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O'Shea O, Murphy G, Fox L, O'Reilly KMA. Changes in physical activity in people with idiopathic pulmonary fibrosis before and after virtual pulmonary rehabilitation: a feasibility study. BMC Pulm Med 2024; 24:215. [PMID: 38698361 PMCID: PMC11064383 DOI: 10.1186/s12890-024-03030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is recommended for the treatment of people with idiopathic pulmonary fibrosis (IPF). Physical activity is an important health behaviour, closely linked to survival in people with IPF. Little is known about the impact of virtual (V) PR on physical activity in people with IPF. OBJECTIVE To explore the feasibility of conducting a trial to explore effect of virtual PR on objectively measured physical activity in people with IPF. METHODS All patients with a diagnosis of IPF in a stable phase of the disease were invited to participate in VPR: a 10 week exercise programme delivered twice-weekly for one hour. Data were collected at baseline (BL) and post VPR (10 weeks): Kings Brief Interstitial Lung Disease (K-BILD), Exercise capacity (6-minute walk test (6MWT) or 1-minute sit-to-stand (STS)) and Physical Activity. Physical activity was measured with a triaxial accelerometer for seven days. Screening, recruitment, adherence and safety data were collected. RESULTS 68 people were screened for this study. N = 16 participants were recruited to the study. There was one dropout. N = 15 completed VPR. All results reported in mean (standard deviation) (SD). Participants attended 18.1(2.0) of the 20 sessions. No adverse events were detected. The mean age of participants was 71.5(11.5) years, range: 47-95 years; 7 M:9 F. Mean (SD) FEV1 2.3(0.3)L, FVC 2.8(0.7)L. No statistically significant changes were observed in outcome measures apart from exercise capacity. Light physical activity increased from 152(69.4) minutes per day (n = 16) to 161.9(88.7) minutes per day (n = 14), mean change (SD) (CI) p-value: 9.9 (39.8) [-12.3 to 30.9] p = 0.4. Moderate-to-vigorous physical activity increased from 19.1(18.6) minutes per day (n = 16) to 25.7(28.3) minutes per day (n = 14), mean change (SD) (CI) p-value: 6.7 (15.5) [-2.1 to 15.1] p = 0.1. Step count increased from 3838(2847) steps per day (n = 16) to 4537(3748) steps per day (n = 14), mean change (SD) (CI) p-value: 738 (1916) [-419.3 to 1734.6] p = 0.2. K-BILD (n = 15) increased from 55.1(7.4) at BL to 55.7(7.9) post VPR mean change (SD) [95% confidence interval] (CI) p-value: 1.7(6.5) [-1.7 to 5.3], p = 0.3. 6MWT (n = 5) increased from 361.5(127.1) to 452.2(136.1) meters, mean change (SD) (CI) p-value: 63.7 (48.2) [-3.8 to 123.6], p = 0.04 and 1-minute STS increased from 17.6(3.0) (n = 11) to 23.7(6.3) (n = 10), mean change (SD) (CI) p-value 5.8 (4.6) [2.6 to 9.1], p = 0.003. CONCLUSION VPR can improve physical activity in people with IPF. A number of important feasibility issues included recruitment, retention, adherence and safety have been reported which are crucial for future research in this area. A fully powered trial is needed to determine the response of people with IPF to PR with regard to physical activity.
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Affiliation(s)
- Orlagh O'Shea
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Grainne Murphy
- Department of Physiotherapy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lynn Fox
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Katherine M A O'Reilly
- Department of Respiratory Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Zamparelli SS, Lombardi C, Candia C, Iovine PR, Rea G, Vitacca M, Ambrosino P, Bocchino M, Maniscalco M. The Beneficial Impact of Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis: A Review of the Current Literature. J Clin Med 2024; 13:2026. [PMID: 38610791 PMCID: PMC11012394 DOI: 10.3390/jcm13072026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and irreversible fibrotic disease whose natural history is characterised by a progressive worsening of the pulmonary function, exertional dyspnoea, exercise intolerance, reduced physical activity, and health-related quality of life (HRQOL) impairment. Pulmonary rehabilitation (PR) is a comprehensive, multi-disciplinary programme that uses a combination of strength training, teaching, counselling, and behaviour modification techniques to reduce symptoms and optimise functional capacity in patients with chronic lung disease. Based on the well-documented effectiveness of PR in chronic obstructive pulmonary disease (COPD), over the years supportive evidence of its benefits for other respiratory diseases has been emerging. Although the latest rehabilitation guidelines recognised PR's efficacy for interstitial lung disease (ILD) and IPF in particular, this comprehensive approach remains underused and under-resourced. In this review, we will discuss the advantages and beneficial effects of PR on IPF, analysing its impact on exercise capacity, disease-related symptoms, cardiovascular outcomes, body composition, and HRQOL.
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Affiliation(s)
| | - Carmen Lombardi
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Claudio Candia
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (M.B.)
| | - Paola Rebecca Iovine
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (M.B.)
| | - Gaetano Rea
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Lumezzane Institute, 25065 Lumezzane, Italy;
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (M.B.)
| | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy; (C.C.); (M.B.)
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Lee JYT, Tikellis G, Dowman L, Jones AW, Hoffman M, Mellerick CR, Malaguti C, Khor YH, Holland AE. Self-management interventions for people with pulmonary fibrosis: a scoping review. Eur Respir Rev 2023; 32:230092. [PMID: 37914193 PMCID: PMC10618910 DOI: 10.1183/16000617.0092-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/04/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The most effective method for encouraging self-management in individuals with pulmonary fibrosis (PF) is unclear. This review aimed to identify common self-management components, the outcome measures used and the impact of these components in PF. METHODS A scoping review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis using Medline, Embase, PsychInfo, CINAHL and the Cochrane Central Register of Controlled Trials. Eligible studies included those with educational, behavioural or support components aimed at facilitating self-management among adults with PF and employed quantitative and/or qualitative methods. RESULTS 87 studies were included. Common self-management components included education (78%), managing physical symptoms (66%) and enhancing psychosocial wellbeing (54%). Components were predominantly delivered in a pulmonary rehabilitation setting (71%). No studies tested a PF-specific self-management package. Common outcome measures were 6-min walk distance (60%), St George's Respiratory Questionnaire (37%) and the Medical Research Council Dyspnoea scale (34%). Clinically significant improvements in these outcomes were seen in ≥50% of randomised controlled trials. Qualitative data highlighted the importance of healthcare professional and peer support and increased confidence in managing PF. CONCLUSION Self-management components are commonly incorporated into pulmonary rehabilitation programmes rather than being offered as standalone packages. Future research should focus on testing PF-specific self-management packages and employ standardised outcome assessments that include self-efficacy and health-related behaviours.
