Pulmonary Rehabilitation May Improve 5-Year Survival in Interstitial Lung Disease
Pulmonary rehabilitation (PR) may be associated with improved medium-term survival among people with interstitial lung disease (ILD), according to a pooled analysis of randomized controlled trials published in Chest. Investigators found that while overall median survival did not differ between groups, participation in PR was linked to a significantly lower risk of mortality at 5 years, supporting its role in standard ILD care.
Study Findings
The study combined individual participant data from 2 previously published randomized controlled trials evaluating PR in ILD. A total of 182 participants were included, of whom 87 had idiopathic pulmonary fibrosis (IPF). The cohort was predominantly male (60%), with a mean age of 69 years. Baseline lung function was moderately impaired, with a mean forced vital capacity (FVC) of 76% predicted and carbon monoxide transfer factor of 48% predicted.
Participants were followed from the start of PR until death, lung transplantation, or censoring. Over the follow-up period, 62% of participants died, 6% underwent lung transplantation, 20% were alive, and 12% were lost to follow-up.
Median survival was 6.1 years (95% CI, 4.4–7.9) among those who completed PR compared with 4.7 years (95% CI, 3.4–6.0) in the control group. This difference was not statistically significant on unadjusted analysis. However, after adjustment for key baseline variables—including age, sex, FVC, 6-minute walk distance, exertional oxygen desaturation, and IPF diagnosis—completion of PR was associated with a 44% reduction in mortality risk at 5 years (hazard ratio, 0.56; 95% CI, 0.36–0.88; P = .01).
At 10 years, survival did not differ between the PR and control groups, suggesting the survival benefit may be time-limited.
Clinical Implications
PR is already recommended for people with ILD based on evidence demonstrating improvements in exercise capacity, dyspnea, and quality of life. These new findings suggest that PR may also confer a survival advantage during the first 5 years after participation, even in a population with advanced age and significant functional impairment.
For clinicians managing ILD in the United States and other regions with access to structured PR programs, these data reinforce the importance of early referral and program completion. The observed mortality benefit persisted after adjustment for functional capacity and disease severity, suggesting that PR may influence outcomes through mechanisms beyond exercise tolerance alone, such as improved cardiovascular fitness, symptom self-management, or physical activity behaviors.This pooled analysis suggests that pulmonary rehabilitation may reduce 5-year mortality risk in people with interstitial lung disease. Alongside established functional benefits, the potential survival advantage strengthens the case for integrating PR into routine ILD management.
Reference
Dowman LM, Vainshelboim B, Holland AE. Impact of pulmonary rehabilitation on survival in people with interstitial lung disease. Chest. 2025;167(6):1696-1704.
