Pulmonary rehabilitation outcome of exercise-induced oxygen desaturation in systemic sclerosis with interstitial lung disease

Abstract

While exercise capacity in systemic sclerosis with interstitial lung disease could be improved by exercise training, the training outcome of exercise-induced oxygen desaturation has not been examined. The aim of this study was to investigate the effect of pulmonary rehabilitation on exercise-induced oxygen desaturation during the six-minute walk test and to detect the factors affecting outcome retrospectively. Patients showing impaired exercise capacity (≤80% of predicted) and/or exercise-induced oxygen desaturation (≤−4% in SpO 2 ) at the end of the six-minute walk test underwent routine walking exercise. Sixteen patients with stable systemic sclerosis completed exercise training for 55 days on average. The mean six-minute walk distance improved from 467 m to 502 m (P = 0.0012). The improvement in distance was negatively related to baseline distance (R 2 = 0.28, P = 0.037), but was not related to parameters from pulmonary function tests and echocardiograms. Oxygen saturation was normal at rest, but was decreased in fifteen patients at the end of the test. Exercise-induced oxygen desaturation was positively related to the diffusion capacity of the lungs for carbon monoxide at baseline (R 2 = 0.33, P = 0.026); however, it was not related to any cardiopulmonary parameters after intervention. Seven of sixteen patients ameliorated exerciseinduced oxygen desaturation or showed no oxygen desaturation after exercise training, while others deteriorated. No cardiopulmonary parameters affected the training outcome of exercise-induced oxygen desaturation. Exercise training was beneficial in improving exercise tolerance, but training effects and mechanisms on exercise-induced oxygen desaturation still need more studies to be explained.

Clinical significance and usefulness of rehabilitation for systemic sclerosis

“…Out of 16 patients, 7 showed ameliorated exercise-induced oxygen desaturation or no oxygen desaturation after exercise training. These findings indicated that exercise training was beneficial for improving exercise tolerance (62). Shoemaker et al (63) described a patient with SSc and pulmonary arterial hypertension (PAH) with a forced vital capacity (FVC) of 85% who performed a 6-week cycle ergometer program three times per week at workloads progressing from 50% to 80% of the peak workload; maximal oxygen uptake improved by 4% and 6MWT by 101 m and the exercise program was tolerated well.…”

Diagnostic criteria, severity classification and guidelines of systemic sclerosis

“…For pulmonary rehabilitation, interval training between breaks is effective, based on the characteristics of hypoxia during exercise that are seen in patients with interstitial pneumonia. Someya et al 520 . implemented rehabilitation for a mean period of 55 days in 16 SSc patients with interstitial pneumonia and found that the 6‐min walking distance increased.…”

“…519 For pulmonary rehabilitation, interval training between breaks is effective, based on the characteristics of hypoxia during exercise that are seen in patients with interstitial pneumonia. Someya et al 520 implemented rehabilitation for a mean period of The HAQ is generally used as a rating scale to show disability due to SSc, and this rating scale is recommended. The use of the SF-36 is sometimes seen as a general quality of life (QOL) score.…”

The effect and safety of exercise therapy in patients with systemic sclerosis: a systematic review

“…Three studies [11, 13, 27] concerned exercise therapy specifically, and eight studies concerned comprehensive care [14, 15, 17, 18, 28, 30–32]. Of these studies, one study was not yet mentioned in the two other reviews [32]. That review concluded that although few high-quality RCTs have been conducted to date, previous studies indicated the effect of rehabilitation therapy for decreasing local and systemic disabilities, resulting in improved quality of life.…”