Effect of Pulmonary Rehabilitation on Patients with Interstitial Lung Disease

Effect of Pulmonary Rehabilitation on Patients with Interstitial Lung Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Pulmonary Rehabilitation on Patients with Interstitial Lung Disease Shazly Baghdadi, Rabab Sedeek, Amany Abouzeid, nasser abdulnaby This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7595287/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background The treatment of Interstitial Lung Disease (ILD) typically adheres to a sequence of therapeutic protocols & according to assessment procedures. Efforts must focus on symptom alleviation, including incorporating treatments like pulmonary rehabilitation (PR) & psychosocial support to enhance case wellbeing. We aimed to determine whether PR in interstitial lung diseases cases has an advantageous influence on symptoms, exercise capacity, & quality of life (QOL). Methods This Cross-sectional analytic research was done on 60 ILD patients aged ≥ 18 years old, in both sexes. All patients were subjected to complete history taking, McGill QOL Questionnaire, Hamilton Depression Rating Scale, dyspnea assessment using the modified Medical Research Council scale, BMI, six-minute walk test, spirometry, oxygen saturation and ABG, echocardiography, and high-resolution CT chest. Participants underwent a supervised PR program (2 sessions/week for 8 weeks) following ATS/ERS guidelines, including: Health education (20 minutes) [Medication education, exacerbation review, and rehabilitation importance], exercise training [Warm-up (5–10 min), endurance training, resistance training, respiratory muscle training, and cool-down (5–10 min)], and evaluation of peripheral and respiratory muscle strength. Results Spirometry results showed a significant increase in FVC (p = 0.04), indicating improved lung capacity. Psychological well-being, as measured by the Hamilton Depression Rating Scale (HDRS), improved significantly, with scores decreasing (p = 0.004). Additionally, the MQOL total score increased markedly (p < 0.001), reflecting a significant enhancement in perceived quality of life. The categorical distribution of MQOL also showed significant improvement (p < 0.001). According to comparison between pre- and post- program, there was statistically significant difference regarding mMRC dyspnea scale Pre & Post-test, Heart rate Pre & Post-test, &O2 saturation Pre & Post-test (P = 0.001). Conclusions PR in cases with interstitial lung diseases demonstrated significant benefits by alleviating symptoms such as dyspnea, enhancing QOL, psychological wellbeing, improving exercise capacity, aerobic capacity, respiratory mechanics, & muscle strength. Pulmonary Rehabilitation Peripheral Muscle Strength Indurance Interstitial Lung Diseases Introduction Interstitial Lung Disease (ILD) [1] , often referred to as diffuse parenchymal illnesses, encompasses a diverse array of unique pulmonary ailments categorized based on common clinical, physiological, radiological, or pathological characteristics. What causes it challenging to understand this group of illnesses is the confusing terminology. The pathogenic sequence indeed encompasses a period of fibrosis & inflammation that not only disrupts the interstitial bed, as suggested by the name, but additionally alters the parenchyma, including the alveolar ducts, alveoli, & bronchioles [2] . Efforts must focus on symptom alleviation, including incorporating treatments like pulmonary rehabilitation (PR) & psychosocial support to enhance case wellbeing. Subsequent to alleviating symptoms, the next essential step is to evaluate the case's tolerance & the efficacy of the administered drug [3] . PR is an extensive intervention for symptomatic cases with chronic pulmonary disorders, frequently resulting in reduced daily activities, as recently characterized by the European pulmonary Society (ERS) & American Thoracic Society (ATS) [4] . There are three fundamental forms of PR: out-patient, in-patient, & home-based programs. In the present study, only the out-patient program was applied. Each case receives a tailored regimen that best suits their requirements. The out-patient program facilitates the attainment of higher intensity workouts, hence yielding optimal outcomes. The outpatient program is quite simple as it may be managed by a limited number of individuals, such as those overseen by physiotherapists. A greater number of impaired cases are unable to consistently participate in outpatient programs; hence, they are recommended for inpatient programs. Individuals needing the optimization of medical and ventilatory therapy might undergo inpatient PR. Home-based therapies are beneficial; nevertheless, they may be less efficacious than outpatient and inpatient programs. A home- based program is implemented when other programs are unavailable or when exercise takes precedence over other aspects of rehabilitation [5] . The aim of this work was to regulate whether PR in interstitial lung diseases cases has advantageous influence on symptoms, exercise capacity, & quality of life (QOL) and to evaluate the safety of PR in Interstitial lung diseases cases. Patients and Methods This Cross-sectional analytic research was carried out on 60 ILD patients aged ≥ 18 years old, in both sexes. An informed written assent was obtained from the patient or their relatives. The Ethical Committee's approval was obtained prior to conducting the study. Cairo University Hospital (approval code:) from June 2023 to April 2024. Exclusion criteria were acute exacerbation of Interstitial Lung Disease which recognized as a rapid worsening of respiratory symptoms as increasing dyspnea and need for escalation of treatment (e.g., initiation of oxygen therapy or immunosuppressant) within less than 1 month, unpaid respiratory acidosis on arterial blood gases (ABG), history of unexplained syncope on exertion, and any comorbidities that counteract PR, for example [Unstable cardiac disease (acute heart failure, recent myocardial infarction, severe mitral stenosis, & sever aortic stenosis), severe orthopedic or neuromuscular deficits, and cognitive impairment)]. All patients were subjected to complete history taking, McGill QOL Questionnaire (MQOL), Hamilton Depression Rating Scale (HDRS), dyspnea assessment using the modified Medical Research Council (mMRC) scale, BMI, six-minute walk test (6MWT), spirometry, oxygen saturation and ABG, echocardiography, and high-resolution CT (HRCT) chest. They then underwent a PR program twice weekly for 8 weeks, including patient education, breathing exercises, respiratory muscle training, aerobic and resistance exercise training, and assessment of respiratory and peripheral muscle strength and endurance, with all relevant parameters reassessed post-rehabilitation. PR Protocol: Participants underwent a supervised PR program (2 sessions/week for 8 weeks) following ATS/ERS guidelines, including: a) Health Education (20 minutes): Medication education: Purpose, side effects, adherence importance. Exacerbation review: Frequency, impact, early signs, and management strategies. Rehabilitation importance: Benefits on lung function, QoL, and self-management skills. b) Exercise Training: Warm-up (5–10 min): Light aerobic and stretching exercises. Endurance Training: Interval cycling and arm ergometry at 60–80% peak workload, progressing based on tolerance, with intermittent exercise/rest periods, gradually increasing from 15–20 min to 45–60 min. Resistance Training: Using