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Affiliation(s)
- Joanna Y T Lee
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
| | - Gabriella Tikellis
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
| | - Leona Dowman
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Arwel W Jones
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
| | - Mariana Hoffman
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | - Christie R Mellerick
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
| | - Carla Malaguti
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Yet H Khor
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Australia
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Bassi I, Guerrieri A, Carpano M, Gardini A, Prediletto I, Polastri M, Curtis JR, Nava S. Feasibility and efficacy of a multidisciplinary palliative approach in patients with advanced interstitial lung disease. A pilot randomised controlled trial. Pulmonology 2023; 29 Suppl 4:S54-S62. [PMID: 34969647 DOI: 10.1016/j.pulmoe.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Interstitial lung diseases (ILDs) encompass a heterogeneous group of parenchymal lung disorders which have a significant burden on quality of life and exercise. The primary purpose of this randomised pilot trial performed in advanced ILD was to determine the feasibility and efficacy of a multidisciplinary palliative care approach (including physiotherapist, psychologist, pulmonologists, and palliative care doctors) to relieve patients' symptoms of dyspnoea, depression measured with the Center for Epidemiological Studies-Depression (CES-D) scale and quality-of-life (QoL) at 6 and 12 months. MATHERIALS AND METHODS Fifty patients with confirmed interstitial lung disease at computed tomography (CT) scan and advanced disease were enrolled at our clinic. Patients were randomised to usual care group vs intervention group; in the intervention group, patients were scheduled to meet a physiotherapist, a psychologist, a palliative care doctor, and a pulmonologist specialized in ILD care. Data on dyspnoea, cough, quality of life and depression were recorded; patients in the intervention group were also tested to assess lower body flexibility and strength. RESULTS Both groups showed a worsening in dyspnoea during the time course of the trial, but the Borg scale was less in the intervention group at 6 and 12 months. A similar trend was observed also for the CES-D scale. No differences were observed for the other scales. CONCLUSIONS A multi-disciplinary palliative care intervention in patients with advanced fibrosing interstitial lung disease is feasible and effective. TRIAL REGISTRATION NCT02929966 on ClinGovTrial.
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Affiliation(s)
- I Bassi
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
| | - A Guerrieri
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
| | - M Carpano
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
| | - A Gardini
- Department of Statistical Sciences "P. Fortunati", Alma Mater University, Bologna, 40138, Italy
| | - I Prediletto
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
| | - M Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle WA, 98195, United States; Cambia Palliative Care Center of Excellence, UW Medicine, University of Washington, Seattle WA, 98195, United States
| | - S Nava
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater University, Bologna, 40138, Italy; Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Italy.
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Iwakura M, Kawagoshi A, Tamaki A, Oki Y, Oshima Y, Spruit MA. Physical activity measurements in individuals with interstitial lung disease: a systematic review and meta-analysis. Eur Respir Rev 2023; 32:220165. [PMID: 37437911 DOI: 10.1183/16000617.0165-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/11/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Physical activity (PA) measurements are becoming common in interstitial lung disease (ILD); however, standardisation has not been achieved. We aimed to systematically review PA measurement methods, present PA levels and provide practical recommendations on PA measurement in ILD. METHODS We searched four databases up to November 2022 for studies assessing PA in ILD. We collected information about the studies and participants, the methods used to measure PA, and the PA metrics. Studies were scored using 12 items regarding PA measurements to evaluate the reporting quality of activity monitor use. RESULTS In 40 of the included studies, PA was measured using various devices or questionnaires with numerous metrics. Of the 33 studies that utilised activity monitors, a median of five out of 12 items were not reported, with the definition of nonwear time being the most frequently omitted. The meta-analyses showed that the pooled means (95% CI) of steps, time spent in moderate to vigorous PA, total energy expenditure and sedentary time were 5215 (4640-5791) steps·day-1, 82 (58-106) min·day-1, 2130 (1847-2412) kcal·day-1 and 605 (323-887) min·day-1, respectively, with considerable heterogeneity. CONCLUSION The use of activity monitors and questionnaires in ILD lacks consistency. Improvement is required in the reporting quality of PA measurement methods using activity monitors.
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Affiliation(s)
- Masahiro Iwakura
- Department of Rehabilitation, Akita City Hospital, Akita City, Japan
| | | | - Akira Tamaki
- School of Rehabilitation, Hyogo Medical University, Hyogo, Japan
| | - Yutaro Oki
- Department of Public Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan
| | - Yohei Oshima
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Martijn A Spruit
- Department of Research and Development, CIRO, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+) NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Oliveira A, Habash R, Ellerton L, Maybank A, Alsubheen S, Marques A, Goldstein R, Brooks D. Interstitial lung diseases specific measures in exercise interventions: A systematic review of measurement properties. Ann Phys Rehabil Med 2023; 66:101682. [PMID: 35659584 DOI: 10.1016/j.rehab.2022.101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Effects of exercise-based interventions (EBIs) on people with interstitial lung disease (ILD) are not yet fully understood. Reasons may include the limited use of ILD-specific measures and/or the lack of adequate information regarding their measurement properties. The purpose of this review was to summarize the ILD-specific outcome measures used in EBI studies and their measurement properties. METHODS This was a two-phase systematic review: phase 1 identified ILD-specific measures used in EBI studies; phase 2 reviewed their measurement properties. PubMed, Web of Science, Scopus, EBSCO and EMBASE were searched up to March 2021. One reviewer extracted data, and 2 reviewers independently assessed studies risk of bias as well as the quality of measurement properties using the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) recommendations. RESULTS Phase 1 identified 18 records. The St George's Respiratory Questionnaire for Interstitial Pulmonary Fibrosis (SGRQ-IPF) was the only ILD-specific outcome measure used (n = 2 trials). Phase 2 resulted in 31 eligible records; measurement properties were reported for 12 measures. Measures presented sufficient content validity, internal consistency (Cronbach's alpha 0.61-0.96), test-retest reliability (intraclass correlation coefficient 0.39; 0.96), hypothesis testing and responsiveness but were insufficient for measurement error and indeterminate for cross-cultural and structural validity. The outcome measures King's Brief Interstitial Lung Disease and SGRQ-IPF had higher evidence of adequate measurement properties than other measures. Quality of the evidence was mostly very low to moderate. CONCLUSIONS ILD-specific outcome measures are used infrequently in EBI trials, and there is scarce information regarding their measurement properties. DATABASE REGISTRATION CRD42018112466.
