Exercise Limitation in IPF Patients: A Randomized Trial of Pulmonary Rehabilitation

Jackson, Robert M.; Gómez-Marı́n, Orlando; Ramos, Carol; Sol, Constanza; Cohen, Melvin J.; Gaunaurd, Ignacio; Cahalin, Lawrence P.; Cardenas, Diana D.

doi:10.1007/s00408-014-9566-9

Cited by 83 publications

(98 citation statements)

References 41 publications

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“…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).…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2016

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This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others. @ERSpublications A review of exercise testing to evaluate interventions aimed to improve exercise tolerance in respiratory patients

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Section: Discussionmentioning

confidence: 98%

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

et al. 2016

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“…In COPD; chronic hypoxemia has been associated with increased muscle oxidative stress at rest and exercise compared to non-hypoxemic individuals [63] Individuals with non-IIM; particularly idiopathic pulmonary fibrosis (IPF); can exhibit significant hypoxemia; and evidence of oxidative stress has been recently examined in this population (e.g. increased plasma 15-F2t0 isoprostanes) [25,26].…”

Section: Discussionmentioning

confidence: 99%

“…There was also evidence of Type II muscle fibre atrophy on muscle biopsy in IIM. Alterations in muscle metabolism were reported in three studies and included decreased muscle oxygen extraction with exercise; and evidence of oxidant stress and lipid peroxidation in IPF [25,26,28] (Table 3). Oxidative enzyme concentrations or activity were not reported.…”

Section: Alterations In Peripheral Muscle Structure and Metabolic Chamentioning

confidence: 99%

Peripheral Muscle Dysfunction in Interstitial Lung Disease: A Scoping Study

Wickerson¹,

Brooks²,

Mathur³

2016

Physiother Rehabil

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Purpose: To characterize the state of the evidence for peripheral muscle dysfunction in individuals with interstitial lung disease (ILD). Method:A scoping study was performed by searching multiple electronic databases for published papers and conference abstracts of any study design that included a measure of peripheral muscle dysfunction and/or structural and metabolic characteristics of muscle. All sub-types of ILD were eligible. Result:Forty-five studies representing 2522 individuals with 34 sub-types of ILD were included in this study. Data were charted using descriptive numerical analysis of study characteristics. Peripheral muscle dysfunction was predominantly reflected by reduced volitional isometric strength (17 studies), whereas the evaluation of muscle endurance was rare (2 studies). Volitional muscle force or torque was measured in the quadriceps (14 studies) and handgrip (8 studies), with strength preferentially reduced in the lower limbs. Eight studies measured structural or metabolic characteristics and found evidence of reduced muscle size and oxidative stress. Findings of muscle injury and muscle inflammation (e.g. serum markers, electromyography and muscle biopsies) were reported primarily in individuals with idiopathic inflammatory myopathies and connective tissue diseases. Conclusions:Reduced volitional muscle strength was the most common finding of peripheral muscle dysfunction in ILD. Further quantification of peripheral muscle dysfunction and identification of structural and metabolic characteristics are needed to target specific interventions and optimize muscle function.

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“…30 The long-term effects of PR within this population group are uncertain and a recent study by Jackson et al found that while IPF patients allocated PR showed improvements in quality of life and physical activity, these changes were only noted for the duration of the intervention and not three months later. 31 The lack of sustained improvements may in part reflect the progressive nature of the disease but it is also possible that the rehabilitation needs of some IPF patients differ from those with other chronic lung diseases, with disease severity playing an important part in treatment response. As recommended by the NICE guidelines, further trials are required involving IPF patients with differing disease severities to look at the effect of both short-and longterm outcomes.…”

Section: Pulmonary Rehabilitationmentioning

confidence: 99%

Therapeutic advances in idiopathic pulmonary fibrosis

Fraser

Hoyles

2016

Clinical Medicine

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Idiopathic pulmonary fibrosis (IPF) is characterised by progressive accumulation of scar tissue in the lung and is associated with a median life expectancy of 2-4 years. Until recently, treatment options were limited, focusing on ineffective anti-inflammatory therapy, palliation, transplant or trial recruitment. Significant recent advances in the field have led to two novel anti-fibrotic agents, pirfenidone and nintedanib, which have been shown to significantly slow disease progression in IPF. This article outlines the approach to management of IPF, the role of specialist centres and specialist interstitial lung disease multidisciplinary review, and explores both the trial evidence and practical considerations in the use of these anti-fibrotic agents.

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Exercise Limitation in IPF Patients: A Randomized Trial of Pulmonary Rehabilitation

Cited by 83 publications

References 41 publications

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

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

Peripheral Muscle Dysfunction in Interstitial Lung Disease: A Scoping Study

Therapeutic advances in idiopathic pulmonary fibrosis

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