Comparison of High-intensity Interval Training Versus Moderate-intensity Continuous Training in Pulmonary Rehabilitation for Interstitial Lung Disease: a Randomised Controlled Pilot Feasibility Trial

Overview

Journal BMJ Open

Specialty General Medicine

Date 2023 Aug 22

PMID 37607782

Authors

Dimitra Nikoletou

Irina Chis Ster

Carmen Y Lech

Iain S MacNaughton

Felix Chua

Raminder Aul

Paul W Jones

Affiliations

Soon will be listed here.

Abstract

Objectives: This study aimed to investigate the feasibility and efficacy of high-intensity interval training (HIIT) compared with moderate-intensity continuous training (MICT) in pulmonary rehabilitation (PR) for people with interstitial lung disease (ILD).

Design: Single-centre, randomised controlled feasibility, pilot trial.

Setting: Patients were recruited from the chest clinic of a tertiary ILD centre and attended circuit-based PR in the hospital's gym, followed by a personalised 6-month community programme.

Participants: 58 patients, stratified per ILD type, were randomised into two groups: 33 to HIIT (18 males:15 females) (mean age (SD): 70.2 (11.4) years) and 25 to the MICT exercise mode (14 males:11 females) (mean age (SD): 69.8 (10.8) years).

Interventions: 8-week, twice weekly, circuit-based PR programme of exercise and education, followed by a personalised 6-month community exercise programme.

Outcome Measures: Feasibility outcomes included staff-to-patient ratio and dropout rates per group. Primary outcome was the 6 min walk distance (6MWD). Secondary outcomes included the sniff nasal pressure, mouth inspiratory and expiratory pressures, handgrip and quadriceps strength and health status. Random-effects models were used to evaluate average variation in outcomes through time across the two groups.

Results: The 6MWD peaked earlier with HIIT compared with MICT (at 4 months vs 5 months) but values were lower at peak (mean (95% CI): 26.3 m (3.5 to 49.1) vs 51.6 m (29.2 to 73.9)) and declined faster at 6 months post-PR. Secondary outcomes showed similar faster but smaller improvements with HIIT over MICT and more consistent maintenance 6 months post-PR with MICT than HIIT.

Conclusions: HIIT is feasible in circuit-based ILD PR programmes and provides quick improvements but requires closer supervision of training and resources than MICT and benefits may be less well sustained. This would make it a less attractive option for clinical PR programmes. A definitive, multicentre randomised controlled trial is required to address the role of HIIT in ILD.

Trial Registration Number: ISRCTN55846300.

Citing Articles

Classification of Patients Based on Dyspnea and Desaturation During Exercise in Interstitial Lung Disease.

Otake K, Misu S, Yamamoto A, Yamaguchi T, Nagatani C, Sakai H Respir Care. 2025; 70(1):56-64.

PMID: 39964866 PMC: 11824878. DOI: 10.1089/respcare.11712.

Pulmonary rehabilitation in connective tissue disease-associated interstitial lung disease: A systematic review.

Seleoglu I, Demirel A Sarcoidosis Vasc Diffuse Lung Dis. 2024; 41(4):e2024061.

PMID: 39655592 PMC: 11708958. DOI: 10.36141/svdld.v41i4.15633.

Protected characteristics reported in pulmonary rehabilitation: a scoping review.

Drover H, Gardiner L, Singh S, Evans R, Daynes E, Orme M Eur Respir Rev. 2024; 33(172).

PMID: 39009405 PMC: 11262624. DOI: 10.1183/16000617.0236-2023.

References

Leong S, Bos S, Lordan J, Nair A, Fisher A, Meachery G . Lung transplantation for interstitial lung disease: evolution over three decades. BMJ Open Respir Res. 2023; 10(1). PMC: 9980330. DOI: 10.1136/bmjresp-2022-001387. View

Beauchamp M, Nonoyama M, Goldstein R, Hill K, Dolmage T, Mathur S . Interval versus continuous training in individuals with chronic obstructive pulmonary disease--a systematic review. Thorax. 2009; 65(2):157-64. DOI: 10.1136/thx.2009.123000. View

