Baruch Vainshelboim1,2,3, Mordechai R Kramer4,5, Benjamin D Fox4,5, Shimon Izhakian4, Alexander Sagie5,6, José Oliveira7. 1. Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel - baruch.v1981@gmail.com. 2. Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal - baruch.v1981@gmail.com. 3. Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Stanford University, Palo Alto, CA, USA - baruch.v1981@gmail.com. 4. Pulmonary Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. 5. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 6. Echocardiography Unit, Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. 7. Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.
Abstract
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 mLO2/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.
RCT Entities:
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 mLO2/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.