Pulmonary Rehabilitation in Interstitial Lung Disease: Benefits and Predictors of Response

Alicia Ferreira, MD; Chris Garvey, FNP; Gerilynn L. Connors, RRT; Lana Hilling, RCP; Julia Rigler, RRT; Susan Farrell, RRT; Cindy Cayou, RCP; Cyrus Shariat, MD; Harold R. Collard, MD, FCCP


CHEST. 2009;135(2):442-447. 

In This Article

Materials and Methods

Study Subjects

Records of patients with a diagnosis of ILD who had been referred for PR at one of three centers (Seton Medical Center, Daly City, CA; Inova Fairfax Hospital, Falls Church, VA; or John Muir Health, Concord, CA) between January 2003 and March 2008 were retrospectively collected and analyzed. Inclusion criteria were a referring diagnosis of ILD and documentation of pre- and post-PR variables (see following). Institutional review board approval for this project was obtained at all sites.

Variables Recorded

Variables recorded included age, gender, baseline pulmonary function test values, specifically FVC and diffusion capacity of the lung for carbon monoxide (DLCO), smoking history, use of long-term oxygen therapy (LTOT), pre- and post-PR Borg dyspnea score, pre- and post-PR 6-min walk test (6MWT) distance, and the PR center attended. Pre- and post-PR University of California San Diego (UCSD) shortness of breath questionnaire scores and Center for Epidemiologic Studies-Depression (CES-D) scores were available for patients treated at one institution, John Muir Health. The Borg dyspnea score, UCSD shortness of breath questionnaire, and the CES-D score were all performed according to published standards.[18,19,20] The 6MWTs were performed according to modified guidelines of the American Thoracic Society.[21] Supplemental oxygen was used during the test in patients who were already on LTOT or in those who desaturated below 88%.

Pulmonary Rehabilitation Program

The three PR centers provided similar PR protocols. All PR programs were multidisciplinary, outpatient programs that consisted of two or three sessions per week (2 to 3 h each) of exercise and educational activities for > 6 to 8 weeks. The exercise sessions included endurance, strength, and respiratory muscles training, along with pacing and breathing techniques. The educational topics included medication and oxygen use, nutrition, panic control and relaxation techniques, as well as psychosocial support and end-of-life issues. All three PR centers are certified by the American Association of Cardiovascular and Pulmonary Rehabilitation.

Statistical Analysis

Descriptive statistics are reported as mean (± SD) or median (± 25th percentile and 75th percentile) as appropriate. Changes in Borg score and 6MWT distance values were analyzed using the paired t test for the complete study group and selected subgroups. The percentages of patients who achieved changes greater than the established minimal clinically significant difference for each outcome were also determined for variables in which this has been described (1 unit in the Borg score, 5 unit in the UCSD questionnaire, 54 m in the 6MWT distance).[18,19,22] Regression analysis was performed to identify significant predictor variables for change in Borg score and both baseline and change in 6MWT distance. A p value < 0.05 was considered statistically significant. A statistical software package (SAS, version 9.2; SAS Institute; Cary, NC) was used for all statistical analyses.


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