Exercise-Based Pulmonary Rehabilitation for Interstitial Lung Diseases: A Review of Components, Prescription, Efficacy, and Safety

Interstitial lung diseases (ILDs) comprise a heterogeneous group of disorders (such as idiopathic pulmonary fibrosis, sarcoidosis, asbestosis, and pneumonitis) characterized by lung parenchymal impairment, inflammation, and fibrosis. The shortness of breath (i.e., dyspnea) is a hallmark and disabling symptom of ILDs. Patients with ILDs may also exhibit skeletal muscle dysfunction, oxygen desaturation, abnormal respiratory patterns, pulmonary hypertension, and decreased cardiac function, contributing to exercise intolerance and limitation of day-to-day activities. Pulmonary rehabilitation (PR) including physical exercise is an evidence-based approach to benefit functional capacity, dyspnea, and quality of life in ILD patients. However, despite recent advances and similarities with other lung diseases, the field of PR for patients with ILD requires further evidence. This mini-review aims to explore the exercise-based PR delivered around the world and evidence supporting prescription modes, considering type, intensity, and frequency components, as well as efficacy and safety of exercise training in ILDs. This review will be able to strengthen the rationale for exercise training recommendations as a core component of the PR for ILD patients.

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LACTATE TO PYRUVATE RATIOS AS A MARKER OF SKELETAL MUSCLE DYSFUNCTION AND HYPOXIA IN INTERSTITIAL LUNG DISEASES

CHEST Journal ◽

10.1016/j.chest.2019.08.850 ◽

2019 ◽

Vol 156 (4) ◽

pp. A905

Author(s):

Kadambari Vijaykumar ◽

Joseph Barney

Keyword(s):

Skeletal Muscle ◽

Lung Diseases ◽

Interstitial Lung Diseases ◽

Muscle Dysfunction ◽

Skeletal Muscle Dysfunction

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Skeletal muscle dysfunction in chronic renal failure: effects of exercise

AJP Renal Physiology ◽

10.1152/ajprenal.00296.2005 ◽

2006 ◽

Vol 290 (4) ◽

pp. F753-F761 ◽

Cited By ~ 77

Author(s):

Gregory R. Adams ◽

Nosratola D. Vaziri

Keyword(s):

Skeletal Muscle ◽

Renal Failure ◽

Exercise Capacity ◽

Muscle Function ◽

Chronic Illnesses ◽

Treatment Modalities ◽

Muscle Dysfunction ◽

Obstructive Pulmonary Disease ◽

Skeletal Muscle Dysfunction

A number of chronic illnesses such as renal failure (CRF), obstructive pulmonary disease, and congestive heart failure result in a significant decrease in exercise tolerance. There is an increasing awareness that prescribed exercise, designed to restore some level of physical performance and quality of life, can be beneficial in these conditions. In CRF patients, muscle function can be affected by a number of direct and indirect mechanisms caused by renal disease as well as various treatment modalities. The aims of this review are twofold: first, to briefly discuss the mechanisms by which CRF negatively impacts skeletal muscle and, therefore, exercise capacity, and, second, to discuss the available data on the effects of programmed exercise on muscle function, exercise capacity, and various other parameters in CRF.

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Thoracoabdominal asynchrony associates with exercise intolerance in fibrotic interstitial lung diseases

Respirology ◽

10.1111/resp.14064 ◽

2021 ◽

Author(s):

Pauliane Vieira Santana ◽

Leticia Zumpano Cardenas ◽

Jeferson George Ferreira ◽

Carlos Roberto Ribeiro Carvalho ◽

André Luis Pereira Albuquerque ◽

...

Keyword(s):

Lung Diseases ◽

Interstitial Lung Diseases ◽

Exercise Intolerance ◽

Thoracoabdominal Asynchrony

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Short-term Efficacy of Upper-Extremity Exercise Training in Patients With Chronic Airway Obstruction: A Systematic Review

Physical Therapy ◽

10.2522/ptj.20070368 ◽

2009 ◽

Vol 89 (5) ◽

pp. 443-455 ◽

Cited By ~ 18

Author(s):

Stefania Costi ◽

Mauro Di Bari ◽

Paolo Pillastrini ◽

Roberto D'Amico ◽

Ernesto Crisafulli ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Exercise Training ◽

Pulmonary Rehabilitation ◽

Health Related Quality ◽

Inclusion Criteria ◽

Patient Centered ◽

Related Quality ◽

Health Related

Background, Objectives, and Measurements Patients with chronic airway obstruction (CAO) frequently experience dyspnea and fatigue during activities performed by accessory muscles of ventilation, which competitively participate in arm elevation. This systematic review of randomized controlled trials (RCTs) concerning patients with CAO addresses the effects of upper-extremity exercise training (UEET), added to lower-extremity training or comprehensive pulmonary rehabilitation, on the following patient-centered outcomes: exercise capacity, symptoms, ability to perform daily activities, and health-related quality of life. Methods Studies were retrieved using comprehensive database and hand-search strategies. Two independent reviewers determined study eligibility based on inclusion criteria. A detailed description of treatments was mandatory. Reviewers rated study quality and extracted information on study methods, design, intervention, and results. Results Forty publications were evaluated. Four RCTs met the inclusion criteria but had serious methodological limitations, which introduce possible biases that reduce their internal validity. The outcomes measured were heterogeneous, and the results were inconsistent regarding maximal exercise capacity, dyspnea, and health-related quality of life. No effect of UEET was demonstrated for measures of arm fatigue. Limitations and Conclusions The limited methodological quality of the studies retrieved prevented us from performing a meta-analysis, the results of which could be misleading. This systematic review shows that there is limited evidence examining UEET and that the evidence available is of poor quality. Therefore, a recommendation for the inclusion or exclusion of UEET in pulmonary rehabilitation programs for individuals with CAO is not possible. Further research is needed to definitively ascertain the effects of this training modality on patient-centered outcomes.

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Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases

European Respiratory Review ◽

10.1183/16000617.0076-2018 ◽

2018 ◽

Vol 27 (150) ◽

pp. 180076 ◽

Cited By ~ 72

Author(s):

Vincent Cottin ◽

Nikhil A. Hirani ◽

David L. Hotchkin ◽

Anoop M. Nambiar ◽

Takashi Ogura ◽

...

Keyword(s):

Interstitial Pneumonia ◽

Lung Diseases ◽

Hypersensitivity Pneumonitis ◽

Early Death ◽

Occupational Exposures ◽

Interstitial Lung Diseases ◽

Lung Function Decline ◽

Nonspecific Interstitial Pneumonia ◽

Immunomodulatory Therapies

Although these conditions are rare, a proportion of patients with interstitial lung diseases (ILDs) may develop a progressive-fibrosing phenotype. Progressive fibrosis is associated with worsening respiratory symptoms, lung function decline, limited response to immunomodulatory therapies, decreased quality of life and, potentially, early death. Idiopathic pulmonary fibrosis may be regarded as a model for other progressive-fibrosing ILDs. Here we focus on other ILDs that may present a progressive-fibrosing phenotype, namely idiopathic nonspecific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, connective tissue disease-associated ILDs (e.g.rheumatoid arthritis-related ILD), fibrotic chronic hypersensitivity pneumonitis, fibrotic chronic sarcoidosis and ILDs related to other occupational exposures. Differential diagnosis of these ILDs can be challenging, and requires detailed consideration of clinical, radiological and histopathological features. Accurate and early diagnosis is crucial to ensure that patients are treated optimally.

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