Pulmonary rehabilitation improves distance-saturation product in IPF: Greater benefits in patients with exercise-induced desaturation

Hülya Şahin; Ilknur Naz Gursan; Fatma Demirci Ucsular; Gulistan  Karadeniz

doi:10.36141/svdld.v42i4.17284

Authors

Hülya Şahin Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital
ılknur Naz Gursan Izmir Katip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
Fatma Demirci Ucsular Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Pulmonary Rehabilitation Unit, Izmir, Turkey
Gulistan karadeniz Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Pulmonary Rehabilitation Unit, Izmir, Turkey

Keywords:

idiopathic Pulmonary Fibrosis (IPF), Pulmonary rehabilitation, Desaturation, Desaturation distance ratio

Abstract

Background and aim: Exercise-induced dyspnea and desaturation are hallmark features of idiopathic pulmonary fibrosis (IPF) and are linked to disease severity and poor outcomes. The distance-saturation product (DSP), calculated by multiplying the walking distance by oxygen saturation, has been proposed as a mortality predictor. This study aimed to investigate the effects of a pulmonary rehabilitation (PR) program on clinical outcomes and DSP in two IPF patient groups: those with and without desaturation during the six-minute walk test (6MWT).

Methods: IPF patients who completed a standardized PR program were included. Assessments before and after PR included spirometry, arterial blood gas analysis, Medical Research Council (MRC) dyspnea scale, 6MWT, St. George’s Respiratory Questionnaire (SGRQ), 36-Item Short Form Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). DSP was calculated at the end of the 6MWT. Patients with oxygen saturation ≤88% during baseline 6MWT were assigned to the desaturated group; others were assigned to the non-desaturated group.

Results: Fifty patients were enrolled (20 desaturated, 30 non-desaturated). Following PR, only the desaturated group showed significant improvements in forced vital capacity (FVC), oxygen saturation, and SF-36 domains. In both groups, PaO₂, 6MWT distance, and DSP increased significantly, while MRC, SGRQ, and HADS scores decreased. However, the gains in 6MWT distance and DSP were significantly greater in the desaturated group.

Conclusion: PR improved functional, psychological, and quality-of-life outcomes in both groups, with more pronounced benefits on sa in desaturated patients. Referral to PR is especially recommended for this subgroup.

References

1. Vainshelboim B, Kramer MR, Izhakian S, Lima RM, Oliveira J. Physical activity and exertional desaturation are associated with mortality in idiopathic pulmonary fibrosis. J Clin Med. 2016;5:73.

2. Kataoka K, Nishiyama O, Ogura T, Mori Y, Kozu R, Arizono S, et al. Long-term effect of pulmonary rehabilitation in idiopathic pulmonary fibrosis: a randomised controlled trial Thorax. 2023;7:784-91.

3. Nolan CM, Polgar O, Schofield SJ, Patel S, Barker RE, Walsh JA, et al. Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis and COPD: A Propensity-Matched Real-World Study. Chest. 2022;161:728-37.

4. Zamparelli SS, Lombardi C, Candia C, Iovine PR, Rea G, Vitacca M, et al. The Beneficial Impact of Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis: A Review of the Current Literature. J Clin Med. 2024;13:2026.

5. Lettieri CJ, Nathan SD, Browning RF, Barnett SD, Ahmad S, Shorr AF. The distance-saturation product predicts mortality in idiopathic pulmonary fibrosis. Respir Med. 2006;100:1734-41.

6. Bloem AEM, Dolk HM, Wind AE, van der Vis JJ, Kampen MJ, Custers JWH, et al. Prognostic value of the 6-min walk test derived attributes in patients with idiopathic pulmonary fibrosis. Respir Med. 2025;236:107862.

7. Nishiyama O, Kataoka K, Ando M, Arizono S, Morino A, Nishimura K, et al. Protocol for long-term effect of pulmonary rehabilitation under nintedanib in idiopathic pulmonary fibrosis. ERJ Open Res. 2021;7:00321-2021.