free weights, Thera-Band, and balls at 50–85 percent 1-RM, 2–4 sets of 6–12 reps, progressing with increased resistance, repetitions, or sets. Respiratory Muscle Training: Pursed-lip breathing Diaphragmatic breathing Incentive spirometry (three-ball device) Cool-down (5–10 min): Gentle breathing and stretching. Oxygen saturation, heart rate, mMRC grade, and limb fatigue were monitored throughout sessions, with supplemental oxygen provided to maintain SO₂ ≥85%. c) Evaluation of Peripheral and Respiratory Muscle Strength: Respiratory Muscle Strength: Maximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP) restrainedbnm,.bnm,.bnm,. using MicroRPM with standard procedures: MIP: Inhalation against occluded mouthpiece after full exhalation. MEP: Exhalation against occluded mouthpiece after full inhalation. Highest value from three trials recorded. Normal values: MIP: Men: -100 to -130 cmH₂O, Women: -75 to -100 cmH₂O MEP: Men: +150 to +230 cmH₂O, Women: +80 to +150 cmH₂O Peripheral Muscle Strength and Endurance: Assessed using a hand-held dynamometer: Upper limbs: Patients squeezed the dynamometer maximally for 3–5 seconds, best of three trials recorded, and lower limbs: Dynamometer applied proximal to the joint; patients performed maximal contraction for 3–5 seconds, with the best of three trials recorded. Muscle endurance was evaluated based on the number of repetitions performed before fatigue. The primary outcome were dyspnea, and QOL. The secondary outcomes were functional and maximal exercise capacity, and VO2max estimation. Sample Size Calculation: Sample size has been assessed to determine the number of participants essential to identify a significant variance in 6-minute walk distance. Data from previous study [6] has been utilized to compute the needed sample size (calculated effect size of 0.65) for a power of 80% & an alpha of 0.05. Utilizing the sample size calculation of GPower software version 3.1.9.6 (Franz Faul, Kiel university, Germany), a sample of 50 individuals were required. Taking into account an anticipated 20% dropout rate, 60 participants were enrolled. Statistical analysis By means of SPSS v26 (IBM Inc., Armonk, NY, USA), statistical analysis was conducted. The unpaired Student's t-test was employed to compare the two groups' quantitative variables, which were presented as mean and standard deviation (SD). Qualitative variables were analyzed using the Chi-square test or Fisher's exact test when appropriate, and were presented as frequency and percentage (%). o Logistic regression model has been utilized to assess the risk factors for respiratory function limitations in ILD, adjustment for age & sex were conducted by multivariate logistic regression analysis. A two tailed P value < 0.05 was considered statistically significant. Results Table 1 displays that mean age was 58.12 ± 9.22 years. The majority were male (58.3%) and nearly half were employed (48.3%). The mean body weight and height were 63.45 ± 9.17 kg and 161.55 ± 5.89 cm, respectively. The average pulse rate was 85.25 ± 6.59 beats per minute. Most participants (96.7%) had normal blood pressure, while only 3.3% were hypertensive. Regarding exposure history, 20% reported exposure to smoking and 30% to irritants or allergens. The prevalence of diabetes mellitus and hypertension was low, at 5% and 3.3%, respectively. Table 1 Baseline characteristics, physical examination, Medical History and exposure findings among the studied group (N = 60) Variable N = 60 Age (years) 58.12 ± 9.22 Gender - Female 25 (41.7%) - Male 35 (58.3%) Occupation - Non-employed 31 (51.7%) - Employed 29 (48.3%) Weight (kg) 63.45 ± 9.17 Height (cm) 161.55 ± 5.89 Pulse (b/min) 85.25 ± 6.59 BP (mmHg) - Normal 58 (96.7%) - High 2 (3.3%) Exposure to smoking 12(20%) Exposure to Irritant/Allergen 18(30%)) Diabetes mellitus 3(5%) Hypertension 2(3.3%) Data are presented as mean ± SD or frequency (%). BP: Blood Pressure. Spirometry results showed a significant increase in FVC from 41.09 ± 22.14 to 49.94 ± 24.85 (p = 0.04), indicating improved lung capacity. However, changes in FEV₁, FEV₁/FVC ratio, and VC were not statistically significant (p > 0.05). Psychological well-being, as measured by the Hamilton Depression Rating Scale (HDRS), improved significantly, with scores decreasing from 14.31 ± 3.22 to 12.66 ± 2.96 (p = 0.004). Additionally, the MQOL total score increased markedly from 1.38 ± 0.65 to 3.71 ± 0.96 (p < 0.001), reflecting a significant enhancement in perceived quality of life. The categorical distribution of MQOL also showed significant improvement (p < 0.001). Prior to the program, 66.7% of participants reported mild QoL, with no individuals in the good or very good categories. Post-program, 48.3% reported good and 26.7% gave a very good quality of life, with none remaining in the mild category. Table 2 Table 2 Distribution of ABG, spirometry, psychological measures, and MQOL among the studied group (N = 60) Variable Pre-Program Post-Program P-value Spirometry FVC 41.09 ± 22.14 49.94 ± 24.85 0.04* FEV1 45.98 ± 19.01 48.15 ± 12.5 0.461 FEV1/FVC Ratio 110.24 ± 17.37 112.38 ± 19.2 0.524 VC 48.27 ± 8.68 53.66 ± 20.76 0.066 MQOL Total Score Categories Mild 40 (66.7%) 0 < 0.001* Medium 20 (33.3%) 15 (25%) Good 0 29 (48.3%) Very Good 0 16 (26.7%) Psychological Assessment and MQOL Score HDRS 14.31 ± 3.22 12.66 ± 2.96 0.004* MQOL Total Score 1.38 ± 0.65 3.71 ± 0.96 < 0.001* Data are presented as mean ± SD or frequency (%). FVC: Forced Vital Capacity, FEV₁: Forced Expiratory Volume in One Second, VC: Vital Capacity, QoL: Quality of Life, HDRS: Hamilton Depression Rating Scale.*: Significant as P value < 0.05 According to comparison between pre- and post- program, there was statistically significant difference regarding mMRC dyspnea scale Pre & Post-test, Heart rate Pre & Post-test, &O2 saturation Pre & Post-test (P = 0.001). Aerobic capacity showed marked enhancement, with VO₂ peak increasing from 57.93 ± 7.41% to 64.96 ± 8.60% (p < 0.001), and the six-minute walk distance (6MWD) improved significantly from 210.81 ± 66.31 m to 325.45 ± 60.60 m (p < 0.001) Table 3 Table 3 Distribution of Six-Minute Walk Distance and mMRC Dyspnea Scale Pre- and Post-Program and secondary outcome among Studied Group (N = 60) Variable Pretest Posttest P-value Pre-Program mMRC dyspnea scale 3.25 ± 0.60 3.56 ± 0.49 0.001* Heart rate (b/min) 87.33 ± 4.03 121.01 ± 8.30 0.001* O₂ saturation (%) 95.21 ± 1.39 94.31 ± 1.08 0.001* Post-Program mMRC dyspnea scale 2.25 ± 0.81 3.11 ± 0.66 0.001* Heart rate (b/min) 86.93 ± 3.66 124.18 ± 7.40 0.001* O₂ saturation (%) 94.78 ± 1.04 95.68 ± 1.01 0.001* Aerobic Capacity VO₂peak (%) 57.93 ± 7.41 64.96 ± 8.60 < 0.001* 6MW Distance (m) 210.81 ± 66.31 325.45 ± 60.60 < 0.001* Data are presented as mean ± SD. mMRC: Modified Medical Research Council, O₂: Oxygen, *: Significant as P value < 0.05. Discussion Interstitial lung diseases incorporate a diverse array of conditions, marked by increasing dyspnoea, activity restriction, & diminished QOL, resulting in diffuse inflammation and/or fibrosis of the lung vasculature & parenchyma [ 7 ] . The classification of interstitial lung diseases is predicated on either known etiologies (such as inhaled agents, infections, medication, etc.) or unidentified causes (including sarcoidosis, asbestosis, idiopathic pulmonary fibrosis, & pneumonitis), particular illness entities, or distinct histological, radiological, or clinical patterns [ 8 ] . By revealing the result of high-resolution computed tomography, it was revealed that: 8 cases (13.3%) had Respiratory bronchiolitis-ILD, 30 patients (50%) had Idiopathic pulmonary fibrosis. 