In the journal Breathe, published by the European Respiratory Society (ERS), clinical exercise physiologist Baruch Vainshelboim, PhD, reviewed the evidence regarding supervised exercise training for IPF.*
Aerobic, resistance/weight, balance and flexibility training are four common modes of exercise, which is broadly regarded as a “safe, effective, and powerful behavioral treatment in prevention and rehabilitation medicine.” It can improve health-related functional measures such as heart-lung capacity, muscular strength, body fat reduction, and movement ability, and is recommended by numerous authorities such as the World Health Organization, US Centers for Disease Control and Prevention, and American Heart Association.
Why Exercise with IPF
- Numerous studies have shown that both healthy people and those with chronic diseases who exercise regularly and are more fit have less risk of dying from all causes (example, heart disease and cancer).
- Though exercise intolerance is common for people with IPF, the American Thoracic Society and ERS both advise exercise training in a pulmonary rehab setting for ILD, including IPF. Research on supervised exercise, including the author’s own, has shown meaningful near-term benefit for IPF patients, helping them cope with daily activities and improving quality of life.
- IPF patients tend to be less physically active to avoid excessive breathlessness, which lowers their functional capacity and quality of life. But a 2014 study showed that short-term exercise in a pulmonary rehabilitation setting is safe and effective for improving these measures in people with ILD and IPF.
- Importantly, the exercise capacity measures of six-minute walk distance (6MWD) and VO2max (the maximum oxygen volume used during intense exercise) are strong mortality predictors in IPF and were significantly improved with exercise.
When and Where to Exercise
- It is unclear whether regular exercise can benefit different stages of IPF, but some research has shown better exercise response (adaptation) in mild-to-moderate IPF versus severe disease. For example, one study showed greater improvement with mild IPF in lung function, oxygen saturation, and blood pressure in the right ventricle of the heart.
- In most of the research, exercise was conducted under supervision in a pulmonary rehabilitation or outpatient setting, though some was done at home, on an inpatient basis, or some combination.
- Totaling over 400 IPF patients, studies of supervised exercise in a rehabilitation setting showed the strongest evidence of positive change in 6MWD, with an average increase of 50 meters. Just 17 patients exercised at home, averaging a 40-meter improvement, and 65 patients in combined programs, averaging a 15-meter improvement.
- The author suggests that future research determine whether supervised exercise is preferable with IPF due to increased symptoms upon exertion, requiring knowledge of exercise principles applied to the disease.
Types of Exercise and Physical Activity
- Most of the exercise studies for IPF involved aerobic exercise (walking, cycling, or both), resis-tance, and flexibility training for arms and legs. In some cases, breathing exercises were also done.
- All showed improvement, but there is inconsistency in degree of improvement and measures. Moreover, most used standard procedure for chronic obstructive pulmonary disorder that may not be entirely suitable for IPF.
- In one clinical study of 34 IPF patients by the author, supervised exercise tailored to IPF produced a significant average improvement of 81 meters in 6MWD versus controls, along with much better heart-lung fitness (VO2max) and stamina.
- A complete training program should consist, at minimum, of aerobic, resistance/weight, and flexibility/stretching exercise. Ideally, breathing and balance exercise should also be included. (The optimal amount of these exercises for IPF requires further study.)
- Like the general population, people with lung disease who are inactive have a higher risk of death. A recent study linked lower physical activity to worse disease outcomes (example, 6MWD and breathlessness), implying that activity could have a positive impact on such outcomes with further research advised.
- Supervised exercise and pulmonary rehabilitation have been shown to lead to increased physical activity, but more research into its effect on IPF patient activity level is needed.
We don’t yet know how the body adapts to exercise in IPF. The training response could be related to repetitive high ventilatory demand, chest expansion from deep breathing, and stretching of respiratory muscles leading to more efficient breathing and less breathlessness during daily activities, for example.
Given the progressive nature of IPF and its limited treatments options, with the benefits of exercise training consistently seen in research, the author concludes that supervised exercise-based pulmonary rehabilitation should be seriously considered as standard care.
The research article can be found at:
*Vainshelboim, B. (2016). Exercise training in idiopathic pulmonary fibrosis: is it of benefit? Breathe, 12(2), 130-38.