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Evidence summaries

Pulmonary Rehabilitation for Interstitial Lung Disease

Pulmonary rehabilitation appears to be safe and to provide short-term improvement of functional exercise capacity, dyspnoea and quality of life in patients with interstitial lung disease. Level of evidence: "B"

The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding).

Summary

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.

Pulmonary rehabilitation compared with no pulmonary rehabilitation for interstitial lung disease (ILD)

OutcomeRelative effect (95% CI)Assumed risk - No rehabilitationCorresponding risk - Pulmonary rehabilitation (95% CI)Participants (studies)
*Follow-up: end of rehabilitation (8-12 weeks)
Change in 6-minute walk distance*MD 44.34 (26.04 to 62.64)Mean change ranged across control groups from-4 to 17 metresMean 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/minMean 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 pointsMean 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 pointsMean change was8.9 higher(3 to 14.8 higher)106 (3 studies)
6-month survivalRR 0.9 (0.13 to 4.77)74 per 100067 per 1000(10 to 353)57 (1 study)

References

  • Dowman L, Hill CJ, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev 2014;(10):CD006322. [PubMed]

Primary/Secondary Keywords