The evidence of benefits of exercise training in interstitial lung disease

a randomised controlled trial

Leona M. Dowman, Christine F. McDonald, Catherine J. Hill, Annemarie L. Lee, Kathryn Barker, Claire Boote, Ian Glaspole, Nicole S.L. Goh, Anne M. Southcott, Angela T. Burge, Rebecca Gillies, Alicia Martin, Anne E. Holland

Research output: Contribution to journalArticleResearchpeer-review

46 Citations (Scopus)

Abstract

BACKGROUND: Uncertainty exists regarding the clinical relevance of exercise training across the range of interstitial lung diseases (ILDs).

OBJECTIVE: To establish the impact of exercise training in patients with ILDs of differing aetiology and severity.

METHODS: 142 participants with ILD (61 idiopathic pulmonary fibrosis (IPF), 22 asbestosis, 23 connective tissue disease-related ILD (CTD-ILD) and 36 with other aetiologies) were randomised to either 8 weeks of supervised exercise training or usual care. Six-minute walk distance (6MWD), Chronic Respiratory Disease Questionnaire (CRDQ), St George Respiratory Questionnaire IPF-specific version (SGRQ-I) and modified Medical Research Council dyspnoea score were measured at baseline, 9 weeks and 6 months.

MEASUREMENTS AND MAIN RESULTS: Exercise training significantly increased 6MWD (25 m, 95% CI 2 to 47 m) and health-related quality of life (CRDQ and SGRQ-I) in people with ILD. Larger improvements in 6MWD, CRDQ, SGRQ-I and dyspnoea occurred in asbestosis and IPF compared with CTD-ILD, but with few significant differences between subgroups. Benefits declined at 6 months except in CTD-ILD. Lower baseline 6MWD and worse baseline symptoms were associated with greater benefit in 6MWD and symptoms following training. Greater gains were seen in those whose exercise prescription was successfully progressed according to the protocol. At 6 months, sustained improvements in 6MWD and symptoms were associated with better baseline lung function and less pulmonary hypertension.

CONCLUSIONS: Exercise training is effective in patients across the range of ILDs, with clinically meaningful benefits in asbestosis and IPF. Successful exercise progression maximises improvements and sustained treatment effects favour those with milder disease.

TRIAL REGISTRATION NUMBER: Results, ACTRN12611000416998.

Original languageEnglish
Pages (from-to)610-619
Number of pages10
JournalThorax
Volume72
Issue number7
DOIs
Publication statusPublished - 1 Jul 2017

Keywords

  • Asbestos Induced Lung Disease
  • Connective tissue disease associated lung disease
  • Exercise
  • Idiopathic pulmonary fibrosis
  • Interstitial Fibrosis
  • Pulmonary Rehabilitation

Cite this

Dowman, Leona M. ; McDonald, Christine F. ; Hill, Catherine J. ; Lee, Annemarie L. ; Barker, Kathryn ; Boote, Claire ; Glaspole, Ian ; Goh, Nicole S.L. ; Southcott, Anne M. ; Burge, Angela T. ; Gillies, Rebecca ; Martin, Alicia ; Holland, Anne E. / The evidence of benefits of exercise training in interstitial lung disease : a randomised controlled trial. In: Thorax. 2017 ; Vol. 72, No. 7. pp. 610-619.
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abstract = "BACKGROUND: Uncertainty exists regarding the clinical relevance of exercise training across the range of interstitial lung diseases (ILDs).OBJECTIVE: To establish the impact of exercise training in patients with ILDs of differing aetiology and severity.METHODS: 142 participants with ILD (61 idiopathic pulmonary fibrosis (IPF), 22 asbestosis, 23 connective tissue disease-related ILD (CTD-ILD) and 36 with other aetiologies) were randomised to either 8 weeks of supervised exercise training or usual care. Six-minute walk distance (6MWD), Chronic Respiratory Disease Questionnaire (CRDQ), St George Respiratory Questionnaire IPF-specific version (SGRQ-I) and modified Medical Research Council dyspnoea score were measured at baseline, 9 weeks and 6 months.MEASUREMENTS AND MAIN RESULTS: Exercise training significantly increased 6MWD (25 m, 95{\%} CI 2 to 47 m) and health-related quality of life (CRDQ and SGRQ-I) in people with ILD. Larger improvements in 6MWD, CRDQ, SGRQ-I and dyspnoea occurred in asbestosis and IPF compared with CTD-ILD, but with few significant differences between subgroups. Benefits declined at 6 months except in CTD-ILD. Lower baseline 6MWD and worse baseline symptoms were associated with greater benefit in 6MWD and symptoms following training. Greater gains were seen in those whose exercise prescription was successfully progressed according to the protocol. At 6 months, sustained improvements in 6MWD and symptoms were associated with better baseline lung function and less pulmonary hypertension.CONCLUSIONS: Exercise training is effective in patients across the range of ILDs, with clinically meaningful benefits in asbestosis and IPF. Successful exercise progression maximises improvements and sustained treatment effects favour those with milder disease.TRIAL REGISTRATION NUMBER: Results, ACTRN12611000416998.",
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author = "Dowman, {Leona M.} and McDonald, {Christine F.} and Hill, {Catherine J.} and Lee, {Annemarie L.} and Kathryn Barker and Claire Boote and Ian Glaspole and Goh, {Nicole S.L.} and Southcott, {Anne M.} and Burge, {Angela T.} and Rebecca Gillies and Alicia Martin and Holland, {Anne E.}",
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The evidence of benefits of exercise training in interstitial lung disease : a randomised controlled trial. / Dowman, Leona M.; McDonald, Christine F.; Hill, Catherine J.; Lee, Annemarie L.; Barker, Kathryn; Boote, Claire; Glaspole, Ian; Goh, Nicole S.L.; Southcott, Anne M.; Burge, Angela T.; Gillies, Rebecca; Martin, Alicia; Holland, Anne E.