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Affiliation(s)
- Ana Oliveira
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; West Park Healthcare Centre, Toronto, Ontario, Canada; Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
| | | | | | - Aline Maybank
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Sanaa Alsubheen
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Roger Goldstein
- West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Medicine, Physical Therapy and Rehabilitation Science Institute, University of Toronto, Ontario, Canada
| | - Dina Brooks
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Medicine, Physical Therapy and Rehabilitation Science Institute, University of Toronto, Ontario, Canada
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Lei S, Li X, Xie Y, Li J. Clinical evidence for improving exercise tolerance and quality of life with pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis: A systematic review and meta-analysis. Clin Rehabil 2022; 36:999-1015. [PMID: 35481421 DOI: 10.1177/02692155221095481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of pulmonary rehabilitation for exercise tolerance and quality of life improvement in idiopathic pulmonary fibrosis. METHODS We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang Database, and Chongqing VIP for randomized controlled trials that compared pulmonary rehabilitation with usual care for idiopathic pulmonary fibrosis. The risk of bias and certainty of evidence were assessed using Cochrane Collaboration's Risk of Bias tool and the Grading of Recommendations, Assessment, Development and Evaluation criteria. RESULTS Eleven trials in total with 549 participants. Compared with usual care, pulmonary rehabilitation significantly increased 6-minute walking distance (mean difference: 35.2m, 95% confidence intervals: 25.4m-44.9m; ten trials; 447 participants; moderate), decreased the St George's Respiratory Questionnaire total scores (mean difference: -9.11, 95% confidence intervals: -10.78 to -7.43; six trials; 303 participants; moderate), and reduced the modified Medical Research Council scores were lower (mean difference: -0.76, 95% confidence intervals: -1.25 to -0.27; three trials; 196 participants; low). Improvements were noted in forced vital capacity percent-predicted (mean difference: 4.88, 95% confidence intervals: 2.67 to 7.10; four trials; 214 participants; moderate) and diffusing capacity for carbon monoxide (mean difference: 4.71, 95% confidence intervals: 0.96 to 8.46; six trials; 358 participants; low). CONCLUSIONS Pulmonary rehabilitation may significantly improve exercise tolerance and quality of life in idiopathic pulmonary fibrosis patients, but the quality of evidence was low to moderate. Large sample, multicenter, randomized controlled trials are needed to verify the efficacy and safety of pulmonary rehabilitation.
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Affiliation(s)
- Siyuan Lei
- 66322Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Co-construction Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province/Henan Key Laboratory of Chinese Medicine for Respiratory Disease, 232830Henan University of Chinese Medicine, Zhengzhou, China
| | - Xuanlin Li
- Co-construction Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province/Henan Key Laboratory of Chinese Medicine for Respiratory Disease, 232830Henan University of Chinese Medicine, Zhengzhou, China
| | - Yang Xie
- Co-construction Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province/Henan Key Laboratory of Chinese Medicine for Respiratory Disease, 232830Henan University of Chinese Medicine, Zhengzhou, China.,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiansheng Li
- 66322Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Co-construction Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province/Henan Key Laboratory of Chinese Medicine for Respiratory Disease, 232830Henan University of Chinese Medicine, Zhengzhou, China.,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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Machado FVC, Bloem AEM, Schneeberger T, Jarosch I, Gloeckl R, Winterkamp S, Franssen FME, Koczulla AR, Pitta F, Spruit MA, Kenn K. Relationship between body composition, exercise capacity and health-related quality of life in idiopathic pulmonary fibrosis. BMJ Open Respir Res 2021; 8:e001039. [PMID: 34711642 PMCID: PMC8557280 DOI: 10.1136/bmjresp-2021-001039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/18/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Bioelectrical impedance analysis (BIA) can be used to estimate Fat-Free Mass Index (FFMI). However, the use of directly measured BIA variables, such as phase angle (PhA), has gained attention. The frequency of low FFMI and PhA and its associations with exercise capacity and health-related quality of life (HRQL) in patients with idiopathic pulmonary fibrosis (IPF) have been scarcely studied. OBJECTIVES To investigate the frequency of low FFMI and PhA and their associations with exercise capacity and HRQL in patients with IPF. METHODS Patients underwent assessment of lung function, body composition, exercise capacity by the 6 min walk distance (6MWD), and HRQL by the Medical Outcomes Study Short-Form 36-item Questionnaire (SF-36). Patients were classified as presenting normal or low PhA or FFMI, accordingly to the 10th percentiles of age-sex-body mass index (BMI)-specific reference values. RESULTS 98 patients (84 males, age: 68±8 years, forced vital capacity: 64%±18%predicted) were included. 24 patients presented low PhA. They were characterised by worse lung function, exercise capacity and HRQL compared with patients with normal PhA. 10 patients presented low FFMI, but despite differences in body composition, no differences were found between these patients and patients with normal FFMI. In a single regression analysis, age, lung function and body composition variables (except FFMI) were related to 6MWD and SF-36 Physical Summary Score (R²=0.06-0.36, p<0.05). None of the variables were related to SF-36 Mental Summary Score. CONCLUSION One-fourth of the patients with IPF with normal to obese BMI present abnormally low PhA. Patients classified as low PhA presented worse lung function, exercise capacity and HRQL.
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Affiliation(s)
- Felipe V C Machado
- Department of Research and Development, Ciro - Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Physiotherapy, Laboratory of Research in Respiratory Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Ada E M Bloem
- University of Applied Sciences Utrecht, Institute of Movement Studies, Faculty of Health Care, Utrecht, The Netherlands
- Department of Pulmonology, ILD Centre of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Tessa Schneeberger
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
| | - Inga Jarosch
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
| | - Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
| | - Sandra Winterkamp
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Frits M E Franssen
- Department of Research and Development, Ciro - Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Andreas R Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
| | - Fabio Pitta
- Department of Physiotherapy, Laboratory of Research in Respiratory Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Martijn A Spruit
- Department of Research and Development, Ciro - Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Klaus Kenn
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
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9
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Guler SA, Hur SA, Stickland MK, Brun P, Bovet L, Holland AE, Bondarenko J, Hambly N, Wald J, Makhdami N, Kreuter M, Gloeckl R, Jarosch I, Tan B, Johannson KA, McBride SA, De Boer K, Sandoz JS, Sun K, Assayag D, Bhatt SP, Morisset J, Ferraro V, Garvey C, Camp PG, Ryerson CJ. Survival after inpatient or outpatient pulmonary rehabilitation in patients with fibrotic interstitial lung disease: a multicentre retrospective cohort study. Thorax 2021; 77:589-595. [PMID: 34462346 DOI: 10.1136/thoraxjnl-2021-217361] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The impact of pulmonary rehabilitation (PR) on survival in patients with fibrotic interstitial lung disease (ILD) is unknown. Given the challenges conducting a large randomised controlled trial, we aimed to determine whether improvement in 6-minute walk distance (6MWD) was associated with better survival. METHODS This retrospective, international cohort study included patients with fibrotic ILD participating in either inpatient or outpatient PR at 12 sites in 5 countries. Multivariable models were used to estimate the association between change in 6MWD and time to death or lung transplantation accounting for clustering by centre and other confounders. RESULTS 701 participants (445 men and 256 women) with fibrotic ILD were included. The mean±SD ages of the 196 inpatients and 505 outpatients were 70±11 and 69±12 years, respectively. Baseline/changes in 6MWD were 262±128/55±83 m for inpatients and 358±125/34±65 m for outpatients. Improvement in 6MWD during PR was associated with lower hazard rates for death or lung transplant on adjusted analysis for both inpatient (HR per 10 m 0.94, 95% CI 0.91 to 0.97, p<0.001) and outpatient PR (HR 0.97, 95% CI 0.95 to 1.00, p=0.042). Participation in ≥80% of planned outpatient PR sessions was associated with a 33% lower risk of death (95% CI 0.49% to 0.92%). CONCLUSIONS Patients with fibrotic ILD who improved physical performance during PR had better survival compared with those who did not improve performance. Confirmation of these hypothesis-generating findings in a randomised controlled trial would be required to definitely change clinical practice, and would further support efforts to improve availability of PR for patients with fibrotic ILD.
