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The evidence of benefits of exercise training in interstitial lung disease: a randomised controlled trial
  1. Leona M Dowman1,2,3,4,
  2. Christine F McDonald3,4,5,
  3. Catherine J Hill2,4,
  4. Annemarie L Lee4,6,
  5. Kathryn Barker7,
  6. Claire Boote7,
  7. Ian Glaspole8,9,
  8. Nicole S L Goh3,4,8,
  9. Anne M Southcott10,
  10. Angela T Burge1,4,6,
  11. Rebecca Gillies1,4,
  12. Alicia Martin7,
  13. Anne E Holland1,4,6
  1. 1Discipline of Physiotherapy, La Trobe University, Alfred Centre, Prahran, Victoria, Australia
  2. 2Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia
  3. 3Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
  4. 4Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
  5. 5Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
  6. 6Department of Physiotherapy, Alfred Health, Prahran, Victoria, Australia
  7. 7Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
  8. 8Allergy, Immunology & Respiratory Medicine Department, Alfred Health, Melbourne, Victoria, Australia
  9. 9Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
  10. 10Department of Respiratory & Sleep Disorders Medicine, Western Health, Footscray, Victoria, Australia
  1. Correspondence to Leona M Dowman, La Trobe University/Alfred Health Clinical School, Level 4, The Alfred Centre, 99 Commercial Rd, Prahran, VIC 3181, Australia; leona.dowman{at}austin.org.au

Abstract

Background Uncertainty exists regarding the clinical relevance of exercise training across the range of interstitial lung diseases (ILDs).

Objective To establish the impact of exercise training in patients with ILDs of differing aetiology and severity.

Methods 142 participants with ILD (61 idiopathic pulmonary fibrosis (IPF), 22 asbestosis, 23 connective tissue disease-related ILD (CTD-ILD) and 36 with other aetiologies) were randomised to either 8 weeks of supervised exercise training or usual care. Six-minute walk distance (6MWD), Chronic Respiratory Disease Questionnaire (CRDQ), St George Respiratory Questionnaire IPF-specific version (SGRQ-I) and modified Medical Research Council dyspnoea score were measured at baseline, 9 weeks and 6 months.

Measurements and main results Exercise training significantly increased 6MWD (25 m, 95% CI 2 to 47 m) and health-related quality of life (CRDQ and SGRQ-I) in people with ILD. Larger improvements in 6MWD, CRDQ, SGRQ-I and dyspnoea occurred in asbestosis and IPF compared with CTD-ILD, but with few significant differences between subgroups. Benefits declined at 6 months except in CTD-ILD. Lower baseline 6MWD and worse baseline symptoms were associated with greater benefit in 6MWD and symptoms following training. Greater gains were seen in those whose exercise prescription was successfully progressed according to the protocol. At 6 months, sustained improvements in 6MWD and symptoms were associated with better baseline lung function and less pulmonary hypertension.

Conclusions Exercise training is effective in patients across the range of ILDs, with clinically meaningful benefits in asbestosis and IPF. Successful exercise progression maximises improvements and sustained treatment effects favour those with milder disease.

Trial registration number Results, ACTRN12611000416998.

  • Asbestos Induced Lung Disease
  • Connective tissue disease associated lung disease
  • Exercise
  • Idiopathic pulmonary fibrosis
  • Interstitial Fibrosis
  • Pulmonary Rehabilitation

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Footnotes

  • Contributors LMD, CFM, CJH, IG, NSLG and AEH participated in the conception and design of the study. LMD, CJH, ALL, KB, CB, ATB and RG participated in the acquisition of the data. LMD and AEH completed the data analysis. LMD, CFM, CJH, ALL, KB, CB, IG, NSLG, AMS, ATB, RG, AM and AEH drafted and critically revised the manuscript and approved the final version for submission.

  • Funding LMD received a National Health and Medical Research Council postgraduate scholarship (Grant ID: GNT1017802) and this trial received grant funding from the Pulmonary Fibrosis Foundation/American Thoracic Society Foundation, Institute for Breathing and Sleep and Eirene Lucas Foundation.

  • Competing interests None declared.

  • Ethics approval La Trobe University, Alfred Health, Austin Health and Western Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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