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Exercise training in interstitial lung disease: lumping or splitting?
  1. Katrina Curtis1,
  2. Nicholas S Hopkinson2
  1. 1Gloucestershire Royal Hospitals NHS Foundation Trust, UK
  2. 2NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital and Harefield NHS Foundation Trust and Imperial College, London, UK
  1. Correspondence to Dr Nicholas S Hopkinson, NIHR Respiratory Biomedical Research Unit, Royal Brompton Hospital, Fulham Road, London SW3 6NP, UK; n.hopkinson{at}ic.ac.uk

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In 1952, Alvan Barach, a New York physician, wrote, ‘It may seem unusual perhaps to suggest exercise to these breathless people, but in fact it is one of the ways by which they can restore physical fitness’.1 Since then, pulmonary rehabilitation (PR) has proven its worth as a high-value treatment for COPD,2 improving exercise capacity, quality of life and muscle strength while also reducing hospital admissions.3–6 The usefulness of PR in other respiratory conditions, including interstitial lung disease (ILD), has been assumed because of the shared presence of deconditioning, fatigue, dyspnoea, exercise intolerance and impaired quality of life, factors known to be amenable to exercise training.

ILD includes a heterogeneous group of disorders, with severity and prognosis that vary both between subtypes and at an individual level. The basis of exercise training as a treatment modality may therefore be less straightforward than in other pulmonary disorders. People with COPD often present with a long history of physical inactivity and activity levels are typically reduced even in early disease.7 Patients with ILD may have a shorter period prior to presentation and a more rapid trajectory of lung function decline than other chronic lung conditions with less time for deconditioning to develop. In addition, some will be receiving systemic corticosteroid therapy known to have important effects on muscular function8 and important systemic effects may be present, including rheumatological conditions, direct muscle involvement in connective tissue diseases and pulmonary hypertension limiting cardiac output. These all …

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