Table 1.

Randomized controlled trials involving exercise-based pulmonary rehabilitation in patients with interstitial lung disease.

Authors, year	Sample, age (years)	Setting	Exercise/ functional tests	Intervention	Duration, frequency and intensity	Effect of intervention	Adverse effect/adherence
Perez-Bogerd et al. (30)	ILD, n = 60 CG: 64 ± 8 ET: 64 ± 13	Outpatient	6MWT	CG: medical care ET: cycling, treadmill walking, arm cranking, stair climbing and peripheral muscle training + patient education.	60 sessions, 3x/week first 3 months and thereafter 2x/week, 90'. Cycling at 60–85% of the initial maximal work rate on the cycle ergometer and walking at 75–110% of their maximal walking speed during 6MWT + stair climbing (1–3 repetitions of 2′), peripheral muscle training → 70% of 1RM (3 sets of 8 rep).	PR improves exercise tolerance, health status and muscle force in ILD. The benefits are maintained at 1-year follow-up. The intervention did not change physical activity.	Measured/ Measured
Nishiyama et al. (40)	IPF, n = 28 CG: 64.5 ± 9.1 ET: 68.1 ± 8.9	Outpatient	6MWT, Cycle ergometer test	Treadmill + strength training + educational lectures.	8 weeks, 2x/week Treadmill (80% of the patient's maximal walking speed assessed at the 6MWT or 80% of the initial maximum workload at the cycle ergometer + strength training (20′).	PR improves functional exercise capacity and health-related quality of life in patients with IPF.	Not measured/ Not reported
Gaunaurd et al. (41)	IPF, n = 21 CG: 71 ± 6 ET: 66 ± 7	Outpatient	6MWT	Educational lectures + supervised aerobic training and strength training + home-based program (on days they did not do PR).	12 weeks, 2x/week (supervised ET) 90′+ 2 × /week (home-based program), 10 education sessions 30′ cardiopulmonary endurance training (70–80% of the maximum predicted heart rate), 20′ flexibility exercises, and 25′ strength training (initial: 2 sets of 10 repetitions; progression: 3 sets of 15 repetitions).	A 3-month PR significantly improved symptoms (SGRQ-I) and physical activity levels (IPAQ) in subjects with IPF while they actively participate in the program.	Not measured/ Not measured
Jackson et al. (42)	IPF, N = 21 CG: 66 ± 7 ET: 71 ± 6	Outpatient	6MWT, Cycle ergometer test	Educational lectures + cardiopulmonary aerobic training, strength training + flexibility exercise.	12 weeks, 2x/week, 120′; educational lectures (1 session biweekly) 30′ cardiopulmonary endurance training (up to 80 % maximum heart rate), flexibility exercises (3 sets x 30″) and 15–30′ strength training (up to 3 sets ×15 repetitions).	PR effectively maintained exercise oxygen uptake over 3 months and lengthened constant load exercise time in patients with moderately severe IPF.	Unclear/Unclear
Dowman et al. (43)	ILD, n = 142 IPF: CG: 73 ± 9 ET: 70 ± 10 Asbestosis: CG: 72 ± 9 ET: 72 ± 7 CTD-ILD: CG: 65 ± 11 ET: 63 ± 10	Outpatient	6MWT	CG: phone calls for support ET: supervised exercise program → aerobic training, cycling and walking, plus upper and lower limb strength training + home-based program.	8 weeks, 2x/week, 30′ Initial intensity for walking: 80% of peak walking speed of the 6MWT; cycling at 70% of the maximum work rate estimated from the 6MWT and, strength training at an initial load (10–12 RM). Exercise progressed weekly.	ET promoted improvement in 6MWD, symptoms and HRQoL. Magnitude of change was greater in those with asbestosis compared with IPF. Individuals with a range of severity stand to benefit, however longer-lasting effects may occur in milder disease.	No adverse event/Measured
Vainshelboim et al. (44)	IPF, n =3 4 CG: 66 ± 9 ET: 68.8 ± 6	Outpatient	6MWT, 30-S Chair- Stand to Test Leg Strength, CPET	CG: medical care ET: supervised exercise program → aerobic training interval + upper and lower limb strength training + flexibility exercises.	12 weeks, 2x/week, 60′ First 6 weeks: 50–60% of peak work rate in cycling and, 70–80% of individual average walking speed measured during the 6MWD and moderate intensity to strength training (1 set of 12-15 repetitions). Last 6 weeks: duration maintained, 60–70% of peak work rate in cycling and 80–90% of individual average walking speed, strength and flexibility training maintained and increased load+stair climbing (3–5′).	ET showed clinical outcomes were preserved at baseline levels with improvements in leg strength and HRQoL. The CG showed a trend of deterioration in the outcomes.	Unclear/Unclear
Greening et al. (45)	CRD, n =389 CG: 71.2 ± 10.0 ET: 71.1 ± 9.4	Inpatient	ISWT, ESWT	CG: standard care ET: supervised strength training and aerobic training + neuromuscular electrical stimulation. After discharge → unsupervised home- based program, + telephone consultations.	Walking was performed at a set walking speed predetermined by the ESWT at 85% oxygen consumption, ST (3 sets of 8 repetitions based on the 1RM, neuromuscular electrical stimulation (both quadriceps 30′ daily, symmetrical biphasic pulse at 50 Hz, pulse duration of 300 ms, 15″ on and five″ off.	Early rehabilitation during hospital admission for CRD did not reduce the risk of subsequent readmission or enhance recovery of physical function following the event over 12 months.	Unclear/ Measured
Holland et al. (46)	ILD (60% with IPF), n = 57 CG: 67 ± 13 ET: 70 ± 8	Outpatient	6MWT, CPET	CG: phone calls for support ET: supervised and unsupervised exercise program → aerobic training (cycling and walking training) + upper and lower limb strength training.	8 weeks, 2 × /week, 30′ Initial intensity for walking: 80% of peak walking speed achieved on the 6MWT.	ET improves exercise capacity and symptoms in patients with ILD, but these benefits are not sustained 6 months following intervention.	Unclear/ Measured

ILD, interstitial lung disease; CG, control group; ET, exercise training; 6MWT, six-minute walking test; PR, pulmonary rehabilitation; IPF, idiopathic pulmonary fibrosis; SGRQ-I, St George Respiratory Questionnaire for IPF; IPAQ, International Physical Activity Questionnaire; CTD-ItD, connective tissue disease-related ILD; RM, repetition maximum; CPET, Cardiopulmonary Exercise Test; HRQoL, health-related quality of life; CRD, chronic respiratory disease; ISTW, incremental shuttle walk test ESWT, endurance shuttle walk test.