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Affiliation(s)
- Sabina Anna Guler
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Seo Am Hur
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Brun
- Bern Rehabilitation Center, Heiligenschwendi, Bern, Switzerland
| | - Luc Bovet
- Bern Rehabilitation Center, Heiligenschwendi, Bern, Switzerland
| | - Anne E Holland
- Department of Physiotherapy, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Department of Physiotherapy, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Nathan Hambly
- Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, Hamilton, Ontario, Canada
| | - Joshua Wald
- Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, Hamilton, Ontario, Canada
| | - Nima Makhdami
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Kreuter
- Center for interstitial and rare lung diseases, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Inga Jarosch
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Benjamin Tan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S Ainslie McBride
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaissa De Boer
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Kelly Sun
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Surya P Bhatt
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama At Birmingham, Birmingham, Alabama, USA
| | - Julie Morisset
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Vincent Ferraro
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Chris Garvey
- Pulmonary Rehabilitation and Sleep Disorders Center, University of California San Francisco, San Francisco, California, USA
| | - Pat G Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Li X, Yu R, Wang P, Wang A, Huang H. Effects of Exercise Training on Cardiopulmonary Function and Quality of Life in Elderly Patients with Pulmonary Fibrosis: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147643. [PMID: 34300094 PMCID: PMC8306771 DOI: 10.3390/ijerph18147643] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 12/21/2022]
Abstract
(1) Objective: Our objective was to conduct a meta-analysis of randomized controlled trials that have evaluated the benefits of exercise training for elderly pulmonary fibrosis (PF) patients. (2) Methods: Studies in either English or Chinese were retrieved from the China National Knowledge Infrastructure (CNKI) and the Wanfang, PubMed, Web of Science and SPORTDiscus databases from inception until the first week of April 2021. Age, body mass index (BMI), and exercise frequency, intensity, type, and duration were considered for each participant. The specific data recorded were the six-minute walk distance (6MWD), maximal rate of oxygen consumption (peak VO2), predicted forced vital capacity (FVC% pred), predicted diffusing capacity of the lung for carbon monoxide (DLCO% pred), predicted total lung capacity (TLC% pred), St. George’s respiratory questionnaire (SGRQ) total score and a modified medical research council score (mMRC). (3) Results: Thirteen studies comprised this meta-analysis (eleven randomized controlled trials and two prospective studies design), wherein 335 patients were exercised and 334 were controls. The results showed that exercise training increased the 6MWD (Cohen’s d = 0.77, MD = 34.04 (95% CI, 26.50–41.58), p < 0.01), peak VO2 (Cohen’s d = 0.45, MD = 1.13 (95% CI, 0.45–1.82), p = 0.0001) and FVC% pred (Cohen’s d = 0.42, MD = 3.94 (95% CI, 0.91–6.96), p = 0.01). However, exercise training reduced scores for the SGRQ (Cohen’s d = 0.89, MD = −8.79 (95% CI, −10.37 to −7.21), p < 0.01) and the mMRC (Cohen’s d = 0.64, MD = −0.58 (95% CI, −0.79 to −0.36), p < 0.01). In contrast, exercise training could not increase DLCO% pred (Cohen’s d = 0.16, MD = 1.86 (95% CI, −0.37–4.09), p = 0.10) and TLC% pred (Cohen’s d = 0.02, MD = 0.07 (95% CI, −6.53–6.67), p = 0.98). Subgroup analysis showed significant differences in frequency, intensity, type, and age in the 6MWD results (p < 0.05), which were higher with low frequency, moderate intensity, aerobic–resistance–flexibility–breathing exercises and age ≤ 70. Meanwhile, the subgroup analysis showed significant differences in exercise intensity and types in the mMRC results (p < 0.05), which were lower with moderate intensity and aerobic–resistance exercises. (4) Conclusions: Exercise training during pulmonary rehabilitation can improved cardiopulmonary endurance and quality of life in elderly patients with PF. The 6MWDs were more noticeable with moderate exercise intensity, combined aerobic–resistance–flexibility–breathing exercises and in younger patients, which all were not affected by BMI levels or exercise durations. As to pulmonary function, exercise training can improve FVC% pred, but has no effect on DLCO% pred and TLC% pred.
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Affiliation(s)
- Xiaohan Li
- Faculty of Sport Science, Research Academy of Grand Health, Ningbo University, Ningbo 315211, China;
| | - Rongfang Yu
- School of Physical Education & Sport Training, Shanghai University of Sport, Shanghai 200438, China;
| | - Ping Wang
- School of Physical Education and Exercise Sciences, Lingnan Normal University, Zhanjiang 524048, China;
| | - Aiwen Wang
- Faculty of Sport Science, Research Academy of Grand Health, Ningbo University, Ningbo 315211, China;
- Correspondence: (A.W.); (H.H.)
| | - Huiming Huang
- Faculty of Sport Science, Research Academy of Grand Health, Ningbo University, Ningbo 315211, China;
- Correspondence: (A.W.); (H.H.)
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11
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Luppi F, Kalluri M, Faverio P, Kreuter M, Ferrara G. Idiopathic pulmonary fibrosis beyond the lung: understanding disease mechanisms to improve diagnosis and management. Respir Res 2021; 22:109. [PMID: 33865386 PMCID: PMC8052779 DOI: 10.1186/s12931-021-01711-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/11/2021] [Indexed: 02/07/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disorder with an estimated median survival time of 3–5 years after diagnosis. This condition occurs primarily in elderly subjects, and epidemiological studies suggest that the main risk factors, ageing and exposure to cigarette smoke, are associated with both pulmonary and extrapulmonary comorbidities (defined as the occurrence of two or more disorders in a single individual). Ageing and senescence, through interactions with environmental factors, may contribute to the pathogenesis of IPF by various mechanisms, causing lung epithelium damage and increasing the resistance of myofibroblasts to apoptosis, eventually resulting in extracellular matrix accumulation and pulmonary fibrosis. As a paradigm, syndromes featuring short telomeres represent archetypal premature ageing syndromes and are often associated with pulmonary fibrosis. The pathophysiological features induced by ageing and senescence in patients with IPF may translate to pulmonary and extrapulmonary features, including emphysema, pulmonary hypertension, lung cancer, coronary artery disease, gastro-oesophageal reflux, diabetes mellitus and many other chronic diseases, which may lead to substantial negative consequences in terms of various outcome parameters in IPF. Therefore, the careful diagnosis and treatment of comorbidities may represent an outstanding chance to improve quality of life and survival, and it is necessary to contemplate all possible management options for IPF, including early identification and treatment of comorbidities.
