Supervised exercise training improves exercise cardiovascular function in idiopathic pulmonary fibrosis

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and fatal interstitial lung disease associated with cardiovascular impairments which compromise exercise tolerance and worsen prognosis. AIM: To examine the effect of participating in supervised exercise training (ET) program on cardiovascular function in patients with IPF. DESIGN: A randomized controlled study. SETTING: Outpatient hospital. POPULATION: Thirty-two IPF patients (68 +/- 8 years). METHODS: An ET group (N.= 15) participated in a 12-week twice a week 60-minute supervised exercise program while a control group (N.= 17) received usual care. At baseline and after the 12-week intervention all patients underwent resting echocardiography, cardiopulmonary exercise testing and N-terminal pro-brain natriuretic peptide (NT-proBNP) assessments. RESULTS: The ET group significantly improved peak values of exercise cardiovascular indexes while the control group showed a trend of deterioration in the outcomes. The mean difference between the groups (95% CI) for circulatory power was 638 mLO(2)/kg/min/mmHg (95% CI: 197-1080) (P=0.006), cardiac power output 0.3 W (95% CI: 0.1 to 0.6) (P=0.041), and stroke work 312 mL/beat/mmHg (95% CI: 52-573) (P-0.02). No significant differences between groups were detected in most echocardiography measures and NT-proBNP. Changes in exercise cardiovascular indexes showed significant correlation with improvements in functional capacity, dyspnea and quality of life among ET group. CONCLUSIONS: Participation in supervised ET program can improve exercise cardiovascular function in patients with IPF, however resting cardiac evaluations seem to be less sensitive to detect such changes. CLINICAL REHABILITATION IMPACT: These findings underscore the utility of supervised ET for cardiovascular enhancement which may also be clinically beneficial in reducing the cardiovascular morbidity and mortality in IPF patients.