Benefits of Pulmonary Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis Receiving Antifibrotic Drug Treatment

Abstract

Background: Although patients with idiopathic pulmonary fibrosis (IPF) often receive treatment with antifibrotic drugs (AFDs) and pulmonary rehabilitation (PR) concurrently, there are no reports on the effect of PR on patients with IPF receiving AFDs. Therefore, we investigated the effect of PR on patients with IPF receiving AFDs. Methods: Eighty-seven eligible patients with IPF (61 male; 72.0 ± 8.1 years; GAP severity stage I/II/III: 26/32/12) were recruited for the study. Patients who completed a 3-month outpatient PR program and those who did not participate were classified into four groups according to use of AFDs: PR group (n = 29), PR+AFD group (n = 11), treatment-free observational group (control group; n = 26), and AFD group (n = 21). There was no significant difference in age, sex, or severity among the groups. Patients were evaluated for physical functions such as 6-min walk distance (6MWD) and muscle strength, dyspnea, and health-related quality of life (HRQOL) at baseline and at 3 months. Results: In the PR group, dyspnea and 6MWD showed significant improvement after the 3-month PR program (p < 0.05 and p < 0.01, respectively). HRQOL was significantly worse at 3 months (p < 0.05) in the AFD group, but not in the other groups. The change in 6MWD from baseline to the 3-month time point was significantly higher in the PR+AFD group than in the AFD groups (p < 0.01). Conclusion: It was suggested that AFD treatment reduced exercise tolerance and HRQOL at 3 months; however, the concurrent use of PR may prevent or mitigate these effects.

The Beneficial Impact of Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis: A Review of the Current Literature

“…Iwanami et al [26] described a significantly higher value of ∆6MWD in patients who received both PR and AFD when compared to only AFD-treated cases (PR + AFD: + 34.1 m; AFD: −34.5 m) and inferred a synergistic effect of PR and AFDs. This could be explained by the capacity of PR to prevent the decline in 6MWD and HRQOL caused by the side effects of AFDs, although the overall incidence of side effects has been reported to be similar in treated and untreated patients [63].…”

“…Moreover, PR can take place in different settings, thus affecting the adherence degree of the patient as well as the overall effectiveness of the therapy. Most of the studies so far included in this review took place in a supervised outpatient [22,23,25,27,[31][32][33][34]49] or inpatient [28] setting, while only a few were conducted as home-based [24,33,35] or combined [26,29] PR programmes. Home-based PR is a self-care-based, mostly unsupervised intervention in which the physiotherapist provides a training scheme and the participants perform the PR exercise by themselves.…”

“…Recommended training variables such as the ideal frequency, intensity, time, and type (known as the FITT components) have not been defined yet for IPF. In most of the studies reported in this review (Supplemental Table S1), exercise training was practiced with an overall frequency of 2-3 days per week at a moderate-to-vigorous intensity [22][23][24][25][26][27]29,[31][32][33][34][35]49], although a higher frequency at the same level of intensity was also reported to be beneficial [28][29][30]36]. Aerobic exercises had an average length of 20-30 min per session, with an intensity of over 60-80% maximal work rate delivered.…”

Impact of Controlling Nutritional Status Score on Mortality in Elderly Patients with Idiopathic Pulmonary Fibrosis

“…A retrospective study was conducted by extracting 170 patients with IPF from the 390 participants who participated in the Toho Rehabilitation for Interstitial Pneumonia (TRIP) study conducted from July 2014 to July 2017. The TRIP study examined the long-term effects of respiratory rehabilitation on patients with interstitial lung disease (ILD) [21][22][23]. We excluded patients who met the following exclusion criteria: (1) patients in an unstable condition; (2) patients with pneumomediastinum/pneumothorax; (3) ILD types other than IPF; (4) patients with dementia; (5) patients with malignant tumors; and (6) patients younger than 65 years old.…”

Maintenance programmes following pulmonary rehabilitation in idiopathic pulmonary fibrosis: exercise, drugs and rock n’ roll

“…In particular, nintedanib slows the decline in measures of disease severity5 and it is hypothesised that there may be a cumulative benefit on exercise capacity by combining nintedanib and exercise. However, due to the relatively recent availability of this therapy, there are limited data, with retrospective analyses reporting conflicting results on the short-term effect of antifibrotic therapies plus PR on exercise capacity 6 7…”