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Affiliation(s)
- Fabrizio Luppi
- Respiratory Unit, University of Milano Bicocca, S. Gerardo Hospital, ASST Monza, Monza, Italy
| | - Meena Kalluri
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 3-134 Clinical Sciences Building, 11304 83 Ave., Edmonton, AB, T6G 2G3, Canada
| | - Paola Faverio
- Respiratory Unit, University of Milano Bicocca, S. Gerardo Hospital, ASST Monza, Monza, Italy
| | - Michael Kreuter
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, University of Heidelberg, German Center for Lung Research, ThoraxklinikHeidelberg, Germany
| | - Giovanni Ferrara
- Sensory Motor Adaptive Rehabilitation Technology (SMART) Network, University of Alberta, Edmonton, AB, Canada. .,Division of Pulmonary Medicine, Department of Medicine, University of Alberta, 3-134 Clinical Sciences Building, 11304 83 Ave., Edmonton, AB, T6G 2G3, Canada.
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12
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Bajwah S, Colquitt J, Loveman E, Bausewein C, Almond H, Oluyase A, Dzingina M, Maddocks M, Higginson IJ, Wells A. Pharmacological and nonpharmacological interventions to improve symptom control, functional exercise capacity and quality of life in interstitial lung disease: an evidence synthesis. ERJ Open Res 2021; 7:00107-2020. [PMID: 33532482 PMCID: PMC7836673 DOI: 10.1183/23120541.00107-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/13/2020] [Indexed: 11/09/2022] Open
Abstract
We assessed efficacy and effectiveness of pharmacological and nonpharmacological interventions in improving symptom control, functional exercise capacity and quality of life (QoL) in people living with fibrotic interstitial lung disease (ILD). We summarised evidence from three previous reviews (to June 2014) and conducted an updated search of nine databases and grey literature (2011-2019) (registration: CRD42017065933) for prospective studies of interventions aimed to alleviate symptoms, improve QoL or functional exercise capacity in fibrotic ILD. Data were synthesised through narrative synthesis or meta-analysed as appropriate. Forty-seven studies with 2527 participants were included. From 22 pharmacological studies of 11 different interventions (n=1683), the most tested interventions were bosentan and sildenafil. From 25 nonpharmacological studies, the most tested intervention was for pulmonary rehabilitation/exercise training (PR) (22 studies, n=748). There was an improvement in 6-min walk distance immediately following PR (six studies; n=200, mean difference (MD) (95% CI) 39.9 m (18.2 to 61.5)), but not longer term (3 or 6 months, four studies; n=147, MD 5.3 m (-12.9 to 23.4). Multiple, varied outcome measures were used (e.g. 37 studies assessing dyspnoea used 10 different scales with a lack of reporting of rate of deterioration in outcomes). Evidence gap mapping highlighted the most and least researched symptoms, as dyspnoea and cough, respectively. This evidence synthesis highlights overwhelmingly that the most researched symptom is dyspnoea and the strongest evidence base is for short-term PR. The least researched symptom was cough. Research going forward must focus on prioritising and standardising meaningful outcomes and focussing interventions on neglected symptoms.
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Affiliation(s)
- Sabrina Bajwah
- Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, London, UK,Sabrina Bajwah, Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, Bessemer Road, London SE5 9PJ, UK. E-mail:
| | | | | | | | | | - Adejoke Oluyase
- Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, London, UK
| | - Mendy Dzingina
- Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, London, UK
| | - Irene J. Higginson
- Cicely Saunders Institute, Dept of Palliative Care Policy and Rehabilitation, King's College London, London, UK
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13
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MOTOC NS, MAIEREAN AD, MAN MA, ALEXESCU TG, CIUMARNEAN L, TONCA C, DOGARU G, TODEA DA, DOMOKOS B. The efficacy of pulmonary rehabilitation in improving the clinical status in
idiopathic pulmonary fibrosis. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fatal lung disease with a median survival rate of 2-4 years after diagnosis, occurring primarily in older adults. The diagnosis is suggested by histology or radiologic evidence of a usual interstitial pneumonia (UIP) pattern and exclusion of known cases of pulmonary fibrosis. There are some comorbidities associated with IPF such as pulmonary hypertension, emphysema, chronic obstructive pulmonary disease (COPD), asthma, lung cancer, cardiovascular disorders, gastroesophageal reflux disease (GERD), sleep disorders and psychiatric disturbances. The management of IPF focuses on the amelioration of symptoms, preserving lung function, improving health status, minimizing the adverse effects of therapy and improving survival. Pulmonary rehabilitation is suggested for IPF patients when adequate medical therapy controls poorly the disease progression and mental, physical or social consequences of the illness persist during daily life. Currently, there are only two approved available antifibrotic therapies, pirfenidone and nintedanib, capable to reduce disease progression and physical deterioration, but cure is elusive and improvements are hardly observed. In addition, there is a continuous need of non-drug therapy components which should be included in IPF patient management: education, psychosocial support, exercise training, nutrition, symptom management and palliative care, non-invasive ventilation and pulmonary transplant. These complementary therapies have been proven to improve dyspnea, exercise capacity, fatigue and quality of life.
