New pulmonary rehabilitation exercise for pulmonary fibrosis to improve the pulmonary function and quality of life of patients with idiopathic pulmonary fibrosis: a randomized control trial

Abstract

Background: The aim of our study is to investigate the impact of the simple breathing exercises (LHP's respiratory rehabilitation for pulmonary fibrosis, LHP's RRPF) on patients with idiopathic pulmonary fibrosis (IPF).Methods: (I) The safety and effectiveness of LHP's RRPF were first verified in 20 healthy individuals. (II) A total of 101 patients with IPF administrated in Shanghai Pulmonary Hospital between January 2015 and May 2017 were screened, and 82 cases were randomly assigned to receive a 12-month LHP's RRPF program (exercise group) or usual medical care (control group). Lung function, chest X-ray, 6-minute walk distance (6MWD), quality of life (St. George's Respiratory Questionnaire, SGRQ), and EKG were measured at the 6 th and 12 th month during the trial.Results: At the 6 th month visit, the exercise group showed improved SGRQ score and lung function parameters (FVC, FEV1, and DLCO). At the 12 th months visit, the exercise group had significantly improved SGRQ score, 6MWD, and lung function (FVC, FEV1, and DLCO) compared to the control group (P<0.05).No obvious adverse events occurred in the exercise group. The incidence of acute exacerbation and one-year mortality were 7.69% and 2.56%, respectively in the exercise group, which were lower than those (20.9% and 9.3%, respectively) in the control group.Conclusions: LHP's RRPF can delay the pulmonary function decline of patients with IPF and improve their quality of life. This breathing exercise may be an adjunct to pulmonary rehabilitation for IPF.

Baseline Stiffness Modulates the Non-Linear Response to Stretch of the Extracellular Matrix in Pulmonary Fibrosis

“…Nevertheless, it is unknown whether such positive effects of exercise in experimental and clinical lung fibrosis are caused by the reparative events elicited by exercise (e.g., in the inflammatory cascade) or by the increased lung stretching associated with exercise. However, it is interesting to note that a recent clinical trial in patients with lung fibrosis has shown that an exercise program involving only the lung (based exclusively on deep breath exercises) improved the pulmonary function and quality of life of patients [ 46 ]. All these indirect data are concurrent with our findings here that stretch induces strain-softening in fibrotic ECM, which could thus promote both restoration of lung mechanics and fibroblast reprogramming.…”

Clinical evidence for improving exercise tolerance and quality of life with pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis: A systematic review and meta-analysis

“…The meta-analysis of six studies 15,18,20,21,23,25 that provided data on diffusing capacity for carbon monoxide showed an improvement in favor of pulmonary rehabilitation (mean difference: 4.71, 95% confidence intervals: 0.96 to 8.46, P = 0.01). Significant heterogeneity was found between the studies (χ 2 = 21.64, P = 0.0006, I 2 = 77%) (Figure 7).…”

“…The main characteristics of these eleven trials [14][15][16][17][18][19][20][21][22][23][24][25] are presented in Table 1a. These were published between 2008 and 2021 in seven countries, namely, the United States of America, China, Germany, Israel, Denmark, Japan, and Poland, with five studies performed in middle-high income countries and six in high-income countries.…”

“…The severity of idiopathic pulmonary fibrosis ranged from mild to moderate in most studies. In addition, all studies [14][15][16][17][18][19][20][21][22][23][24][25] reported the frequency of pulmonary rehabilitation, four studies reported the applications of oxygen therapy, [14][15][16]18 and four studies [14][15][16]21 reported the intensity of exercise. The characteristics of the pulmonary rehabilitation programs are provided in Table 1b.…”

“…Three other well-performed two randomized controlled trials on the efficacy of pulmonary rehabilitation for idiopathic pulmonary fibrosis were published in 2021. [23][24][25] Therefore, we conducted a metaanalysis to evaluate the efficacy and safety of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis and to provide the best evidence for pulmonary rehabilitation in idiopathic pulmonary fibrosis.…”