The impact of different pulmonary rehabilitation approaches on fibrotic interstitial lung disease: a comparative randomized trial

Background: Fibrosing Interstitial Lung Diseases (F-ILDs) lead to reduced exercise capacity and quality of life. Pulmonary Rehabilitation (PR) exercise programs have shown potential in improving symptoms and functional capacity in these patients. This study aimed to compare the effectiveness of different PR exercise approaches in patients with F-ILDs. Research design and methods: This randomized, three-arm controlled trial included F-ILD patients divided into three groups: hospital-based supervised(HGr), synchronized-online(SOGr) with live video calls, and video-based (VGr) with recorded exercise videos. All groups underwent an 8-week program combining aerobic and resistance training. Clinical parameters assessed included 6-minute walking distance(6MWD), modified medical research council dyspnea score(mMRC), respiratory function tests, Saint George Respiratory Questionnaire (SGRQ), International Physical Activity Questionnaire Short Form(IPAQ-SF), fatigue severity scale (FSS), and muscle strength. Results: Of the 75 patients, 65 completed the study, with comparable demographic and baseline characteristics. Significant improvements in 6MWD, mMRC, maximal inspiratory pressure, IPAQ-SF, SGRQ, and peripheral muscle strength were seen in all groups. Post-hoc analysis showed HGr had greater improvements in forced vital capacity and FSS compared to SOGr. Conclusion: Hospital-based, synchronized-online, and video-based PR programs all improve clinical outcomes in patients with F-ILDs. However, supervised in-hospital PR yielded greater benefits in lung function and fatigue reduction compared to the online approaches Clinicaltrial registration: https://clinicaltrials.gov/study/NCT05166057.