehabilitation (64 s, 95% CI −42.3 to 171)) than in the control (−123 s (95% CI −232 to −13)) group (mean difference, 187 s (95% CI 34 to 153), p=0.019).InterpretationAlthough pulmonary rehabilitation in patients taking nintedanib did not improve 6MWD in the long term, it led to prolonged improvement in endurance time.Trial registration numberUMIN000026376.

Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients With COPD, Heart Failure, or Interstitial Lung Disease

“…Compared with other interventions described in this paragraph, ADAPT was a single intervention that led to improvements for multiple illnesses, not only in overall quality of life but also depression and anxiety symptoms and disease-specific health status. The magnitude of the intervention effects on quality of life, depression, and anxiety are comparable with or greater than other palliative care and disease-specific care delivery interventions, pharmacotherapy, and psychotherapy . Specifically, palliative care has demonstrated a standardized mean effect of 0.27 (95% CI, 0.15-0.38) on patient quality of life in advanced cancer in a Cochrane review and 0.46 (95% CI, 0.08-0.83) in another meta-analysis .…”

“…In ILD, a nurse-led early palliative care intervention improved knowledge and disease preparedness but not quality of life, anxiety, or depression . A recent trial of pulmonary rehabilitation in ILD had mixed effects and did not evaluate quality-of-life outcomes …”

The Beneficial Impact of Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis: A Review of the Current Literature

“…Moreover, such side effects can impair HRQOL, exercise tolerance, and daily life. Considering the available evidence [29,50], which shows an increase in 6MWD and HRQOL and a reduction in dyspnoea following PR, therapy with AFDs should be integrated by non-pharmacological programmes, especially PR. To date, only a few studies have focused on the effects of the combination of AFDs and PR.…”

“…The FITNESS study [29] was the first RCT to evaluate the long-term effects of a combination of outpatient and home-based PR schemes in IPF patients taking AFDs. Although no significant difference in 6MWD was found between the two groups after completing the 52-week training period, the change in ET using a cycle ergometer was significantly better in the PR group than in the control one, with a ∆ET of 187 s. This result confirms the importance of a multidisciplinary approach to IPF patients and underscores the importance of PR as a therapeutical asset to improve the wellbeing of patients.…”

“…Moreover, PR can take place in different settings, thus affecting the adherence degree of the patient as well as the overall effectiveness of the therapy. Most of the studies so far included in this review took place in a supervised outpatient [22,23,25,27,[31][32][33][34]49] or inpatient [28] setting, while only a few were conducted as home-based [24,33,35] or combined [26,29] PR programmes. Home-based PR is a self-care-based, mostly unsupervised intervention in which the physiotherapist provides a training scheme and the participants perform the PR exercise by themselves.…”