4 patients (6.7%) had Bronchiolitis obliterans organizing pneumonia. 4 patients (6.7%) had Connective tissue disease related ILD. 7 patients (11.7%) had Non-specific interstitial pneumonia, 4 patients (6.7%) had Unspecified, 3 patients (5%) had Sarcoidosis. These outcomes are consistent with previous reports Raghu et al., [ 9 ] which found IPF to be the most common subtype of ILD with the poorest prognosis and the greatest burden on physical functioning. More than half of the patients in our investigation had severe disease (> 50% parenchymal involvement), which emphasizes the need for early intervention with PR. A relatively low incidence of PH in ILD patients has been reported in some studies, with rates between 8% & 15% at the time of initial diagnosis, particularly in early-stage IPF. [ 10 ] Kacprzak et al., [ 11 ] . According to ABG, Post-PR results demonstrated a significant increase in PaCO2 levels, likely due to improved alveolar ventilation efficiency & reduced respiratory muscle fatigue. While no significant change was seen in PaO2 or pH, the improved CO2 retention suggests better ventilation-perfusion matching. These results align with data from Spruit et al. [ 12 ] , who found improved gas exchange & ventilatory efficiency post-PR in ILD. In the present research, PR result in significant improvements in pulmonary function tests (f), notably in forced critical capacity (FVC) while there is no statistically significant difference regarding FEV₁& FEV₁/FVC. [ 12 ] Similarly, a systematic review & meta-analysis by Torres-Sánchez et al. [ 13 ] demonstrated that PR interventions increased predicted FVC by approximately 5.47%, indicating a clinically relevant improvement in lung function among ILD patients. Conversely, Furthermore, a randomized controlled trial by Vainshelboim et al. [ 14 ] reported that while PR improved exercise capacity & QOL in ILD cases, it didn’t significantly alter lung function measures such as FVC or DLCO. As regarding QOL, our study revealed that PR result in a marked improvement in life quality, as evidenced by a statistically significant rise in MQOL scores. The mean score rose from 23.48 ± 11.14 to 63.21 ± 16.34 (p < 0.001). This improvement is in line with the outcome of Torres-Sánchez et al. [ 13 ] , who conducted a meta-analysis & found a mean increase of 3.9 points in QoL among ILD patients after PR. Conversely, Fan et al. [ 15 ] noted substantial variability in QoL outcomes across ILD subtypes in their systematic review. The authors suggested that while PR may benefit QoL in certain ILD types, such as NSIP, the effect was less clear in rapidly progressive conditions like IPF, possibly due to irreversible disease burden. According to depression scores HDRS, a significant decrease in depression scores (HDRS) was noted post- PR. This psychological benefit can be attributed to improved physical functioning, social engagement during group sessions, & enhanced autonomy. This in agreement with Shen et al. [ 16 ] , the research delineates the characteristics of pain as distinct from depression scores in cases with interstitial lung disease. A total of sixty-three subjects with ILD & sixty- three healthy controls have been enrolled. The stated average age of all participants was 62 ± 9 years, while the average pack years among subjects with ILD was 16.68, significantly higher than the 4.2 years observed in healthy controls (P-value under 0.0001). However, a technical review by Holland et al. [ 17 ] found only limited evidence supporting long-term psychological benefits of PR, especially in studies lacking specific psychological support components. They suggested that the inclusion of cognitive behavioral therapy or structured counseling may be required for sustained improvements. In our study, patients demonstrated a significant enhancement in dyspnea levels as assessed by the mMRC scale following PR. This improvement is in agreement with the outcomes of Kataoka et al. [ 18 ] , who reported reduced mMRC scores after an 8-week PR program in cases having idiopathic pulmonary fibrosis. However, Vainshelboim et al. [ 19 ] reported only modest changes in mMRC scores after PR in ILD patients, indicating that while PR may enhance exercise capacity, the perception of breathlessness can be influenced by other non-reversible disease factors such as fibrosis severity or baseline functional status. Concerning six-minute Walk distance, the current investigation showed that a statistically significant variance has been observed with regard to Heart rate Post-test, O2 saturation Post-test & mMRC dyspnea scale Post-test, while there was no statistically significant variance regarding Heart rate pretest & O2 saturation pretest. The 6MWT distance significantly increased after PR, from a mean of 210.81 ± 66.31 meters to 325.45 ± 60.6 meters (p < 0.001). This increase reflects improved submaximal exercise capacity, better oxygen utilization, & enhanced muscle performance. This outcomes is consistent with Mendes et al., [ 20 ] found that the 6-min walk test (6MWT) is more commonly utilized to monitor progress of ILDs over time & during rehabilitation programs [ 20 , 21 ] . In contrast, Dowman et al. [ 22 ] , in a Cochrane systematic review, reported that in patients with advanced ILD, PR did not consistently result in significant improvements in 6MWD. This could be attributed to the presence of limiting factors such as exercise-induced hypoxemia, muscular deconditioning, or irreversible lung impairment. VO2peak (Aerobic Capacity): In our investigation, there was a statistically significant rise in VO2peak following PR that highlights improved cardiopulmonary fitness. Aerobic capacity enhancement reflects not only cardiac adaptation but also improved peripheral oxygen extraction. According to Wickerson et al. [ 23 ] , aerobic training can reverse exercise-induced desaturation & increase VO2peak in ILD patients, leading to improved tolerance to daily physical activity. However, Dowman et al. [ 22 ] , in a Cochrane review, concluded that while PR enhances functional capacity, it may not significantly impact VO₂ peak in all patients, particularly those with severe oxygen desaturation or advanced disease. As regarding Peripheral Muscle Strength, there were marked improvements in upper & lower limb strength (1RM and 20RM), reflecting the effectiveness of resistance training in the PR program. Jarosch et al. [ 24 ] further emphasized that peripheral muscle dysfunction is common in ILD & contributes to declined exercise capacity. In contrast, Ozalevli et al. [ 25 ] didn’t detect significant alteration in peripheral muscle strength in a cohort of ILD patients after PR. They hypothesized that advanced fibrosis & reduced oxygen delivery may blunt muscular adaptation, particularly in patients with severe disease According to Respiratory Muscle Strength, significant improvements were observed in both maximal inspiratory pressure (Pimax) & maximal expiratory pressure (Pemax) after PR. This is attributed to the incorporation of respiratory muscle training (RMT), including diaphragmatic breathing & pursed-lip breathing exercises Martí et al. [ 26 ] found that adding inspiratory muscle training (IMT) to standard PR resulted in greater improvements in respiratory pressures. Conversely, Mochizuki et al. [ 27 ] found no significant gains in respiratory muscle strength in ILD cases who underwent conventional PR without