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Physical training for interstitial lung disease

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Abstract

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Background

Interstitial lung disease (ILD) is characterised by reduced functional capacity, dyspnoea and exercise‐induced hypoxia. Physical training is beneficial for people with other chronic lung conditions, however its effects in ILD have not been well characterised.

Objectives

To assess the effects of physical training on exercise capacity, symptoms, quality of life and survival compared to no physical training in people with ILD.

Search methods

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 4), MEDLINE, EMBASE, CINAHL and the Physiotherapy Evidence Database (PEDro) (all searched from inception to December 2009). The reference lists of relevant studies were hand‐searched for qualifying studies.

Selection criteria

Randomised or quasi‐randomised controlled trials in which physical training was compared to no physical training or to other therapy in people with ILD of any aetiology were included.

Data collection and analysis

Two review authors independently selected trials for inclusion, extracted data and assessed risk of bias. Authors were contacted to obtain missing data and information regarding adverse effects. A priori subgroup analyses were specified for participants with idiopathic pulmonary fibrosis (IPF), severe lung disease and training modality.

Main results

Five studies were included, three of which were published as abstracts. Two studies were included in the meta‐analysis (43 participants who undertook physical training and 42 control participants). One study used a blinded assessor and intention‐to‐treat analysis. No adverse effects of physical training were reported. Physical training improved the 6‐minute walk distance with weighted mean difference (WMD) 38.61 metres (95% confidence interval 15.37 to 61.85 metres). Improvement in 6‐minute walk distance was also seen in the subgroup of participants with IPF (WMD 26.55 metres, 2.81 to 50.30 metres). No effect of physical training on VO2peak was evident. There was a reduction in dyspnoea (standardised mean difference (SMD) ‐0.47, 95% CI: ‐0.91 to ‐0.04) however this did not reach significance in the IPF subgroup (SMD ‐0.43, 95% CI: ‐0.94 to 0.08). Quality of life improved following physical training in all participants (SMD 0.58, 95% CI: 0.15 to 1.02) and in IPF (SMD 0.57, 95% CI: 0.06 to 1.09). Only one study reported longer‐term outcomes, with no significant effects of physical training on clinical variables or survival at six months. Insufficient data were available to examine the impact of disease severity or training modality.

Authors' conclusions

Physical training is safe for people with ILD. Improvements in functional exercise capacity, dyspnoea and quality of life are seen immediately following training, with benefits also evident in IPF. There is little evidence regarding longer‐term effects of physical training.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Plain language summary

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Physical training for interstitial lung disease (ILD)

People with ILD often have reduced exercise capacity and shortness of breath during exercise. Physical training can improve well being in people with other chronic lung diseases, but little is known regarding physical training in ILD. We conducted a review to establish whether physical training is safe for people with ILD, and to examine the effects of physical training on exercise capacity, shortness of breath and quality of life. We also looked at whether people with idiopathic pulmonary fibrosis, a type of ILD which can progress rapidly, could benefit from physical training. Five studies were included, however only two studies contained sufficient information for the analysis (43 participants receiving physical exercise and 42 participants not). There were no reports of unwelcome effects of physical training. Immediately following training, participants could walk further than those who had not undertaken the training (on average 39 metres further in six minutes), reported less shortness of breath and improved quality of life. People with idiopathic pulmonary fibrosis also experienced improvements following physical training although these tended to be smaller. There was not enough information to establish whether there were any ongoing effects once the training had stopped. Bigger studies are required to determine which method of physical training is most beneficial and whether the severity of ILD influences the benefits of physical training.