Exercise training with negative pressure ventilation improves exercise capacity in patients with severe restrictive lung disease: a prospective controlled study

Background: Exercise training is of benefit for patients with restrictive lung disease. However, it tends to be intolerable for those with severe disease. We examined whether providing ventilatory assistance by using negative pressure ventilators (NPV) during exercise training is feasible for such patients and the effects of training. Methods: 36 patients with restrictive lung disease were prospectively enrolled for a 12-week multidisciplinary rehabilitation program. During this program, half of them (n:18; 60.3 +/- 11.6 years; 6 men; FVC: 32.5 +/- 11.7% predicted) received regular sessions of exercise training under NPV, whilst the 18 others (59.6 +/- 12.3 years; 8 men; FVC: 37.7 +/- 10.2% predicted) did not. Exercise capacity, pulmonary function, dyspnea and quality of life were measured. The primary endpoint was the between-group difference in change of 6 minute-walk distance (6MWD) after 12 weeks of rehabilitation. Results: All patients in the NPV-exercise group were able to tolerate and completed the program. The between-group differences were significantly better in the NPV-exercise group in changes of 6MWD (34.1 +/- 12.7 m vs. -32.5 +/- 17.5 m; P = 0.011) and St George Score (-14.5 +/- 3.6 vs. 11.8 +/- 6.0; P < 0.01). There was an improvement in dyspnea sensation (Borg's scale, from 1.4 +/- 1.5 point to 0.8 +/- 1.3 point, P = 0.049) and a small increase in FVC (from 0.85 +/- 0.09 L to 0.91 +/- 0.08 L, P = 0.029) in the NPV-exercise group compared to the control group. Conclusion: Exercise training with NPV support is feasible for patients with severe restrictive lung diseases, and improves exercise capacity and health-related quality of life.