Effectiveness of pulmonary rehabilitation in patients with interstitial lung disease of different etiology: a multicenter prospective study

Abstract

Background: Recent evidences show that Pulmonary Rehabilitation (PR) is effective in patients with Interstitial Lung Disease (ILD). It is still unclear whether disease severity and/or etiology might impact on the reported benefits. We designed this prospective study 1) to confirm the efficacy of rehabilitation in a population of patients with ILDs and 2) to investigate whether baseline exercise capacity, disease severity or ILD etiology might affect outcomes.

Methods: Forty-one patients (IPF 63%, age 66.9 ± 11 ys) were enrolled in a standard PR course in two centers. Lung function, incremental and endurance cyclo-ergometry, Six Minutes Walking Distance (6MWD), chronic dyspnea (Medical Research Council scale-MRC) and quality of life (St. George Respiratory Questionnaire-SGRQ) were recorded before and at the end of PR to measure any pre-to-post change. Correlation coefficients between the baseline level of Diffuse Lung Capacity for Carbon monoxide (DLCO), Forced Vital Capacity (FVC), 6MWD, power developed during incremental endurance test, GAP index (in IPF patients only) and etiology (IPF or non-IPF) with the functional improvement at the 6MWDT (meters), at the incremental and endurance cyclo-ergometry (endurance time) and the HRQoL were assessed.

Results: Out of the 41 patients, 97% (n = 40) completed the PR course. Exercise performance (both at peak load and submaximal effort), symptoms (iso-time dyspnea and leg fatigue), SGRQ and MRC significantly improved after PR (p < .001). Patients with lower baseline 6MWD showed greater improvement in 6MWD (Spearman r score = - .359, p = .034) and symptoms relief at SGRQ (r = -.315, p = .025) regardless of underlying disease.

Conclusion: Present study confirms that comprehensive rehabilitation is feasible and effective in patients with ILD of different severity and etiology. The baseline submaximal exercise capacity inversely correlates with both functional and symptom gains in this heterogeneous population.

Keywords: Endurance test; Endurance time; Functional performance; Interstitial lung diseases; Pulmonary rehabilitation.

Fig. 1

Study flowchart

Fig. 2

Effect of PR setting and center of enrollment on PR effectiveness expressed in terms of relative change from baseline. Cycle dyspnea and leg fatigue were assessed at isotime. * Center A = “Don Gnocchi” Institute, Firenze, Italy. ** Center B = “Villa Pineta” Rehabilitation Hospital in Pavullo n/F, Modena, Italy

Fig. 3

Correlation between baseline FVC (panel a), DLCO (panel b), GAP index (panel c), ILD etiology (panel d), power developed at endurance test (ET) (panel e), distance covered at 6MWDT panel f)  and change in 6MWDT distance (%) after PR. Statistical significant is indicated by p value while correlation is indicated by the Pearson’s correlation coefficient r

Fig. 4

Correlation between baseline FVC (panel a), DLCO (panel b), GAP index (panel c), ILD etiology (panel d), power developed at endurance test (ET) (panel e), distance covered at 6MWDT panel f) and change in SGRQ (total) after PR. Statistical significant is indicated by p value while correlation is indicated by the Pearson’s correlation coefficient r

Fig. 5

Correlation between baseline FVC (panel a), DLCO (panel b), GAP index (panel c), ILD etiology (panel d), power developed at endurance test (ET) (panel e), distance covered at 6MWDT panel f) and change in Endurance Time after PR. Statistical significant is indicated by p value while correlation is indicated by the Pearson’s correlation coefficient r