specific IMT. This suggests that targeted respiratory training may be necessary to achieve optimal benefits in muscle strength. A significant training influence has been seen, characterized by enhanced endurance time at 50-W exercise, sustained exercise VO2 throughout constant- load testing, a rise in treadmill MET-minutes, & improved respiratory muscular strength (MIP) following rehabilitation [ 28 ] . The strengths of the study were multidimensional assessment (physiological, functional, psychological), use of validated & objective tools (6MWT, spirometry, HDRS, MQOL), and focused PR protocol tailored to ILD patients. We recommended that future research should include meticulously prepared randomized controlled trials or extensive comparative observational research, inclusion a representative sample of cases with comparable gender, age, & illness severity, the MQOL (quality of life) score is the best measure, the sample size of future investigations must be large enough to give meaningful conclusions & to control for confounding factors, to accurately evaluate long-term results, investigation should have a longer follow-up duration, and future investigation must involve multicenter investigations to validate our findings. Limitations: Lack of a control group, single-center study with limited sample size (n = 60), short duration of follow-up; long-term outcomes remain unclear, lack of physiotherapist, lack of nutritionist, and lack of psychotherapist. Conclusions PR in cases having interstitial lung diseases demonstrated significant benefits by alleviating symptoms as dyspnea, enhancing QOL, psychological wellbeing, improving exercise capacity, aerobic capacity, respiratory mechanics, & muscle strength. Furthermore, the intervention was found to be safe and well-tolerated, supporting its use as an effective management strategy for ILD patients. Declarations Financial support and sponsorship: Nil Conflict of Interest: Nil Author Contribution 1 and 1* wrote the main manuscript text and 2 prepared figures. all authors reviewed the manuscript. Acknowledgement I dedicated doctor Zeinab Abdelrady Abdellatef for helping us in the quality of life questionnaire and Hamilton depression rating scale References Skeoch S, Weatherley N, Swift AJ, Oldroyd A, Johns C, Hayton C, et al. Drug-Induced Interstitial Lung Disease: A Systematic Review. J Clin Med. 2018;7. Martinez FJ, Collard HR, Pardo A, Raghu G, Richeldi L, Selman M, et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7595287","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":521824615,"identity":"97c8c3e9-eae0-4ae2-9805-443c401b383a","order_by":0,"name":"Shazly Baghdadi","email":"","orcid":"","institution":"Aswan University","correspondingAuthor":false,"prefix":"","firstName":"Shazly","middleName":"","lastName":"Baghdadi","suffix":""},{"id":521824616,"identity":"0ca98f2b-de85-498f-b1f0-32e2ec20d695","order_by":1,"name":"Rabab Sedeek","email":"data:image/png;base64,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","orcid":"","institution":"Aswan University","correspondingAuthor":true,"prefix":"","firstName":"Rabab","middleName":"","lastName":"Sedeek","suffix":""},{"id":521824617,"identity":"11873b33-9ce4-40d2-84fe-e7bd6b21c359","order_by":2,"name":"Amany Abouzeid","email":"","orcid":"","institution":"Cairo University","correspondingAuthor":false,"prefix":"","firstName":"Amany","middleName":"","lastName":"Abouzeid","suffix":""},{"id":521824619,"identity":"e61e7b9b-5c17-43ff-bc41-14120213daab","order_by":3,"name":"nasser abdulnaby","email":"","orcid":"","institution":"Cairo University","correspondingAuthor":false,"prefix":"","firstName":"nasser","middleName":"","lastName":"abdulnaby","suffix":""}],"badges":[],"createdAt":"2025-09-12 00:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7595287/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7595287/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92605863,"identity":"3c5c6134-b7a9-4980-be4f-9ef60975b4b1","added_by":"auto","created_at":"2025-10-01 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15:00:16","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85999,"visible":true,"origin":"","legend":"","description":"","filename":"ce91749369d24803a0316a95aa8af1481enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7595287/v1/2c4d1090eac9e79b012dd89c.xml"},{"id":92604846,"identity":"9c3c9807-8cde-40c8-b8f0-f47740a5d732","added_by":"auto","created_at":"2025-10-01 15:00:16","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85391,"visible":true,"origin":"","legend":"","description":"","filename":"ce91749369d24803a0316a95aa8af1481structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7595287/v1/2ead1b20608330163005686e.xml"},{"id":92604991,"identity":"cf350af1-63d1-43d2-a042-d780646908df","added_by":"auto","created_at":"2025-10-01 15:00:19","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":94181,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7595287/v1/1284536942a12a54292c58fc.html"},{"id":92606690,"identity":"c420b773-0f59-4aa2-a35f-6576574b98e1","added_by":"auto","created_at":"2025-10-01 15:16:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":930228,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7595287/v1/9a8dcf30-3131-4eff-bec3-5402bf31d3d4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Pulmonary Rehabilitation on Patients with Interstitial Lung Disease","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInterstitial Lung Disease (ILD) \u003csup\u003e[1]\u003c/sup\u003e, often referred to as diffuse parenchymal illnesses, encompasses a diverse array of unique pulmonary ailments categorized based on common clinical, physiological, radiological, or pathological characteristics. What causes it challenging to understand this group of illnesses is the confusing terminology. The pathogenic sequence indeed encompasses a period of fibrosis \u0026amp; inflammation that not only disrupts the interstitial bed, as suggested by the name, but additionally alters the parenchyma, including the alveolar ducts, alveoli, \u0026amp; bronchioles \u003csup\u003e[2]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eEfforts must focus on symptom alleviation, including incorporating treatments like pulmonary rehabilitation (PR) \u0026amp; psychosocial support to enhance case wellbeing. Subsequent to alleviating symptoms, the next essential step is to evaluate the case\u0026apos;s tolerance \u0026amp; the\u0026nbsp;efficacy of the administered drug \u003csup\u003e[3]\u003c/sup\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePR is an extensive intervention for symptomatic cases with chronic pulmonary disorders, frequently resulting in reduced daily activities, as recently characterized by the European pulmonary Society (ERS) \u0026amp; American Thoracic Society (ATS) \u003csup\u003e[4]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThere are three fundamental forms of PR: out-patient, in-patient, \u0026amp; home-based programs. In the present study, only the out-patient program was applied.