Endurance Time Is the Most Responsive Exercise Measurement in Idiopathic Pulmonary Fibrosis

Abstract

BACKGROUND: Although pulmonary rehabilitation (PR) has been reported to improve exercise capacity in patients with idiopathic pulmonary fibrosis, it is unknown which exercise measurement is the most responsive for evaluation of PR efficacy. The purpose of this study was to compare the responsiveness of 5 exercise measurements by evaluating the efficacy of PR in subjects with idiopathic pulmonary fibrosis. METHODS: We conducted a prospective observational study in which 53 subjects with idiopathic pulmonary fibrosis were enrolled. The PR group underwent a 10-week out-patient PR program. The control group was observed without any additional intervention, including PR. Five exercise measurements (endurance time [ET], peak work rate, peak oxygen consumption [V O 2 ], 6-min walk distance, and incremental shuttle walk distance) were evaluated at baseline and after 10 weeks. The effect size was used for the assessment of responsiveness. RESULTS: In each group, 24 subjects completed the 5 measurements at baseline and after 10 weeks. The changes in ET (PR: 181.6%; control: ؊8.2%), peak V O 2 (PR: 7.6%; control: ؊5.4%), peak work rate (PR: 15.1%; control: ؊5.1%), 6-min walk distance (PR: 6.0%; control: ؊3.8%), and incremental shuttle walk distance (PR: 9.1%; control: ؊5.1%) were significantly different between the groups after 10 weeks (P < .05). In the PR group, ET showed the most striking improvement among the 5 measurements (P < .05), and its effect size was as large as 2.96, whereas those of the others were all < 0.5. CONCLUSIONS: ET is the most responsive exercise measurement for evaluating PR efficacy in patients with idiopathic pulmonary fibrosis.

Exercise Training-Based Pulmonary Rehabilitation Program Is Clinically Beneficial for Idiopathic Pulmonary Fibrosis

“…In contrast, Huppmann et al [34] and Ryerson et al [35] showed higher improvement rates in 6MWD following pulmonary rehabilitation programs in the most deconditioned ILD patients and those with low baseline values, respectively [34,35]. Our findings are also in concordance with a recent report by Arizono et al [36], who also showed significant improvements of CPET parameters in IPF patients, but not V O 2 peak. Following the intervention we also found significant improvements in pulmonary and ventilatory parameters in the ET group (table 2).…”

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

“…a 100-s or 33% improvement was reached in 30 (91%) out of 33 and 27 (82%) out of 33 investigations, respectively) (figure 1). tLIM is also responsive to rehabilitation in idiopathic PAH [121,122] and IPF [123,124]. In one observational study of 53 IPF patients, the effect size for tLIM after rehabilitation was larger than for V′O 2 peak, WRpeak, 6MWD and ISWT [123] (table 3).…”

“…tLIM is also responsive to rehabilitation in idiopathic PAH [121,122] and IPF [123,124]. In one observational study of 53 IPF patients, the effect size for tLIM after rehabilitation was larger than for V′O 2 peak, WRpeak, 6MWD and ISWT [123] (table 3). Oxygen therapy significantly increases tLIM by an average of 162 (95% CI 118-207) s in patients with COPD who desaturate during exercise [59].…”

Current best practice in rehabilitation in interstitial lung disease

“…Other tests of exercise capacity may have greater sensitivity to change following PR. A comparison of five exercise measurements (endurance time, peak work rate, peak oxygen consumption, 6MWD, and SWT) at the beginning and end of PR in patients with IPF found cycle endurance time was the most responsive [Arizono et al 2014].…”