Clinical Utility of Pulmonary Rehabilitation in Diffuse Parenchymal Lung Diseases

ABSTRACT Pulmonary rehabilitation (PR) can help in improving the exercise capacity and quality of life (QoL) in diffuse parenchymal lung diseases (DPLDs), even in end-stage lung diseases listed for lung transplant. With the paucity of literature from the Indian population, the current study assessed PR’s benefits on the respiratory functions and exercise capacity in DPLD. This prospective interventional study was conducted over 18 months in patients with diagnosed stable DPLD who were previously not involved in any PR program. All the enrolled patients underwent 12-week in-hospital, supervised PR program, which included exercise training with increasing load, endurance training, resistance training, flexibility training, and stretching. The patients were evaluated for the measures at baseline and after 12 weeks of a rehabilitation program. There was a significant improvement in respiratory capacity forced expiratory volume in 1 s (FEV1), 6-min walk distance (6MWD), Modified Medical Research Council (MMRC), and total St. George’s Respiratory Questionnaire scores (P < 0.05) after the completion of the PR program. Among the outcome parameters, there were no significant differences in the PO2 and FEV1/forced vital capacity ratio (P > 0.05) etiologically; the improvement was significant for all outcome parameters except MMRC and symptom score in the idiopathic pulmonary fibrosis (IPF) group (P = 0.165). In the non-IPF group, the improvement was significant for all outcome parameters except PO2 (P = 0.9). On multivariate linear regression, age was the only independent factor for 6MWD (P = 0.0002; 95% confidence interval [CI]: −5.019–−1.665) and MMRC (P = 0.005; 95% CI: 0.007–0.037). This study reveals that PR is effective for people with DPLD in decreasing the symptoms and improving the exercise capacity and QoL. Clinical improvement is greater in those with non-IPF compared to IPF, but both groups as a whole achieved clinically significant improvements. An adaptation of the PR regimen as per age may be necessary for optimizing the clinical benefits.