\u003c/p\u003e\n\u003cp\u003eEach case receives a tailored regimen that best suits their requirements. The out-patient program facilitates the attainment of higher intensity workouts, hence yielding optimal outcomes. The outpatient program is quite simple as it may be managed by a limited number of individuals, such as those overseen by physiotherapists. A greater number of impaired cases are unable to consistently participate in outpatient programs; hence, they are recommended for inpatient programs. Individuals needing the optimization of medical and ventilatory therapy might undergo inpatient PR. Home-based therapies are beneficial; nevertheless, they may be less efficacious than outpatient and inpatient programs. A home- based program is implemented when other programs are unavailable or when exercise takes precedence over other aspects of rehabilitation \u003csup\u003e[5]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe aim of this work was\u0026nbsp;to regulate whether PR\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003ein interstitial lung diseases cases has advantageous influence on symptoms, exercise capacity, \u0026amp; quality of life (QOL) and to evaluate the safety of PR in Interstitial lung diseases cases.\u0026nbsp;\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003eThis Cross-sectional analytic research was carried out on 60 ILD patients aged \u0026ge; 18 years old, in both sexes.\u003c/p\u003e\n\u003cp\u003eAn informed written assent was obtained from the patient or their relatives. \u0026nbsp;The Ethical Committee\u0026apos;s approval was obtained prior to conducting the study. Cairo University Hospital (approval code:) from June 2023 to April 2024.\u003c/p\u003e\n\u003cp\u003eExclusion criteria were acute exacerbation of Interstitial Lung Disease which recognized as a rapid worsening of respiratory symptoms as increasing dyspnea and need for escalation of treatment (e.g., initiation of oxygen therapy or immunosuppressant) within less than 1 month, unpaid respiratory acidosis on arterial blood gases (ABG), history of unexplained syncope on exertion, and any comorbidities that counteract PR, for example [Unstable cardiac disease (acute heart failure, recent myocardial infarction, severe mitral stenosis, \u0026amp; sever aortic stenosis), severe orthopedic or neuromuscular deficits, and cognitive impairment)].\u003c/p\u003e\n\u003cp\u003eAll patients were subjected to complete history taking, McGill QOL Questionnaire (MQOL), Hamilton Depression Rating Scale (HDRS), dyspnea assessment using the modified Medical Research Council (mMRC) scale, BMI, six-minute walk test (6MWT), spirometry, oxygen saturation and ABG, echocardiography, and high-resolution CT (HRCT) chest. They then underwent a PR program twice weekly for 8 weeks, including patient education, breathing exercises, respiratory muscle training, aerobic and resistance exercise training, and assessment of respiratory and peripheral muscle strength and endurance, with all relevant parameters reassessed post-rehabilitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePR Protocol:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants underwent a supervised PR program (2 sessions/week for 8 weeks) following ATS/ERS guidelines, including:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea) Health Education (20 minutes):\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eMedication education:\u003c/strong\u003e Purpose, side effects, adherence importance.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eExacerbation review:\u003c/strong\u003e Frequency, impact, early signs, and management strategies.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRehabilitation importance:\u003c/strong\u003e Benefits on lung function, QoL, and self-management skills.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eb) Exercise Training:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eWarm-up (5\u0026ndash;10 min):\u003c/strong\u003e Light aerobic and stretching exercises.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEndurance Training:\u003c/strong\u003e Interval cycling and arm ergometry at 60\u0026ndash;80% peak workload, progressing based on tolerance, with intermittent exercise/rest periods, gradually increasing from 15\u0026ndash;20 min to 45\u0026ndash;60 min.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eResistance Training:\u003c/strong\u003e Using free weights, Thera-Band, and balls at 50\u0026ndash;85 percent 1-RM, 2\u0026ndash;4 sets of 6\u0026ndash;12 reps, progressing with increased resistance, repetitions, or sets.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRespiratory Muscle Training:\u003c/strong\u003e\n \u003cul style=\"list-style-type: circle;\"\u003e\n \u003cli\u003ePursed-lip breathing\u003c/li\u003e\n \u003cli\u003eDiaphragmatic breathing\u003c/li\u003e\n \u003cli\u003eIncentive spirometry (three-ball device)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCool-down (5\u0026ndash;10 min):\u003c/strong\u003e Gentle breathing and stretching.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOxygen saturation, heart rate, mMRC grade, and limb fatigue were monitored throughout sessions, with supplemental oxygen provided to maintain SO₂ \u0026ge;85%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec) Evaluation of Peripheral and Respiratory Muscle Strength:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRespiratory Muscle Strength:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eMaximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP)\u0026nbsp;\u003c/strong\u003erestrainedbnm,.bnm,.bnm,. using \u003cstrong\u003eMicroRPM\u003c/strong\u003e with standard procedures:\u003cul style=\"list-style-type: circle;\"\u003e\n \u003cli\u003eMIP: Inhalation against occluded mouthpiece after full exhalation.\u003c/li\u003e\n \u003cli\u003eMEP: Exhalation against occluded mouthpiece after full inhalation.\u003c/li\u003e\n \u003cli\u003eHighest value from three trials recorded.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eNormal values:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eMIP:\u003c/strong\u003e Men: -100 to -130 cmH₂O, Women: -75 to -100 cmH₂O\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMEP:\u003c/strong\u003e Men: +150 to +230 cmH₂O, Women: +80 to +150 cmH₂O\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003ePeripheral Muscle Strength and Endurance:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAssessed using a hand-held dynamometer: Upper limbs: Patients squeezed the dynamometer maximally for 3\u0026ndash;5 seconds, best of three trials recorded, and lower limbs: Dynamometer applied proximal to the joint; patients performed maximal contraction for 3\u0026ndash;5 seconds, with the best of three trials recorded.\u003c/p\u003e\n\u003cp\u003eMuscle endurance was evaluated based on the number of repetitions performed before fatigue.\u003c/p\u003e\n\u003cp\u003eThe primary outcome were dyspnea, and QOL. The secondary outcomes were functional and maximal exercise capacity, and VO2max estimation.\u003c/p\u003e\n\u003cp\u003eSample Size Calculation:\u003c/p\u003e\n\u003cp\u003eSample size has been assessed to determine the number of participants essential to identify a significant variance in 6-minute walk distance. Data from previous study\u0026nbsp;\u003cstrong\u003e\u003csup\u003e[6]\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ehas been utilized to compute the needed sample size (calculated effect size of 0.65) for a power of 80% \u0026amp; an alpha of 0.05. Utilizing the sample size calculation of GPower software version 3.1.9.6 (Franz Faul, Kiel university, Germany), a sample of 50 individuals were required. Taking into account an anticipated 20% dropout rate, 60 participants were enrolled.