8. Sweer L, Zwillich CW. Dyspnea in the patient with chronic obstructive pulmonary disease. Etiology and management. Clin Chest Med. 1990;11:417–45.

9. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–81.

10. Lama VN, Flaherty KR, Toews GB, Colby TV, Travis WD, Long Q, et al. Prognostic value of desaturation during a 6-minute walk test in idiopathic interstitial pneumonia. Am J Respir Crit Care Med. 2003;168:1084-90.

11. Aydemir O, Guvenir T, Kuey L, Kultur S. Reliability and validity of the Turkish version of hospital anxiety and depression scale. Turk Psikiyatri Derg. 1997;8:280–7.

12. Polatlı M, Yorgancıoğlu A, Aydemir Ö, Yılmaz Demirci N, Kırkıl G, Atış Naycı S, et al. St. George solunum anketinin Türkçe geçerlilik ve güvenilirliği. Tuberk Toraks. 2013;61:81–7.

13. Kocyigit H, Aydemir O, Fisek G, Olmez N, Memis A. Validity and reliability of Turkish version of Short form 36: A study of a patients with romatoid disorder. Drug Therapy. 1999;12:102–6.

14. Spruit M, Singh S, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2013;188:13–64.

15. Nakazawa A, Cox NS, Holland AE. Current best pracice in rehabilitation in interstitial lung disease. Ther Adv Respir Dis. 2017;112:115–28.

16. Kenn K, Gloeckl R, Behr J. Pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis--a review. Respiration. 2013;86(2):89-99.

17. Suadnyana IAA, Negara NLGAM, Wiraguna I. W.The relationship between smoking dose with oxygen saturation and cardiorespiratory endurance on young adult men. Physical Therapy Journal of Indonesia. 2023;4:50-4.

18. Vainshelboim B. Exercise training in idiopathic pulmonary fibrosis: is it of benefit? Breathe (Sheff). 2016;12:130-8.

19. Otake K, Misu S, Fujikawa T, Sakai H, Tomioka H. Exertional Desaturation Is More Severe in Idiopathic Pulmonary Fibrosis Than in Other Interstitial Lung Diseases. Phys Ther Res. 2023;26:32-7.

20. Nishiyama O, Kondoh Y, Kimura T, Kato K, Kataoka K, Ogawa T, et al. Effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Respirology. 2008;13:394-9.

21. Vainshelboim B, Oliveira J, Yehoshua L, Weiss I, Fox BD, Fruchter O, Kramer MR. Exercise training-based pulmonary rehabilitation program is clinically beneficial for idiopathic pulmonary fibrosis. Respiration. 2014;88:378-88.

22. Holland AE, Hill CJ, Glaspole I, Goh N, McDonald CF. Predictors of benefit following pulmonary rehabilitation for interstitial lung disease. Respir Med. 2012;106:429-35.

23. Jarosch I, Schneeberger T, Gloeckl R, Kreuter M, Frankenberger M, Neurohr C, et al. Short-Term Effects of Comprehensive Pulmonary Rehabilitation and its Maintenance in Patients with Idiopathic Pulmonary Fibrosis: A Randomized Controlled Trial. J Clin Med. 2020;9:1567.

24. Arizono S, Taniguchi H, Sakamoto K, Kondoh Y, Kimura T, Kataoka K, et al. Pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis: comparison with chronic obstructive pulmonary disease. Sarcoidosis Vasc Diffuse Lung Dis. 2017;34:283–9.

25. Kozu R, Senjyu H, Jenkins SC, Mukae H, Sakamoto N, Kohno S. Differences in response to pulmonary rehabilitation in idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. Respiration. 2011;81:196–205.

26. Altenburg WA, de Greef MH, ten Hacken NH, Wempe JB. A better response in exercise capacity after pulmonary rehabilitation in more severe COPD patients. Respir Med 2012; 106: 694-700.

27. Zanini A, Chetta A, Gumiero F, Della Patrona S, Casale S, Zampogna E, et al. Six-minute walking distance improvement after pulmonary rehabilitation is associated with baseline lung function in complex COPD patients: a retrospective study. Biomed Res Int 2013;2013:483162.