Abstract
BackgroundInterstitial lung disease encompasses a diverse group of chronic lung conditions characterised by distressing dyspnoea, fatigue, reduced exercise tolerance and poor health-related quality of life. Exercise training is one of the few treatments to induce positive changes in exercise tolerance and symptoms, however there is marked variability in response. The aetiology and severity of interstitial lung disease may influence the response to treatment. The aims of this project are to establish the impact of exercise training across the range of disease severity and to identify whether there is an optimal time for patients with interstitial lung disease to receive exercise training.Methods/DesignOne hundred and sixteen participants with interstitial lung disease recruited from three tertiary institutions will be randomised to either an exercise training group (supervised exercise training twice weekly for eight weeks) or a usual care group (weekly telephone support). The 6-minute walk distance, peripheral muscle strength, health-related quality of life, dyspnoea, anxiety and depression will be measured by a blinded assessor at baseline, immediately following the intervention and at six months following the intervention. The primary outcome will be change in 6-minute walk distance following the intervention, with planned subgroup analyses for participants with idiopathic pulmonary fibrosis, dust-related interstitial lung disease and connective-tissue related interstitial lung disease. The effects of disease severity on outcomes will be evaluated using important markers of disease severity and survival, such as forced vital capacity, carbon monoxide transfer factor and pulmonary hypertension.DiscussionThis trial will provide certainty regarding the role of exercise training in interstitial lung disease and will identify at what time point within the disease process this treatment is most effective. The results from this study will inform and optimise the clinical management of people with interstitial lung disease.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12611000416998
Highlights
Interstitial lung disease encompasses a diverse group of chronic lung conditions characterised by distressing dyspnoea, fatigue, reduced exercise tolerance and poor health-related quality of life
We have previously shown that exercise training could significantly improve exercise capacity and reduce dyspnoea and fatigue symptoms in patients with Interstitial Lung Disease (ILD) of varying aetiology [17]
Interstitial lung disease represents a heterogeneous group of chronic, disabling lung disorders [55] which are associated with significant dyspnoea and fatigue, reduced exercise capacity and diminished quality of life [2]
Summary
Interstitial lung disease represents a heterogeneous group of chronic, disabling lung disorders [55] which are associated with significant dyspnoea and fatigue, reduced exercise capacity and diminished quality of life [2]. The most recent published guidelines on IPF [11] provide only a weak recommendation for pulmonary rehabilitation as part of managing IPF due to low quality of evidence concerning the benefit of pulmonary rehabilitation in this particular form of ILD They indicate there is moderate quality data demonstrating improvement in functional status and patient-centered outcome, uncertainty still remains regarding duration of benefit and further research is needed to impact on the strength of this recommendation. This study will provide patients and clinicians with certainty regarding the role of exercise training as well as the magnitude and duration of expected benefits If this trial provides evidence of benefit, it will provide a scientific rationale for pulmonary rehabilitation to be considered standard care for people with ILD.
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