\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBy means of SPSS v26 (IBM Inc., Armonk, NY, USA), statistical analysis was conducted. \u0026nbsp;The unpaired Student\u0026apos;s t-test was employed to compare the two groups\u0026apos; quantitative variables, which were presented as mean and standard deviation (SD). \u0026nbsp;Qualitative variables were analyzed using the Chi-square test or Fisher\u0026apos;s exact test when appropriate, and were presented as frequency and percentage (%). o \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Logistic regression model has been utilized to assess the risk factors for respiratory function limitations in ILD, adjustment for age \u0026amp; sex were conducted by multivariate logistic regression analysis. A two tailed P value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e displays that mean age was 58.12\u0026thinsp;\u0026plusmn;\u0026thinsp;9.22 years. The majority were male (58.3%) and nearly half were employed (48.3%). The mean body weight and height were 63.45\u0026thinsp;\u0026plusmn;\u0026thinsp;9.17 kg and 161.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89 cm, respectively. The average pulse rate was 85.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59 beats per minute. Most participants (96.7%) had normal blood pressure, while only 3.3% were hypertensive. Regarding exposure history, 20% reported exposure to smoking and 30% to irritants or allergens. The prevalence of diabetes mellitus and hypertension was low, at 5% and 3.3%, respectively.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline characteristics, physical examination, Medical History and exposure findings among the studied group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;60\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.12\u0026thinsp;\u0026plusmn;\u0026thinsp;9.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (58.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Non-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (48.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.45\u0026thinsp;\u0026plusmn;\u0026thinsp;9.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeight (cm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e161.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePulse (b/min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBP (mmHg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Normal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (96.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- High\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure to smoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eExposure to Irritant/Allergen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(30%))\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or frequency (%). BP: Blood Pressure.\u003c/p\u003e\n\u003cp\u003eSpirometry results showed a significant increase in FVC from 41.09\u0026thinsp;\u0026plusmn;\u0026thinsp;22.14 to 49.94\u0026thinsp;\u0026plusmn;\u0026thinsp;24.85 (p\u0026thinsp;=\u0026thinsp;0.04), indicating improved lung capacity. However, changes in FEV₁, FEV₁/FVC ratio, and VC were not statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Psychological well-being, as measured by the Hamilton Depression Rating Scale (HDRS), improved significantly, with scores decreasing from 14.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22 to 12.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96 (p\u0026thinsp;=\u0026thinsp;0.004). Additionally, the MQOL total score increased markedly from 1.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65 to 3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reflecting a significant enhancement in perceived quality of life. The categorical distribution of MQOL also showed significant improvement (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Prior to the program, 66.7% of participants reported mild QoL, with no individuals in the good or very good categories. Post-program, 48.3% reported good and 26.7% gave a very good quality of life, with none remaining in the mild category. Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of ABG, spirometry, psychological measures, and MQOL among the studied group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePre-Program\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePost-Program\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSpirometry\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFVC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.09\u0026thinsp;\u0026plusmn;\u0026thinsp;22.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.94\u0026thinsp;\u0026plusmn;\u0026thinsp;24.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFEV1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.98\u0026thinsp;\u0026plusmn;\u0026thinsp;19.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.15\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.461\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFEV1/FVC Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110.24\u0026thinsp;\u0026plusmn;\u0026thinsp;17.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112.38\u0026thinsp;\u0026plusmn;\u0026thinsp;19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eVC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.66\u0026thinsp;\u0026plusmn;\u0026thinsp;20.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eMQOL Total Score Categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedium\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGood\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29 (48.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery Good\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychological Assessment and MQOL Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDRS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMQOL Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or frequency (%). FVC: Forced Vital Capacity, FEV₁: Forced Expiratory Volume in One Second, VC: Vital Capacity, QoL: Quality of Life, HDRS: Hamilton Depression Rating Scale.*: Significant as P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eAccording to comparison between pre- and post- program, there was statistically significant difference regarding mMRC dyspnea scale Pre \u0026amp; Post-test, Heart rate Pre \u0026amp; Post-test, \u0026amp;O2 saturation Pre \u0026amp; Post-test (P\u0026thinsp;=\u0026thinsp;0.001). Aerobic capacity showed marked enhancement, with VO₂ peak increasing from 57.93\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41% to 64.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.60% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the six-minute walk distance (6MWD) improved significantly from 210.81\u0026thinsp;\u0026plusmn;\u0026thinsp;66.31 m to 325.45\u0026thinsp;\u0026plusmn;\u0026thinsp;60.60 m (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) Table 3\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of Six-Minute Walk Distance and mMRC Dyspnea Scale Pre- and Post-Program and secondary outcome among Studied Group (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003ePre-Program\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003emMRC dyspnea scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart rate (b/min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e121.01\u0026thinsp;\u0026plusmn;\u0026thinsp;8.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eO₂ saturation (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-Program\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003emMRC dyspnea scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart rate (b/min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124.18\u0026thinsp;\u0026plusmn;\u0026thinsp;7.