‘Don’t push yourself’ mantra debunked for ILD

Clinicians should strongly encourage patients with interstitial lung disease (ILD) to attend pulmonary rehabilitation, new research shows.

Coauthor Professor Christine McDonald, director of respiratory and sleep medicine at Austin Health, said her colleagues were keen to see the same message for ILD as for COPD.

“Basically exercise is good for you. Old warnings about taking it easy or you will desaturate are out of date,” she said.

The research published in Thorax randomised 142 patients with stable disease but dyspnoea on exertion to either twice-weekly supervised exercise training or usual care for eight weeks.

The patients included those with asbestosis, idiopathic pulmonary fibrosis (IPF) and connective tissue disease-related ILD.

“We’ve demonstrated in a mixed group that there are benefits overall from exercise training,” Professor McDonald said.

“While we aren’t changing a progressive disease, we can increase patients’ capacity to exercise by training or desensitise them to dyspnoea by training or increase their quality of life due to a sense of mastery over their condition,” she said.

The study showed improvements in both 6-minute walk distance and health-related quality of life scores at completion of the exercise training program compared to usual care.

However the benefits were not sustained to the six-month follow-up in all patients.

Austin Health exercise physiologist Leona Dowman said tailoring programs to particular sub-groups of patients could be useful.

“Patients with milder disease tended to have more sustained benefits at six months so where possible, consider an early referral to exercise training,” she said.

Patients with connective tissue disease-related ILD who showed less improvement that other patients, may need programs that considered the systemic manifestations of their disease.

For example, hydrotherapy may help patients with joint pain and muscles weakness associated with connective tissue disease.

She said longer duration of programs or repeat ‘booster’ programs were just some of the other suggestions for maintaining the benefits of exercise training.

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