Exercise training for IPF patients is feasible but access needs to be improved

Although exercise training in interstitial lung disease (ILD) has been shown to be both safe and effective, it should be customised in the individual patient. Moreover, access to pulmonary rehabilitation for patients with idiopathic pulmonary fibrosis (IPF) needs to improve in the Nordic countries.

According to Dr Jana de Brandt (Umeå University, Sweden), the ATS/ERS/JRS/ALAT Guideline provides specific recommendations for pulmonary rehabilitation for patients with IPF who have a generally poor prognosis and for whom there is no cure, apart from a possible lung transplantation [1,2]. The aims of exercise training within the relatively short lifespan left for these patients should primarily focus to improve quality of life and, if eligible for lung transplantation, to optimally prepare patients for surgery. Whether pulmonary rehabilitation is effective on different disease parameters in ILD was assessed in a literature review. Randomised controlled trials and quasi‐randomised controlled trials implementing pulmonary rehabilitation were compared with no pulmonary rehabilitation or with other interventions in patients with ILD (see Table) [3].

Table: Effectiveness of pulmonary rehabilitation on various disease parameters in ILD [3]



A study by Perez-Bogerd et al. demonstrated that it is feasible for ILD patients to undertake pulmonary rehabilitation with 69% of patients with IPF completing the program compared with 63% of patients with COPD [4]. However, some considerations need to be considered when prescribing pulmonary rehabilitation in IPF, Dr de Brandt mentioned. “Early referral, well-trained staff, and comorbidities are important issues, and the training program should be customised accordingly. Also, training does not stand alone; education and self-management are also key components of the program which we offer our ILD patients [5,6].”

Dr de Brandt noted that access to non-pharmacological treatment for IPF patients – including pulmonary rehabilitation – is very patchy across Europe. For instance, Finland has no pulmonary rehabilitation services specialised for ILD patients and pulmonary rehabilitation is even unavailable in some university hospitals. In Denmark, pulmonary rehabilitation is limited and often not designed for patients with ILD [7]. “This means there is a big challenge lying ahead of us,” concluded Dr de Brandt [8].

1. Strongman H, et al. Adv Ther. 2018 May;35(5):724-736.
2. Raghu G, et al. Adv Ther. 2022;205(9):e18–e47.
3. Dowman L, et al. Cochrane Database Syst Rev. 2021 Feb 1;2(2):CD006322.
4. Perez-Bogerd S, et al. Respir Res. 2018 Sep 20;19(1):182.
5. Matsuo S, et al. J Clin Med. 2021;10(14):3153.
6. Wickerson L, et al. J Cardiopulm Rehabil Prev. 2018 Nov;38(6):419-424.
7. EU-IPFF. https://www.eu-ipff.org/who-we-are
8. De Brandt J. Exercise adaptations and -prescription in IPF. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.

 

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Posted on 17 August, 202217 August, 2022