The evidence of benefits of exercise training in interstitial lung disease: a randomised controlled trial
The evidence of benefits of exercise training in interstitial lung disease: a randomised controlled trial
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DOI：
10.1136/thoraxjnl-2016-208638
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发表时间：
2017-07-01
期刊：
影响因子：
10
通讯作者：
Holland, Anne E.
中科院分区：
文献类型：
--
作者：
Dowman, Leona M.;McDonald, Christine F.;Holland, Anne E.
背景运动训练在间质性肺疾病（ILD）中的临床意义尚不确定。目的确定运动训练对不同病因和严重程度的ILD患者的影响。（61例特发性肺纤维化（IPF），22例石棉肺，23例结缔组织病相关ILD（CTD-ILD）和36例其他病因患者随机接受8周监督运动训练或常规护理。在基线、9周和6个月时测量6分钟步行距离（6 MWD）、慢性呼吸疾病问卷（CRDQ）、St乔治呼吸问卷IPF特定版本（SGRQ-I）和改良的医学研究理事会呼吸困难评分。（25个月，95% CI 2 - 47个月）和健康相关生活质量（CRDQ和SGRQ-I）。与CTD-ILD相比，石棉肺和IPF患者的6 MWD、CRDQ、SGRQ-I和呼吸困难改善较大，但亚组间差异不显著。除CTD-ILD外，6个月时获益下降。较低的基线6 MWD和更差的基线症状与训练后6 MWD和症状的更大获益相关。在那些根据协议成功进行运动处方的人中，可以看到更大的收益。6个月时，6 MWD和症状的持续改善与更好的基线肺功能和肺动脉高压减少有关。结论运动训练对各种ILD患者有效，对石棉肺和IPF具有临床意义。成功的运动进展最大限度地改善和持续的治疗效果有利于那些轻度疾病。
Background Uncertainty exists regarding the clinical relevance of exercise training across the range of interstitial lung diseases (ILDs).Objective To establish the impact of exercise training in patients with ILDs of differing aetiology and severity.Methods 142 participants with ILD (61 idiopathic pulmonary fibrosis (IPF), 22 asbestosis, 23 connective tissue disease-related ILD (CTD-ILD) and 36 with other aetiologies) were randomised to either 8 weeks of supervised exercise training or usual care. Six-minute walk distance (6MWD), Chronic Respiratory Disease Questionnaire (CRDQ), St George Respiratory Questionnaire IPF-specific version (SGRQ-I) and modified Medical Research Council dyspnoea score were measured at baseline, 9 weeks and 6 months.Measurements and main results Exercise training significantly increased 6MWD (25 m, 95% CI 2 to 47 m) and health-related quality of life (CRDQ and SGRQ-I) in people with ILD. Larger improvements in 6MWD, CRDQ, SGRQ-I and dyspnoea occurred in asbestosis and IPF compared with CTD-ILD, but with few significant differences between subgroups. Benefits declined at 6 months except in CTD-ILD. Lower baseline 6MWD and worse baseline symptoms were associated with greater benefit in 6MWD and symptoms following training. Greater gains were seen in those whose exercise prescription was successfully progressed according to the protocol. At 6 months, sustained improvements in 6MWD and symptoms were associated with better baseline lung function and less pulmonary hypertension.Conclusions Exercise training is effective in patients across the range of ILDs, with clinically meaningful benefits in asbestosis and IPF. Successful exercise progression maximises improvements and sustained treatment effects favour those with milder disease.