Functional status following pulmonary rehabilitation in people with interstitial lung disease: A systematic review and meta-analysis.

Background: Individuals with interstitial lung disease (ILD) often experience worsening symptoms and activity avoidance. Limited data exists on outcome measures for assessing functional status (capacity and performance), as well as on the effectiveness of pulmonary rehabilitation (PR) in improving these outcomes in ILD.

Aim: This review aimed to systematically assess the effects of PR on both functional capacity and performance in individuals with ILD.

Methods: Randomised controlled trials involving pulmonary rehabilitation (PR) in adults with ILD, which included at least an exercise training component and education and/or psychosocial support, were included. Risk of bias and quality of evidence were assessed. Mean changes from baseline and standard deviations were retrieved for each group, and a random-effects model was applied.

Results: Eight studies were included, mostly involving individuals with idiopathic pulmonary fibrosis (n = 5). PR duration ranged from 3 to 26 weeks. Seven studies used the 6MWT to evaluate functional capacity and one also used the 30-s STS. Two studies assessed functional performance, measuring time spent in moderate physical activity with the SenseWear Armband, number of steps per day with the same device, and energy expenditure in MET-min using the international physical activity questionnaire. PR improved functional capacity (6MWT-MD 45.82 m, 95%CI [26.14; 65.50], I² = 71.54%, p < .001; 30-s STS- PR: 3.7 ± 2.6 reps; control group: -0.4 ± 2.5 reps, p < .001) compared to usual care. Only self-reported physical activity levels increased after PR (PR: 51.4 ± 57.7MET-min; control group: 20.9 ± 37.2MET-min, p = .03).

Conclusion: PR is effective at improving functional capacity; however, functional performance is often overlooked, resulting in limited and inconclusive findings.