Swallow E, Reyes D, Hopkinson N, Man W, Porcher R, Cetti E . Quadriceps strength predicts mortality in patients with moderate to severe chronic obstructive pulmonary disease. Thorax. 2006; 62(2):115-20. PMC: 2111256. DOI: 10.1136/thx.2006.062026. View

. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166(1):111-7. DOI: 10.1164/ajrccm.166.1.at1102. View

Dowman L, Hill C, May A, Holland A . Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev. 2021; 2:CD006322. PMC: 8094410. DOI: 10.1002/14651858.CD006322.pub4. View

Sterne J, White I, Carlin J, Spratt M, Royston P, Kenward M . Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009; 338:b2393. PMC: 2714692. DOI: 10.1136/bmj.b2393. View

Ley B, Ryerson C, Vittinghoff E, Ryu J, Tomassetti S, Lee J . A multidimensional index and staging system for idiopathic pulmonary fibrosis. Ann Intern Med. 2012; 156(10):684-91. DOI: 10.7326/0003-4819-156-10-201205150-00004. View

Manali E, Lyberopoulos P, Triantafillidou C, Kolilekas L, Sotiropoulou C, Milic-Emili J . MRC chronic Dyspnea Scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients: a prospective study. BMC Pulm Med. 2010; 10:32. PMC: 2893122. DOI: 10.1186/1471-2466-10-32. View

Spruit M, Singh S, Garvey C, ZuWallack R, Nici L, Rochester C . An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013; 188(8):e13-64. DOI: 10.1164/rccm.201309-1634ST. View

10.

Travis W, Costabel U, Hansell D, King Jr T, Lynch D, Nicholson A . An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013; 188(6):733-48. PMC: 5803655. DOI: 10.1164/rccm.201308-1483ST. View

11.

Shiraev T, Barclay G . Evidence based exercise - clinical benefits of high intensity interval training. Aust Fam Physician. 2012; 41(12):960-2. View

12.

Wisloff U, Stoylen A, Loennechen J, Bruvold M, Rognmo O, Haram P . Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation. 2007; 115(24):3086-94. DOI: 10.1161/CIRCULATIONAHA.106.675041. View

13.

Cottin V, Wollin L, Fischer A, Quaresma M, Stowasser S, Harari S . Fibrosing interstitial lung diseases: knowns and unknowns. Eur Respir Rev. 2019; 28(151). PMC: 9489101. DOI: 10.1183/16000617.0100-2018. View

14.

Helgerud J, Hoydal K, Wang E, Karlsen T, Berg P, Bjerkaas M . Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc. 2007; 39(4):665-71. DOI: 10.1249/mss.0b013e3180304570. View

15.

Vainshelboim B, Oliveira J, Yehoshua L, Weiss I, Fox B, Fruchter O . Exercise training-based pulmonary rehabilitation program is clinically beneficial for idiopathic pulmonary fibrosis. Respiration. 2014; 88(5):378-88. DOI: 10.1159/000367899. View

16.

Vogiatzis I, Nanas S, Kastanakis E, Georgiadou O, Papazahou O, Roussos C . Dynamic hyperinflation and tolerance to interval exercise in patients with advanced COPD. Eur Respir J. 2004; 24(3):385-90. DOI: 10.1183/09031936.04.00128903. View

17.

Vogiatzis I, Terzis G, Nanas S, Stratakos G, Simoes D, Georgiadou O . Skeletal muscle adaptations to interval training in patients with advanced COPD. Chest. 2005; 128(6):3838-45. DOI: 10.1378/chest.128.6.3838. View

18.

Roberts C, Torgerson D . Understanding controlled trials: baseline imbalance in randomised controlled trials. BMJ. 1999; 319(7203):185. PMC: 1116277. DOI: 10.1136/bmj.319.7203.185. View

19.

Kapnadak S, Raghu G . Lung transplantation for interstitial lung disease. Eur Respir Rev. 2021; 30(161). PMC: 9488499. DOI: 10.1183/16000617.0017-2021. View

20.

Mendes P, Wickerson L, Helm D, Janaudis-Ferreira T, Brooks D, Singer L . Skeletal muscle atrophy in advanced interstitial lung disease. Respirology. 2015; 20(6):953-9. DOI: 10.1111/resp.12571. View