Key words: idiopathic pulmonary fibrosis, rehabilitation, quality of life, palliative care,
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Affiliation(s)
- Nicoleta Stefania MOTOC
- 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania
| | - Anca Diana MAIEREAN
- 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania
| | - Milena Adina MAN
- 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania
| | - Teodora Gabriela ALEXESCU
- 2- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Internal Medicine, Cluj Napoca, Romania
| | - Lorena CIUMARNEAN
- 2- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Internal Medicine, Cluj Napoca, Romania
| | - Claudia TONCA
- 3- “Leon Daniello” Clinical Hospital of Pneumology, Cluj Napoca, Romania
| | - Gabriela DOGARU
- 4- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Rehabilitation, Cluj Napoca, Romania
| | - Doina Adina TODEA
- 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania
| | - Bianca DOMOKOS
- 1- “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania
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14
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Using 6-Min Walk Distance Expressed as a Percentage of Reference to Evaluate the Effect of Pulmonary Rehabilitation in Elderly Patients With Interstitial Lung Disease. J Cardiopulm Rehabil Prev 2019; 38:342-347. [PMID: 29485525 DOI: 10.1097/hcr.0000000000000305] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to investigate the effect of outpatient pulmonary rehabilitation (PR) program and the use of 6-min walk distance (6MWD), expressed as a percentage of the predicted value (%6MWD), to quantify response to PR in elderly patients with interstitial lung disease (ILD). METHODS This was a prospective, nonrandomized controlled study. Forty eligible patients with stable ILD (≥65 y old) were advised to attend an outpatient PR program for 3 mo. Thirteen patients completed the PR program and formed the PR group. Ten patients who did not attend the PR program were evaluated after 3 mo and formed the control group. Patients in the PR group underwent a comprehensive 3-mo hospital-based outpatient PR program, consisting of educational support and supervised exercise training, and attended the rehabilitation unit weekly. RESULTS Change in the absolute 6MWD (Δ6MWD) in the PR group was not significantly different compared with the control group (P = .062). Change in %6MWD (Δ%6MWD) was greater in the PR group than in the control group. Baseline 6MWD was not correlated with Δ6MWD, but baseline %6MWD was significantly correlated with Δ6MWD and Δ%6MWD. CONCLUSION PR had a beneficial effect on elderly patients with ILD in terms of exercise endurance. %6MWD might be more useful than the absolute 6MWD as an outcome measure of PR and as a predictor of response to PR in elderly patients with ILD.
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Yu X, Li X, Wang L, Liu R, Xie Y, Li S, Li J. Pulmonary Rehabilitation for Exercise Tolerance and Quality of Life in IPF Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8498603. [PMID: 31016200 PMCID: PMC6448340 DOI: 10.1155/2019/8498603] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/25/2019] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the efficacy and safety of pulmonary rehabilitation (PR) in patients with idiopathic pulmonary fibrosis (IPF). Methods. Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and Chinese Biomedical Literature Database (SinoMed) were comprehensively searched. Randomized controlled trials (RCTs) that investigated the effects of PR for IPF patients were included. Literature selection and data extraction were conducted by two review authors independently. The Cochrane Collaboration's Risk of Bias tool and RevMan software (version 5.3) were used to evaluate the quality of studies and conduct statistical analysis, respectively. Results. Seven studies (190 participants) were included. PR had a significant effect on six-minute walk distance (6MWD) (MD:48.60; 95%CI: 29.03 to 68.18; Z=4.87, P<0.00001), and 6MWD was improved more in subgroup analysis including studies conducted in Asia (MD: 53.62; 95%CI: 30.48 to 76.66; Z=4.54, P<0.00001) and Europe (MD:54.10; 95% CI: 26.65 to 101.56; Z=2.23, P=0.03). Forced vital capacity (FVC%) was higher (MD: 3.69; 95%CI: 0.16 to 7.23; Z=2.05, P=0.04). St. George's Respiratory Questionnaire (SGRQ)/IPF-specific SGRQ (SGRQ-I) total score was lower (MD: -7.87; 95% CI: -11.44 to -4.30; Z=4.32, P<0.0001). No significant effects were found for lung diffusing capacity determined by the single-breath technique (DLCO%) (MD: 3.02; 95%CI: -0.38 to 6.42; Z=1.74, P=0.08). CONCLUSIONS This study suggests that PR may enhance exercise capacity and improve quality of life in IPF patients. Besides, PR may also delay the decline of lung function of patients with IPF. However, further research should more fully assess the efficacy and safety of PR for IPF.
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Affiliation(s)
- Xueqing Yu
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, China
| | - Xuanlin Li
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, China
| | - Liaoyao Wang
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, China
| | - Ran Liu
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, China
| | - Yang Xie
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, China
| | - Suyun Li
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, China
| | - Jiansheng Li
- Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan 450000, China
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16
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The Role of Pulmonary Rehabilitation and Supplemental Oxygen Therapy in the Treatment of Patients with Idiopathic Pulmonary Fibrosis. Respir Med 2019. [DOI: 10.1007/978-3-319-99975-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Perez-Bogerd S, Wuyts W, Barbier V, Demeyer H, Van Muylem A, Janssens W, Troosters T. Short and long-term effects of pulmonary rehabilitation in interstitial lung diseases: a randomised controlled trial. Respir Res 2018; 19:182. [PMID: 30236104 PMCID: PMC6149060 DOI: 10.1186/s12931-018-0884-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few data are available on the long-term effect of pulmonary rehabilitation (PR) and on long PR programs in interstitial lung diseases (ILD). We aimed to evaluate the effects of PR on exercise capacity (6-Minute Walking Distance, 6MWD; Peak Work Rate, Wmax), quality of life (St George's Respiratory Questionnaire, SGRQ), quadriceps force (QF) and objectively measured physical activity in ILD after the 6-month PR-program and after 1 year. METHODS 60 patients (64 ± 11 years; 62% males; 23% with IPF) were randomly assigned to receive a 6 month-PR program or usual medical care. RESULTS Exercise capacity, quality of life and muscle force increased significantly after the program as compared to control (mean,95%CI[ll to ul]; 6MWD + 72,[36 to 108] m; Wmax 19, [8 to 29]%pred; SGRQ - 12,[- 19 to - 6] points; QF 10, [1 to 18] %pred). The gain was sustained after 1 year (6MWD 73,[28 to 118] m; Wmax 23, [10 to 35]%pred; SGRQ - 11,[- 18 to - 4] points; QF 9.5, [1 to 18] %pred). Physical activity did not change. CONCLUSIONS PR improves exercise tolerance, health status and muscle force in ILD. The benefits are maintained at 1-year follow-up. The intervention did not change physical activity. TRIAL REGISTRATION Clinicaltrials.gov NCT00882817 .
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Affiliation(s)
- Silvia Perez-Bogerd
- Erasme University Hospital, Chest Department, Université Libre Bruxelles, B-1060, Brussels, Belgium.,University Hospitals Leuven, Department of Respiratory Diseases, B-3000, Leuven, Belgium
| | - Wim Wuyts
- University Hospitals Leuven, Department of Respiratory Diseases, B-3000, Leuven, Belgium
| | - Veronica Barbier
- University Hospitals Leuven, Department of Respiratory Diseases, B-3000, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, B-3000, Leuven, Belgium
| | - Alain Van Muylem
- Erasme University Hospital, Chest Department, Université Libre Bruxelles, B-1060, Brussels, Belgium
| | - Wim Janssens
- University Hospitals Leuven, Department of Respiratory Diseases, B-3000, Leuven, Belgium.,KU Leuven, Department of Rehabilitation Sciences, B-3000, Leuven, Belgium.,KU Leuven, Department of Chronic Diseases, Metabolism and Ageing, B-3000, Leuven, Belgium
| | - Thierry Troosters
- University Hospitals Leuven, Department of Respiratory Diseases, B-3000, Leuven, Belgium. .,KU Leuven, Department of Rehabilitation Sciences, B-3000, Leuven, Belgium.