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eO₂ saturation (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eAerobic Capacity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eVO₂peak (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.93\u0026thinsp;\u0026plusmn;\u0026thinsp;7.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e6MW Distance (m)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e210.81\u0026thinsp;\u0026plusmn;\u0026thinsp;66.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e325.45\u0026thinsp;\u0026plusmn;\u0026thinsp;60.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD. mMRC: Modified Medical Research Council, O₂: Oxygen, *: Significant as P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eInterstitial lung diseases incorporate a diverse array of conditions, marked by increasing dyspnoea, activity restriction, \u0026amp; diminished QOL, resulting in diffuse inflammation and/or fibrosis of the lung vasculature \u0026amp; parenchyma \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe classification of interstitial lung diseases is predicated on either known etiologies (such as inhaled agents, infections, medication, etc.) or unidentified causes (including sarcoidosis, asbestosis, idiopathic pulmonary fibrosis, \u0026amp; pneumonitis), particular illness entities, or distinct histological, radiological, or clinical patterns \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eBy revealing the result of high-resolution computed tomography, it was revealed that: 8 cases (13.3%) had Respiratory bronchiolitis-ILD, 30 patients (50%) had Idiopathic pulmonary fibrosis. 4 patients (6.7%) had Bronchiolitis obliterans organizing pneumonia. 4 patients (6.7%) had Connective tissue disease related ILD. 7 patients (11.7%) had Non-specific interstitial pneumonia, 4 patients (6.7%) had Unspecified, 3 patients (5%) had Sarcoidosis.\u003c/p\u003e\u003cp\u003eThese outcomes are consistent with previous reports Raghu et al., \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e which found IPF to be the most common subtype of ILD with the poorest prognosis and the greatest burden on physical functioning.\u003c/p\u003e\u003cp\u003eMore than half of the patients in our investigation had severe disease (\u0026gt;\u0026thinsp;50% parenchymal involvement), which emphasizes the need for early intervention with PR.\u003c/p\u003e\u003cp\u003eA relatively low incidence of PH in ILD patients has been reported in some studies, with rates between 8% \u0026amp; 15% at the time of initial diagnosis, particularly in early-stage IPF. \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e Kacprzak et al., \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAccording to ABG, Post-PR results demonstrated a significant increase in PaCO2 levels, likely due to improved alveolar ventilation efficiency \u0026amp; reduced respiratory muscle fatigue. While no significant change was seen in PaO2 or pH, the improved CO2 retention suggests better ventilation-perfusion matching.\u003c/p\u003e\u003cp\u003eThese results align with data from Spruit et al. \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, who found improved gas exchange \u0026amp; ventilatory efficiency post-PR in ILD.\u003c/p\u003e\u003cp\u003eIn the present research, PR result in significant improvements in pulmonary function tests (f), notably in forced critical capacity (FVC) while there is no statistically significant difference regarding FEV₁\u0026amp; FEV₁/FVC. \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eSimilarly, a systematic review \u0026amp; meta-analysis by Torres-S\u0026aacute;nchez et al. \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e demonstrated that PR interventions increased predicted FVC by approximately 5.47%, indicating a clinically relevant improvement in lung function among ILD patients.\u003c/p\u003e\u003cp\u003eConversely, Furthermore, a randomized controlled trial by Vainshelboim et al. \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e reported that while PR improved exercise capacity \u0026amp; QOL in ILD cases, it didn\u0026rsquo;t significantly alter lung function measures such as FVC or DLCO.\u003c/p\u003e\u003cp\u003eAs regarding QOL, our study revealed that PR result in a marked improvement in life quality, as evidenced by a statistically significant rise in MQOL scores. The mean score rose from 23.48\u0026thinsp;\u0026plusmn;\u0026thinsp;11.14 to 63.21\u0026thinsp;\u0026plusmn;\u0026thinsp;16.34 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eThis improvement is in line with the outcome of Torres-S\u0026aacute;nchez et al. \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, who conducted a meta-analysis \u0026amp; found a mean increase of 3.9 points in QoL among ILD patients after PR.\u003c/p\u003e\u003cp\u003eConversely, Fan et al. \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e noted substantial variability in QoL outcomes across ILD subtypes in their systematic review. The authors suggested that while PR may benefit QoL in certain ILD types, such as NSIP, the effect was less clear in rapidly progressive conditions like IPF, possibly due to irreversible disease burden.\u003c/p\u003e\u003cp\u003eAccording to depression scores HDRS, a significant decrease in depression scores (HDRS) was noted post- PR. This psychological benefit can be attributed to improved physical functioning, social engagement during group sessions, \u0026amp; enhanced autonomy.\u003c/p\u003e\u003cp\u003eThis in agreement with Shen et al. \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e, the research delineates the characteristics of pain as distinct from depression scores in cases with interstitial lung disease. A total of sixty-three subjects with ILD \u0026amp; sixty- three healthy controls have been enrolled. The stated average age of all participants was 62\u0026thinsp;\u0026plusmn;\u0026thinsp;9 years, while the average pack years among subjects with ILD was 16.68, significantly higher than the 4.2 years observed in healthy controls (P-value under 0.0001).\u003c/p\u003e\u003cp\u003eHowever, a technical review by Holland et al. \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e found only limited evidence supporting long-term psychological benefits of PR, especially in studies lacking specific psychological support components. They suggested that the inclusion of cognitive behavioral therapy or structured counseling may be required for sustained improvements.\u003c/p\u003e\u003cp\u003eIn our study, patients demonstrated a significant enhancement in dyspnea levels as assessed by the mMRC scale following PR.\u003c/p\u003e\u003cp\u003eThis improvement is in agreement with the outcomes of Kataoka et al. \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, who reported reduced mMRC scores after an 8-week PR program in cases having idiopathic pulmonary fibrosis.\u003c/p\u003e\u003cp\u003eHowever, Vainshelboim et al. \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e reported only modest changes in mMRC scores after PR in ILD patients, indicating that while PR may enhance exercise capacity, the perception of breathlessness can be influenced by other non-reversible disease factors such as fibrosis severity or baseline functional status.