The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding).
A Cochrane review [Abstract] 1 included 9 studies with a total of 386 subjects. Three studies included only people with idiopathic pulmonary fibrosis (IPF), and the other 6 studies included people with a variety of interstitial lung diseases (ILD). The average age of participants ranged from 36 to 71 years. All studies utilised aerobic exercise training or a combination of aerobic and resisted exercise training. Four studies comprised exercise training alone, whereas 4 studies added other interventions to exercise training (educational lectures, nutritional advice, stress management, physiotherapy, and psychosocial support), and inclusion of additional interventions was unclear in 1 study. All studies compared pulmonary rehabilitation versus no pulmonary rehabilitation or a sham training control group.
No adverse effects of pulmonary rehabilitation were reported. Pulmonary rehabilitation improved the 6-minute walk distance, oxygen consumption (VO2) peak, and quality of life, and reduced dyspnoea (table T1). Effects were similar in the subgroup of participants with IPF: improvements in 6-minute walk distance (WMD 35.63 metres, 95% CI 16.02 to 55.23 metres; 4 studies, n=111), VO2 peak (WMD 1.46 mL/kg/min-1, 95% CI 0.54 to 2.39 mL/kg/min-1; 2 studies, n=58), and quality of life (SMD 0.59, 95% CI 0.14 to 1.03; 3 studies, n=83), and reduction of dyspnoea (SMD -0.68, 95% CI -1.12 to -0.25; 3 studies, n=90). Two studies reported longer-term outcomes, with no significant effects of pulmonary rehabilitation on clinical variables or survival at 3 or 6 months. Insufficient data were available to allow conclusions regarding the effects of pulmonary rehabilitation among those with severe disease and those who desaturated.
| Outcome | Relative effect (95% CI) | Assumed risk - No rehabilitation | Corresponding risk - Pulmonary rehabilitation (95% CI) | Participants (studies) |
|---|---|---|---|---|
| Change in 6-minute walk distance* | MD 44.34 (26.04 to 62.64) | Mean change ranged across control groups from-4 to 17 metres | Mean change was44 m higher(26 to 63 m higher) | 168 (5 studies) |
| Change in peak oxygen uptake* | MD 1.24 (0.46 to 2.13) | Mean change ranged across control groups from-0.02 to 0.4 mL/kg/min | Mean change was1.24 mL/kg/min higher(0.46 to 2.03 higher) | 80 (2 studies) |
| Change in dyspnoea* | SMD -0.66 (-1.05 to -0.28) | Mean change ranged across control groups from 0.11 to 0.3 points | Mean change was0.60 lower(0.96 to 0.26 lower) | 113 (3 studies) |
| Change in quality of life* | SMD 0.59 (0.2 to 0.98) | Mean change in the control groups was3.29 points | Mean change was8.9 higher(3 to 14.8 higher) | 106 (3 studies) |
| 6-month survival | RR 0.9 (0.13 to 4.77) | 74 per 1000 | 67 per 1000(10 to 353) | 57 (1 study) |
| *Follow-up: end of rehabilitation (8-12 weeks) | ||||
| References | ||||
| Dowman L, Hill CJ, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev 2014;(10):CD006322. [PubMed]
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