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Wallaert B, Masson N, Le Rouzic O, Chéhère B, Wémeau-Stervinou L, Grosbois JM. Effects of pulmonary rehabilitation on daily life physical activity of fibrotic idiopathic interstitial pneumonia patients. ERJ Open Res 2018; 4:00167-2017. [PMID: 29900176 PMCID: PMC5994481 DOI: 10.1183/23120541.00167-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/12/2018] [Indexed: 01/12/2023] Open
Abstract
According to the international consensus statement of 2011, idiopathic pulmonary fibrosis (IPF) and idiopathic nonspecific interstitial pneumonia (NSIP) are classified as fibrotic idiopathic interstitial pneumonia (f-IIP) of unknown aetiology [1]. f-IIP patients display persistent and significant dyspnoea, exercise intolerance and poor health-related quality of life [2]. f-IIP is also associated with a marked reduction in daily life physical activity (DLPA) [3], which is related to morbidity and mortality in many chronic diseases, including f-IIP [4–6]. Fibrotic idiopathic interstitial pneumonia patients derived benefit from a pulmonary rehabilitation programme in terms of exercise tolerance, anxiety, depression and quality of life without increasing their daily life physical activityhttp://ow.ly/WV7U30kgNkU
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Affiliation(s)
- Benoit Wallaert
- Univ. Lille, CHU Lille, Centre de Référence des Maladies Pulmonaires Rares, Service de Pneumologie Immunologie et Allergologie, Hôpital Calmette, Lille, France.,Institut Pasteur de Lille, Lille, France.,Both authors contributed equally
| | - Nicolas Masson
- Univ. Lille, CHU Lille, Centre de Référence des Maladies Pulmonaires Rares, Service de Pneumologie Immunologie et Allergologie, Hôpital Calmette, Lille, France.,Both authors contributed equally
| | - Olivier Le Rouzic
- Univ. Lille, CHU Lille, Centre de Référence des Maladies Pulmonaires Rares, Service de Pneumologie Immunologie et Allergologie, Hôpital Calmette, Lille, France
| | - Baptiste Chéhère
- Univ. Lille, EA 7369 - URePSSS - Multidisciplinary Research Unit in Sport Health Society, Lille, France
| | - Lidwine Wémeau-Stervinou
- Univ. Lille, CHU Lille, Centre de Référence des Maladies Pulmonaires Rares, Service de Pneumologie Immunologie et Allergologie, Hôpital Calmette, Lille, France.,Institut Pasteur de Lille, Lille, France
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19
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Schertel A, Funke-Chambour M, Geiser T. [Not Available]. PRAXIS 2017; 106:999-1006. [PMID: 28875747 DOI: 10.1024/1661-8157/a002770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Trotz der Verfügbarkeit neuer Antifibrotika, mit denen eine Verlangsamung der Krankheitsprogression erreicht werden kann, bleibt die idiopathische Lungenfibrose eine invalidisierende, progressive Erkrankung mit schlechter Prognose. Mit dem Ziel einer Verbesserung der Lebensqualität und der Vermeidung von Komplikationen werden deshalb neben der antifibrotischen Therapie auch die Behandlung von Komorbiditäten sowie nicht-medikamentöse Therapieansätze eingesetzt, welche im Folgenden vorgestellt werden.
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Affiliation(s)
- Anke Schertel
- 1 Universitätsklinik für Pneumologie, Universitätsspital Inselspital, Universität Bern
| | | | - Thomas Geiser
- 1 Universitätsklinik für Pneumologie, Universitätsspital Inselspital, Universität Bern
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Preliminary study of the anabolic/catabolic balance in patients with interstitial pulmonary fibrosis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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21
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Shao L, Meng D, Yang F, Song H, Tang D. Irisin-mediated protective effect on LPS-induced acute lung injury via suppressing inflammation and apoptosis of alveolar epithelial cells. Biochem Biophys Res Commun 2017; 487:194-200. [DOI: 10.1016/j.bbrc.2017.04.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 02/07/2023]
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van Manen MJG, Geelhoed JJM, Tak NC, Wijsenbeek MS. Optimizing quality of life in patients with idiopathic pulmonary fibrosis. Ther Adv Respir Dis 2017; 11:157-169. [PMID: 28134007 DOI: 10.1177/1753465816686743] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating, progressive and ultimately fatal lung disease. The combination of poor prognosis, uncertainty of disease course and severe symptom burden heavily impacts patients' and their families' quality of life. Though new antifibrotic drugs have been shown to decrease disease progression, the effect on health-related quality of life (HRQOL) has not been convincingly demonstrated. In a relentless disease such as IPF, striving to optimize HRQOL should complement the endeavour to prolong life. Unfortunately, there is a paucity of interventions improving symptoms and functionality for patients with IPF, and research focusing on symptom improvement, and assessing and optimizing HRQOL, is limited. This review summarizes the most recent insights into measuring and improving quality of life for patients with IPF, and discusses challenges in the management of this devastating disease. Moreover, we postulate a new model for continuous care in IPF - 'the ABCDE of IPF care': Assessing patients' needs; Backing patients by giving information and support; delivering Comfort care by focusing on treating symptoms and taking into account Comorbidities; striving to prolong life by Disease modification; helping and preparing patients and their caregivers for the eventual End-of-life events that are likely to occur.
