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Yang P-Y1, Hsieh P-L1,2, Wu H-D3, Chien J-Y4, Wang L-Y1,2
1National Taiwan University Hospital, Physical Therapy Center, Taipei, Taiwan, 2National Taiwan University, School and Graduate Institute of Physical Therapy, College of Medicine, Taipei, Taiwan, 3National Taiwan University Hospital, Department of Integrated Diagnostics and Therapeutics, Taipei, Taiwan, 4National Taiwan University Hospital, Department of Internal Medicine, Taipei, Taiwan
Background: Recent development of new anti-fibrotic agents have demonstrated a reduction in the rate of pulmonary function loss in patients with idiopathic pulmonary fibrosis (IPF). Previous studies have shown effectiveness of pulmonary rehabilitation (PR) on functional exercise capacity, quality of life and dyspnea in IPF patients with mild to moderate physiologic impairments. However, whether pulmonary rehabilitation is beneficial for IPF patients with severe physiologic impairment on anti-fibrotic therapy remains to be determined.
Purpose: The purpose of this case series was to investigate the feasibility of exercise training in IPF patients with severe physiologic impairment on anti-fibrotic therapy.
Methods: Four (3 females) IPF patients with a mean [±SD] age of 52.4 [±15.8] years, with severe physiologic impairment (% predicted FVC [±SD] and DLCO was 53.5 [±8.0]% and 30.9 [±19.6]%, respectively) were enrolled in this case series. All patients received 8-week hospital-based supervised PR program (8WPR), which consisted of chest physiotherapy, breathing retraining, and exercise training. Exercise training included aerobic training using cycle ergometer and resistance training using free weights or TheraBand. Heart rate and pulse oxygen saturation (SpO2) were monitored continuously throughout all training sessions. Dyspnea was assessed using 10-point Borg scale. Functional exercise capacity was measured by 6-minute walk distance (6MWD). One repetition maximum (1-RM) handgrip and leg press were measured to assess peripheral muscle strength. All the measurements were assessed before and after 8WPR. Supplemental O2 was given if severe desaturation occurred during exercise training.
Results: All patients completed the 8-week PR program. The mean maximal training heart rate was 119.2 [±22.6] beats per minute, and one patient was unable to reach target training heart rate due to severe baseline deconditioned status. The mean Borg score during training was 3.9 [±1.0]. The mean O2 used during exercise was 2.5 L/min through nasal cannula. The lowest mean SpO2 observed during exercise training was 86.5 [±2.8]%. Compared to baseline, 1-RM leg press improved an average of 15 Kg while handgrip strength and 6MWD remained similar to that of baseline after 8WPR. No adverse events occurred during 8WPR.
Conclusion(s): Eight-week hospital-based PR is feasible and safe for IPF patients with severe physiologic impairment on anti-fibrotic therapy. How to minimize desaturation magnitude during exercise training remained to be a great challenge.
Implications: Larger sample sizes and whether optimizing SpO2 during exercise with high flow O2 delivery system would lead to greater improvement in functional exercise capacity warrants further investigations IPF patients with severe physiologic impairment on anti-fibrotic therapy.
Keywords: Idiopathic pulmonary fibrosis, Exercise training, Physiologic impairment
Funding acknowledgements: No specific financial support was obtained for this study
Purpose: The purpose of this case series was to investigate the feasibility of exercise training in IPF patients with severe physiologic impairment on anti-fibrotic therapy.
Methods: Four (3 females) IPF patients with a mean [±SD] age of 52.4 [±15.8] years, with severe physiologic impairment (% predicted FVC [±SD] and DLCO was 53.5 [±8.0]% and 30.9 [±19.6]%, respectively) were enrolled in this case series. All patients received 8-week hospital-based supervised PR program (8WPR), which consisted of chest physiotherapy, breathing retraining, and exercise training. Exercise training included aerobic training using cycle ergometer and resistance training using free weights or TheraBand. Heart rate and pulse oxygen saturation (SpO2) were monitored continuously throughout all training sessions. Dyspnea was assessed using 10-point Borg scale. Functional exercise capacity was measured by 6-minute walk distance (6MWD). One repetition maximum (1-RM) handgrip and leg press were measured to assess peripheral muscle strength. All the measurements were assessed before and after 8WPR. Supplemental O2 was given if severe desaturation occurred during exercise training.
Results: All patients completed the 8-week PR program. The mean maximal training heart rate was 119.2 [±22.6] beats per minute, and one patient was unable to reach target training heart rate due to severe baseline deconditioned status. The mean Borg score during training was 3.9 [±1.0]. The mean O2 used during exercise was 2.5 L/min through nasal cannula. The lowest mean SpO2 observed during exercise training was 86.5 [±2.8]%. Compared to baseline, 1-RM leg press improved an average of 15 Kg while handgrip strength and 6MWD remained similar to that of baseline after 8WPR. No adverse events occurred during 8WPR.
Conclusion(s): Eight-week hospital-based PR is feasible and safe for IPF patients with severe physiologic impairment on anti-fibrotic therapy. How to minimize desaturation magnitude during exercise training remained to be a great challenge.
Implications: Larger sample sizes and whether optimizing SpO2 during exercise with high flow O2 delivery system would lead to greater improvement in functional exercise capacity warrants further investigations IPF patients with severe physiologic impairment on anti-fibrotic therapy.
Keywords: Idiopathic pulmonary fibrosis, Exercise training, Physiologic impairment
Funding acknowledgements: No specific financial support was obtained for this study
Topic: Cardiorespiratory
Ethics approval required: Yes
Institution: National Taiwan University Hospital
Ethics committee: Research Ethics committee (REC)
Ethics number: 201805017RINB
All authors, affiliations and abstracts have been published as submitted.