In: Thorax, Vol. 72, No. 7, 01.07.2017, p. 610-619.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The evidence of benefits of exercise training in interstitial lung disease

T2 - a randomised controlled trial

AU - Dowman, Leona M.

AU - McDonald, Christine F.

AU - Hill, Catherine J.

AU - Lee, Annemarie L.

AU - Barker, Kathryn

AU - Boote, Claire

AU - Glaspole, Ian

AU - Goh, Nicole S.L.

AU - Southcott, Anne M.

AU - Burge, Angela T.

AU - Gillies, Rebecca

AU - Martin, Alicia

AU - Holland, Anne E.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - BACKGROUND: Uncertainty exists regarding the clinical relevance of exercise training across the range of interstitial lung diseases (ILDs).OBJECTIVE: To establish the impact of exercise training in patients with ILDs of differing aetiology and severity.METHODS: 142 participants with ILD (61 idiopathic pulmonary fibrosis (IPF), 22 asbestosis, 23 connective tissue disease-related ILD (CTD-ILD) and 36 with other aetiologies) were randomised to either 8 weeks of supervised exercise training or usual care. Six-minute walk distance (6MWD), Chronic Respiratory Disease Questionnaire (CRDQ), St George Respiratory Questionnaire IPF-specific version (SGRQ-I) and modified Medical Research Council dyspnoea score were measured at baseline, 9 weeks and 6 months.MEASUREMENTS AND MAIN RESULTS: Exercise training significantly increased 6MWD (25 m, 95% CI 2 to 47 m) and health-related quality of life (CRDQ and SGRQ-I) in people with ILD. Larger improvements in 6MWD, CRDQ, SGRQ-I and dyspnoea occurred in asbestosis and IPF compared with CTD-ILD, but with few significant differences between subgroups. Benefits declined at 6 months except in CTD-ILD. Lower baseline 6MWD and worse baseline symptoms were associated with greater benefit in 6MWD and symptoms following training. Greater gains were seen in those whose exercise prescription was successfully progressed according to the protocol. At 6 months, sustained improvements in 6MWD and symptoms were associated with better baseline lung function and less pulmonary hypertension.CONCLUSIONS: Exercise training is effective in patients across the range of ILDs, with clinically meaningful benefits in asbestosis and IPF. Successful exercise progression maximises improvements and sustained treatment effects favour those with milder disease.TRIAL REGISTRATION NUMBER: Results, ACTRN12611000416998.

AB - BACKGROUND: Uncertainty exists regarding the clinical relevance of exercise training across the range of interstitial lung diseases (ILDs).OBJECTIVE: To establish the impact of exercise training in patients with ILDs of differing aetiology and severity.METHODS: 142 participants with ILD (61 idiopathic pulmonary fibrosis (IPF), 22 asbestosis, 23 connective tissue disease-related ILD (CTD-ILD) and 36 with other aetiologies) were randomised to either 8 weeks of supervised exercise training or usual care. Six-minute walk distance (6MWD), Chronic Respiratory Disease Questionnaire (CRDQ), St George Respiratory Questionnaire IPF-specific version (SGRQ-I) and modified Medical Research Council dyspnoea score were measured at baseline, 9 weeks and 6 months.MEASUREMENTS AND MAIN RESULTS: Exercise training significantly increased 6MWD (25 m, 95% CI 2 to 47 m) and health-related quality of life (CRDQ and SGRQ-I) in people with ILD. Larger improvements in 6MWD, CRDQ, SGRQ-I and dyspnoea occurred in asbestosis and IPF compared with CTD-ILD, but with few significant differences between subgroups. Benefits declined at 6 months except in CTD-ILD. Lower baseline 6MWD and worse baseline symptoms were associated with greater benefit in 6MWD and symptoms following training. Greater gains were seen in those whose exercise prescription was successfully progressed according to the protocol. At 6 months, sustained improvements in 6MWD and symptoms were associated with better baseline lung function and less pulmonary hypertension.CONCLUSIONS: Exercise training is effective in patients across the range of ILDs, with clinically meaningful benefits in asbestosis and IPF. Successful exercise progression maximises improvements and sustained treatment effects favour those with milder disease.TRIAL REGISTRATION NUMBER: Results, ACTRN12611000416998.

KW - Asbestos Induced Lung Disease

KW - Connective tissue disease associated lung disease

KW - Exercise

KW - Idiopathic pulmonary fibrosis

KW - Interstitial Fibrosis

KW - Pulmonary Rehabilitation

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U2 - 10.1136/thoraxjnl-2016-208638

DO - 10.1136/thoraxjnl-2016-208638

M3 - Article

VL - 72

SP - 610

EP - 619

JO - Thorax

JF - Thorax

SN - 0040-6376

IS - 7

ER -