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Affiliation(s)
- Mirjam J G van Manen
- Department of Respiratory Medicine, Erasmus Medical Center, University Hospital Rotterdam, The Netherlands
| | - J J Miranda Geelhoed
- Department of Respiratory Medicine, Erasmus Medical Center, University Hospital Rotterdam, The Netherlands
| | - Nelleke C Tak
- Department of Respiratory Medicine, Erasmus Medical Center, University Hospital Rotterdam, The Netherlands
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Erasmus Medical Center, University Hospital Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Andrade-Sousa AS, Rogério Pereira P, MacKenzie B, Oliveira-Junior MC, Assumpção-Neto E, Brandão-Rangel MAR, Damaceno-Rodrigues NR, Garcia Caldini E, Velosa APP, Teodoro WR, Ligeiro de Oliveira AP, Dolhnikoff M, Eickelberg O, Vieira RP. Aerobic Exercise Attenuated Bleomycin-Induced Lung Fibrosis in Th2-Dominant Mice. PLoS One 2016; 11:e0163420. [PMID: 27677175 PMCID: PMC5038953 DOI: 10.1371/journal.pone.0163420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 09/08/2016] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate the effect of aerobic exercise (AE) in reducing bleomycin-induced fibrosis in mice of a Th2-dominant immune background (BALB/c). METHODS BALB/c mice were distributed into: sedentary, control (CON), Exercise-only (EX), sedentary, bleomycin-treated (BLEO) and bleomycin-treated+exercised (BLEO+EX); (n = 8/group). Following treadmill adaptation, 15 days following a single, oro-tracheal administration of bleomycin (1.5U/kg), AE was performed 5 days/week, 60min/day for 4 weeks at moderate intensity (60% of maximum velocity reached during a physical test) and assessed for pulmonary inflammation and remodeling, and cytokine levels in bronchoalveolar lavage (BAL). RESULTS At 45 days post injury, compared to BLEO, BLEO+EX demonstrated reduced collagen deposition in the airways (p<0.001) and also in the lung parenchyma (p<0.001). In BAL, a decreased number of total leukocytes (p<0.01), eosinophils (p<0.001), lymphocytes (p<0.01), macrophages (p<0.01), and neutrophils (p<0.01), as well as reduced pro-inflammatory cytokines (CXCL-1; p<0.01), (IL-1β; p<0.001), (IL-5; p<0.01), (IL-6; p<0.001), (IL-13; p<0.01) and pro-fibrotic growth factor IGF-1 (p<0.001) were observed. Anti-inflammatory cytokine IL-10 was increased (p<0.001). CONCLUSION AE attenuated bleomycin-induced collagen deposition, inflammation and cytokines accumulation in the lungs of mice with a predominately Th2-background suggesting that therapeutic AE (15-44 days post injury) attenuates the pro-inflammatory, Th2 immune response and fibrosis in the bleomycin model.
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Affiliation(s)
- Adilson Santos Andrade-Sousa
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Paulo Rogério Pereira
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - BreAnne MacKenzie
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Manoel Carneiro Oliveira-Junior
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Erasmo Assumpção-Neto
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Maysa Alves Rodrigues Brandão-Rangel
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Nilsa Regina Damaceno-Rodrigues
- Laboratory of Cellular Biology (LIM 59), School of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, Sao Paulo – SP, Brazil
| | - Elia Garcia Caldini
- Laboratory of Cellular Biology (LIM 59), School of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, Sao Paulo – SP, Brazil
| | - Ana Paula Pereira Velosa
- Laboratory of Medical Investigation (LIM 17), School of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, Sao Paulo – SP, Brazil
| | - Walcy Rosolia Teodoro
- Laboratory of Medical Investigation (LIM 17), School of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, Sao Paulo – SP, Brazil
| | - Ana Paula Ligeiro de Oliveira
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
| | - Marisa Dolhnikoff
- Department of Pathology, School of Medicine, University of São Paulo, Avenida Doutor Arnaldo, 455, Sao Paulo – SP, Brazil
| | - Oliver Eickelberg
- Comprehensive Pneumology Center (CPC), Ludwig Maximilian Universität München and Helmholtz Zentrum München, Max-Lebsche-Platz 31, München, Germany
| | - Rodolfo Paula Vieira
- Laboratory of Pulmonary and Exercise Immunology (LABPEI) and Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), Nove de Julho University (UNINOVE), Rua Vergueiro, 235/249, São Paulo – SP, Brazil
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Vainshelboim B, Kramer MR, Izhakian S, Lima RM, Oliveira J. Physical Activity and Exertional Desaturation Are Associated with Mortality in Idiopathic Pulmonary Fibrosis. J Clin Med 2016; 5:jcm5080073. [PMID: 27548238 PMCID: PMC4999793 DOI: 10.3390/jcm5080073] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/01/2016] [Accepted: 08/15/2016] [Indexed: 12/31/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease that manifests in hypoxemia, inactivity, and poor prognosis. This study aimed to assess the prognostic role of physical activity (PA) and exertional desaturation (ED) with mortality in IPF. At baseline, 34 IPF patients (68 (50–81) years) were interviewed using the International Physical Activity Questionnaire (IPAQ), and SpO2 was assessed pre to post 6-min walking test (∆SpO2). Patients were prospectively followed up for 40 months. Receiver operating characteristics curve analysis determined cut-off points associated with mortality, and Cox proportional hazard ratio (HR) were conducted. Thresholds for increased mortality risk in IPF patients were determined as IPAQ ≤ 417 metabolic equivalent task (METS)-min/week, p = 0.004 (HR; 9.7, CI 95% (1.3–71.9), p = 0.027), and ∆SpO2 ≥ 10%, p = 0.002, (HR; 23.3, CI 95% (1.5–365), p = 0.025). This study demonstrated a significant association of PA and ED with mortality in IPF patients. The findings emphasize the clinical importance of PA and ED assessments to aid in IPF risk stratification, prognosis prediction, and in providing early appropriate treatments, such as pulmonary rehabilitation, PA consultation, oxygen supplementation, and lung transplantation referral. These results underscore that even low levels of PA corresponding to 100–105 min/week were associated with a reduced mortality risk and better survival in IPF.
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Affiliation(s)
- Baruch Vainshelboim
- Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel.
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto 4200-450, Portugal.
- Cardiology Division, Veterans Affairs Palo Alto Health Care System/Stanford University, Palo Alto, CA 94304, USA.
| | - Mordechai Reuven Kramer
- Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Shimon Izhakian
- Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel.
| | - Ricardo M Lima
- Cardiology Division, Veterans Affairs Palo Alto Health Care System/Stanford University, Palo Alto, CA 94304, USA.
- Faculty of Physical Education, University of Brasília, Brasília 70910-900, Brazil.
| | - Jose Oliveira
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto 4200-450, Portugal.
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Abstract
Key points Educational aims Exercise is a well-documented safe and effective intervention for prevention and rehabilitation of chronic diseases. Idiopathic pulmonary fibrosis (IPF) is a chronic deadly lung disease associated with severe signs and symptoms, exercise intolerance, diminished quality of life and poor prognosis. In the short term, supervised exercise training programmes have demonstrated clinical benefits in improving exercise capacity, dyspnoea and quality of life in patients with IPF. The underlying mechanisms of chronic adaption to a regular exercise regimen in IPF have yet to be well described and require further investigation. The available data underscore the importance of implementing training principles to target the pathophysiological impairments of IPF in order to optimise training adaption and enhance the outcomes. The current exercise training data in IPF provide sufficient evidence of clinical benefit for consideration to be given to recommending exercise-based pulmonary rehabilitation as standard of care for IPF. An overview of data on exercise for IPF patients, highlighting the importance of exercise training in IPF managementhttp://ow.ly/4mWCCd
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Affiliation(s)
- Baruch Vainshelboim
- Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel; Cardiology Division, Veterans Affairs Palo Alto Health Care System/Stanford University, Palo Alto, CA, USA
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