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Pulmonary rehabilitation in idiopathic pulmonary fibrosis: Predictors of adherence and exercise improvement

Background Although there is evidence to support short term benefits of pulmonary rehabilitation (PR) in idiopathic pulmonary fibrosis (IPF), there are concerns about adherence and heterogeneity in response, particularly in patients with more severe disease. Aim To determine whether baseline parameters (age, sex, BMI, MRC dyspnoea score (MRC), oxygen saturations on room air (SpO 2 ), FVC %pred, incremental shuttle walk (ISW) and Hospital Anxiety and Depression scale (HAD)) predict PR completion and exercise response to PR in IPF. Method We analysed data from 82 consecutive IPF patients referred for outpatient PR. Completion was defined as attendance to ≥50% sessions. Exercise response was determined by change in incremental shuttle walk (ISW) pre and post PR. Correlations between baseline variables and completion or exercise improvement were determined by Spearman’s rank. Multiple logistic regression and multiple linear regression were used to identify baseline variables independently associated with completion and exercise improvement. Results 40 IPF patients completed PR (49%). Completion was more likely with lower MRC, higher SpO 2 and ISW (r=-0.28,0.27,0.35; all p 2 (r=-0.40,0.34; p=0.02,0.03). Baseline FVC% did not correlate with completion or exercise response. A multiple logistic regression model had a completion predictor success of 63% with a Nagelkerke’s R 2 of 0.218. A multiple linear regression model comprising age and SpO 2 explained only 11% of variance in ISW change. Conclusion In IPF patients, simple baseline parameters of disease severity cannot predict completion of or exercise response to PR.