Exercise-Based Pulmonary Rehabilitation for Interstitial Lung Diseases: A Review of Components, Prescription, Efficacy, and Safety

Our plain-English summary of Exercise-Based Pulmonary Rehabilitation for Interstitial Lung Diseases: A Review of Components, Prescription, Efficacy, and Safety, by R.G. Mendes, V. Castello-Simões, R. Trimer, et al (Frontiers in Rehabilitation Sciences, 2021).

The study

• Authors: R.G. Mendes, V. Castello-Simões, R. Trimer, A.S. Garcia-Araújo, A.L. Gonçalves Da Silva, S. Dixit, V.A.P. Di Lorenzo, B. Archiza, A. Borghi-Silva
• Journal: Frontiers in Rehabilitation Sciences
• Published: 2021;2:744102
• Type of article: Review
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders (such as idiopathic pulmonary fibrosis, sarcoidosis, asbestosis, and pneumonitis) characterized by lung parenchymal impairment, inflammation, and fibrosis. The shortness of breath (i.e., dyspnea) is a hallmark and disabling symptom of ILDs. Patients with ILDs may also exhibit skeletal muscle dysfunction, oxygen desaturation, abnormal respiratory patterns, pulmonary hypertension, and decreased cardiac function, contributing to exercise intolerance and limitation of day-to-day activities. Pulmonary rehabilitation (PR) including physical exercise is an evidence-based approach to benefit functional capacity, dyspnea, and quality of life in ILD patients. However, despite recent advances and similarities with other lung diseases, the field of PR for patients with ILD requires further evidence. This mini-review aims to explore the exercise-based PR delivered around the world and evidence supporting prescription modes, considering type, intensity, and frequency components, as well as efficacy and safety of exercise training in ILDs. This review will be able to strengthen the rationale for exercise training recommendations as a core component of the PR for ILD patients.

Copyright © 2021 Mendes, Castello-Simões, Trimer, Garcia-Araújo, Gonçalves Da Silva, Dixit, Di Lorenzo, Archiza and Borghi-Silva.

In plain English

This mini-review was not a new study. The authors reviewed research on exercise-based pulmonary rehabilitation for interstitial lung diseases, which the article says include idiopathic pulmonary fibrosis, sarcoidosis, asbestosis and pneumonitis. It did not study asbestos exposure. A table summarized eight randomized controlled trials; most studied idiopathic pulmonary fibrosis patients (62.5%), and all combined aerobic and strength training. The text says seven outpatient programs lasted 8 to 12 weeks, mostly twice weekly, but the table lists one outpatient trial with 60 sessions, three times weekly for three months, then twice weekly. One trial involved inpatients. One trial, by Dowman and colleagues, included 142 patients with idiopathic pulmonary fibrosis, asbestosis or connective tissue disease-related lung disease. As summarized here, exercise training in that trial improved six-minute walk distance, symptoms and quality of life, with greater change in those with asbestosis than in those with idiopathic pulmonary fibrosis. The authors wrote that rehabilitation safety had been poorly studied and few randomized trials exist. They concluded rehabilitation is an important part of care for these patients, but the field has yet to evolve.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative mini-review of published research on exercise-based pulmonary rehabilitation in interstitial lung diseases, including a table summarizing eight randomized controlled trials
• Who was studied: Published studies of patients with interstitial lung diseases (a group the authors say includes idiopathic pulmonary fibrosis, sarcoidosis, asbestosis and pneumonitis). The core is eight randomized controlled trials summarized in Table 1.
• Exposure: Exercise-based pulmonary rehabilitation: aerobic training combined with strength training, plus adjuncts such as oxygen, non-invasive ventilation and neuromuscular electrical stimulation. Asbestos exposure was not studied.
• Main results:
  • Most of the eight reviewed trials specifically evaluated idiopathic pulmonary fibrosis patients (62.5%)
  • The review's text says the seven outpatient programs lasted 8 to 12 weeks, mostly twice a week. Only one trial involved inpatients.
  • Table 1 lists one outpatient trial (Perez-Bogerd et al.) with 60 sessions, three times a week for the first three months and twice a week thereafter. This does not fit the 8 to 12 week range given in the text.
  • The Dowman et al. trial included 142 patients with interstitial lung disease (idiopathic pulmonary fibrosis, asbestosis, or connective tissue disease-related ILD)
  • In the Dowman et al. trial, as summarized here, exercise training improved six-minute walk distance, symptoms and health-related quality of life
  • In the Dowman et al. trial, as summarized here, the magnitude of change was greater in patients with asbestosis than in those with idiopathic pulmonary fibrosis
  • The authors reported that the safety of pulmonary rehabilitation in interstitial lung disease patients has been poorly studied
• The authors' conclusion: The authors concluded that pulmonary rehabilitation is an important part of comprehensive care for interstitial lung disease patients, but that despite evidence of benefits the field has yet to evolve.
• Limitations the authors state:
  • The authors stated that few randomized controlled studies address exercise in pulmonary rehabilitation for the various types of interstitial lung disease
  • The authors stated that pulmonary rehabilitation for interstitial lung disease requires further evidence

Topics

Medical terms in this study, explained in our Lexicon: Pulmonary Rehabilitation, Interstitial Lung Disease, Idiopathic, Pulmonary Fibrosis, Pneumonitis, Inflammation, Fibrosis, Dyspnea.

Related studies

• The evidence of benefits of exercise training in interstitial lung disease: a randomised controlled trial — L.M. Dowman, C.F. McDonald, et al. (2017)
• Exercise alveolar-arterial oxygen pressure difference in interstitial lung disease — C. Risk, G.R. Epler, et al. (1984)
• Mineral dusts directly induce epithelial and interstitial fibrogenic mediators and matrix components in the airway wall — J. Dai, B. Gilks, et al. (1998)
• Biphasic malignant mesothelioma with epithelioid and sarcomatoid components (dedifferentiated mesothelioma) and intrapulmonary growth: a rare entity mimicking desquamative interstitial pneumonia — J. Laforga, A. Gonzalez Garcia (2020)
• Crackles (rales) in the interstitial pulmonary diseases — G.R. Epler, C.B. Carrington, et al. (1978)
• Role of oxidants in interstitial lung diseases: pneumoconioses, constrictive bronchiolitis, and chronic tropical pulmonary eosinophilia — W.N. Rom (2011)

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