Growing evidence demonstrates that pulmonary rehabilitation (PR) programs consisting of individually tailored and supervised aerobic and resistance exercises, breathing techniques, and symptom self-management can improve chronic dyspnea (labored breathing), functional capacity, and quality of life in people with interstitial lung diseases (ILDs).
A study, headed by Dr. Roberto Tonelli of the Department of Medical and Surgical Sciences at Modena, Italy’s University of Modena Reggio Emilia, explored whether ILD severity and/or cause (etiology) would impact the reported benefits of a PR program.*
Between January 2013 and January 2015, 41 patients were enrolled in a standard comprehensive PR course across one in-patient and one out-patient rehabilitation center in Italy. Participants displayed varying degrees of functional performance and lung impairment, and ILDs of differing types:
The PR course consisted of at least 24 sessions of rehabilitation training. The program included:
- six hours per week of individual exercise training. The training involved upper and lower limb endurance training, and both aerobic and resistance training.
- two 30-minute sessions of breathing exercises four to five times per week. Breathing training included controlled and diaphragmatic breathing, pacing, and energy conservation.
- three sessions of group education per week. Education sessions covered nutrition, relaxation techniques, medication use, oxygen intake optimization, and end-of-life issues associated with disease progression.
Evaluation tools used before and after rehabilitation to record baseline and outcome data primarily included:
Forty of the 41 study participants with mild-to-moderate restriction on lung function testing completed the PR program. Clinical outcomes included:
- increased peak and endurance exercise performance
- decreased symptoms (specifically dyspnea and leg muscle fatigue)
- improved MRC-Dyspnea and SGRQ scores
Participants with lower baseline 6MWD scores showed the greatest improvement in walking ability, with significant symptom relief on the SGRQ regardless of disease type.
The study demonstrated that patients with ILDs of differing natures and severities can experience similar benefits from PR, though these findings cannot be generalized for all subgroups. Moreover, the study was limited by its small sample size, lack of a control group, and absence of long-term participant follow-up. In addition, all participants showed mild-to-moderate lung function impairment at baseline, which prevented assessment of PR’s benefits for patients with severe impairment.
The authors suggested that further research is needed to determine the subset(s) of ILD patients who could benefit most from pulmonary rehabilitation, and to explore whether different and/or more specific modalities would further improve gains in patients with greater disease severity.
In the meantime, the authors recommended early referral to pulmonary rehabilitation as a primary treatment for symptomatic ILD patients with mild-to-moderate lung impairment, regardless of disease cause.
Read the full article in BMC Pulmonary Medicine.