Physical Activity and Exertional Desaturation Are Associated with Mortality in Idiopathic Pulmonary Fibrosis

Abstract

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease that manifests in hypoxemia, inactivity, and poor prognosis. This study aimed to assess the prognostic role of physical activity (PA) and exertional desaturation (ED) with mortality in IPF. At baseline, 34 IPF patients (68 (50–81) years) were interviewed using the International Physical Activity Questionnaire (IPAQ), and SpO2 was assessed pre to post 6-min walking test (∆SpO2). Patients were prospectively followed up for 40 months. Receiver operating characteristics curve analysis determined cut-off points associated with mortality, and Cox proportional hazard ratio (HR) were conducted. Thresholds for increased mortality risk in IPF patients were determined as IPAQ ≤ 417 metabolic equivalent task (METS)-min/week, p = 0.004 (HR; 9.7, CI 95% (1.3–71.9), p = 0.027), and ∆SpO2 ≥ 10%, p = 0.002, (HR; 23.3, CI 95% (1.5–365), p = 0.025). This study demonstrated a significant association of PA and ED with mortality in IPF patients. The findings emphasize the clinical importance of PA and ED assessments to aid in IPF risk stratification, prognosis prediction, and in providing early appropriate treatments, such as pulmonary rehabilitation, PA consultation, oxygen supplementation, and lung transplantation referral. These results underscore that even low levels of PA corresponding to 100–105 min/week were associated with a reduced mortality risk and better survival in IPF.

Lifestyle Behaviors and Clinical Outcomes in Idiopathic Pulmonary Fibrosis

“…Recently, the ATS and ERS documented that inactivity among chronic respiratory disease patients is associated with poorer outcomes including higher mortality risk [6]. These reports were confirmed with findings in IPF patients on the association between low activity and poorer survival [9,11,25]. In addition, sitting and walking times, as we observed in the current study, were inversely correlated, providing preliminary evidence of their combined protective benefits against adverse events in IPF (Table 3, Fig.…”

“…Similarly, our group previously reported better survival in individuals with moderate and high compared to low physical activity levels among IPF patients [25]. While, Atkins et al [10] found only a trend towards an association between sedentary behaviors and mortality at 1 and 2 years' follow-up in IPF patients.…”

“…During the interview, these questions were explained and understanding was verified. We have previously reported on the association between total physical activity and mortality in IPF [25]. The current study addressed the specific sitting and walking components in association with hospitalizations and mortality, data that are original and have not been reported elsewhere.…”

Exertional dyspnoea in interstitial lung diseases: the clinical utility of cardiopulmonary exercise testing

“…An even more robust body of evidence shows that exercise tolerance represents a strong end-point to predict the prognosis of ILD patients [76]. In FELL et al's study [12], survival was retrospectively calculated from the date of the first CPET in 117 subjects with IPF.…”

Clinical characteristics and factors associated with mortality in idiopathic pulmonary fibrosis: An experience from a tertiary care center in Pakistan

“…The diagnosis and management of the disease is complicated in the elderly population where the non-specific symptoms of cough and dyspnea can be attributed to other comorbidities like heart failure and chronic obstructive pulmonary disease. 21 Low mixed venous oxygen saturation has also been shown to be a poor predictor of survival in patients with pulmonary hypertension associated with chronic fibrosing idiopathic interstitial pneumonia. 19 Older age has been shown to worsen the prognosis of patients with IPF, supporting the results of this study.…”