\u003c/p\u003e\u003cp\u003eConcerning six-minute Walk distance, the current investigation showed that a statistically significant variance has been observed with regard to Heart rate Post-test, O2 saturation Post-test \u0026amp; mMRC dyspnea scale Post-test, while there was no statistically significant variance regarding Heart rate pretest \u0026amp; O2 saturation pretest.\u003c/p\u003e\u003cp\u003eThe 6MWT distance significantly increased after PR, from a mean of 210.81\u0026thinsp;\u0026plusmn;\u0026thinsp;66.31 meters to 325.45\u0026thinsp;\u0026plusmn;\u0026thinsp;60.6 meters (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This increase reflects improved submaximal exercise capacity, better oxygen utilization, \u0026amp; enhanced muscle performance.\u003c/p\u003e\u003cp\u003eThis outcomes is consistent with Mendes et al., \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e found that the 6-min walk test (6MWT) is more commonly utilized to monitor progress of ILDs over time \u0026amp; during rehabilitation programs \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn contrast, Dowman et al. \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, in a Cochrane systematic review, reported that in patients with advanced ILD, PR did not consistently result in significant improvements in 6MWD. This could be attributed to the presence of limiting factors such as exercise-induced hypoxemia, muscular deconditioning, or irreversible lung impairment.\u003c/p\u003e\u003cp\u003eVO2peak (Aerobic Capacity):\u003c/p\u003e\u003cp\u003eIn our investigation, there was a statistically significant rise in VO2peak following PR that highlights improved cardiopulmonary fitness. Aerobic capacity enhancement reflects not only cardiac adaptation but also improved peripheral oxygen extraction.\u003c/p\u003e\u003cp\u003eAccording to Wickerson et al. \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, aerobic training can reverse exercise-induced desaturation \u0026amp; increase VO2peak in ILD patients, leading to improved tolerance to daily physical activity.\u003c/p\u003e\u003cp\u003eHowever, Dowman et al. \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, in a Cochrane review, concluded that while PR enhances functional capacity, it may not significantly impact VO₂ peak in all patients, particularly those with severe oxygen desaturation or advanced disease.\u003c/p\u003e\u003cp\u003eAs regarding Peripheral Muscle Strength, there were marked improvements in upper \u0026amp; lower limb strength (1RM and 20RM), reflecting the effectiveness of resistance training in the PR program.\u003c/p\u003e\u003cp\u003eJarosch et al. \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e further emphasized that peripheral muscle dysfunction is common in ILD \u0026amp; contributes to declined exercise capacity.\u003c/p\u003e\u003cp\u003eIn contrast, Ozalevli et al. \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e didn\u0026rsquo;t detect significant alteration in peripheral muscle strength in a cohort of ILD patients after PR. They hypothesized that advanced fibrosis \u0026amp; reduced oxygen delivery may blunt muscular adaptation, particularly in patients with severe disease\u003c/p\u003e\u003cp\u003eAccording to Respiratory Muscle Strength, significant improvements were observed in both maximal inspiratory pressure (Pimax) \u0026amp; maximal expiratory pressure (Pemax) after PR. This is attributed to the incorporation of respiratory muscle training (RMT), including diaphragmatic breathing \u0026amp; pursed-lip breathing exercises\u003c/p\u003e\u003cp\u003eMart\u0026iacute; et al. \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e found that adding inspiratory muscle training (IMT) to standard PR resulted in greater improvements in respiratory pressures.\u003c/p\u003e\u003cp\u003eConversely, Mochizuki et al. \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e found no significant gains in respiratory muscle strength in ILD cases who underwent conventional PR without specific IMT. This suggests that targeted respiratory training may be necessary to achieve optimal benefits in muscle strength.\u003c/p\u003e\u003cp\u003eA significant training influence has been seen, characterized by enhanced endurance time at 50-W exercise, sustained exercise VO2 throughout constant- load testing, a rise in treadmill MET-minutes, \u0026amp; improved respiratory muscular strength (MIP) following rehabilitation \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe strengths of the study were multidimensional assessment (physiological, functional, psychological), use of validated \u0026amp; objective tools (6MWT, spirometry, HDRS, MQOL), and focused PR protocol tailored to ILD patients.\u003c/p\u003e\u003cp\u003eWe recommended that future research should include meticulously prepared randomized controlled trials or extensive comparative observational research, inclusion a representative sample of cases with comparable gender, age, \u0026amp; illness severity, the MQOL (quality of life) score is the best measure, the sample size of future investigations must be large enough to give meaningful conclusions \u0026amp; to control for confounding factors, to accurately evaluate long-term results, investigation should have a longer follow-up duration, and future investigation must involve multicenter investigations to validate our findings.\u003c/p\u003e\u003cp\u003eLimitations: Lack of a control group, single-center study with limited sample size (n\u0026thinsp;=\u0026thinsp;60), short duration of follow-up; long-term outcomes remain unclear, lack of physiotherapist, lack of nutritionist, and lack of psychotherapist.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003ePR in cases having interstitial lung diseases demonstrated significant benefits by alleviating symptoms as dyspnea, enhancing QOL, psychological wellbeing, improving exercise capacity, aerobic capacity, respiratory mechanics, \u0026amp; muscle strength. Furthermore, the intervention was found to be safe and well-tolerated, supporting its use as an effective management strategy for ILD patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eFinancial support and sponsorship:\u003c/strong\u003e\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eNil\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConflict of Interest:\u003c/h2\u003e\u003cp\u003eNil\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e1 and 1* wrote the main manuscript text and 2 prepared figures. all authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eI dedicated doctor Zeinab Abdelrady Abdellatef for helping us in the quality of life questionnaire and Hamilton depression rating scale\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSkeoch S, Weatherley N, Swift AJ, Oldroyd A, Johns C, Hayton C, et al. Drug-Induced Interstitial Lung Disease: A Systematic Review. J Clin Med. 2018;7.\u003c/li\u003e\n\u003cli\u003eMartinez FJ, Collard HR, Pardo A, Raghu G, Richeldi L, Selman M, et al. Idiopathic pulmonary fibrosis. Nat Rev Dis Primers. 2017;3:17074.\u003c/li\u003e\n\u003cli\u003eWijsenbeek M, Kreuter M, Olson A, Fischer A, Bendstrup E, Wells CD, et al. Progressive fibrosing interstitial lung diseases: current practice in diagnosis and management. Curr Med Res Opin. 2019;35:2015-24.\u003c/li\u003e\n\u003cli\u003eDowman L, Hill CJ, May A, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev. 2021;2:Cd006322.\u003c/li\u003e\n\u003cli\u003eSingh S, Sharma BB, Bairwa M, Gothi D, Desai U, Joshi JM, et al. Management of interstitial lung diseases: A consensus statement of the Indian Chest Society (ICS) and National College of Chest Physicians (NCCP). Lung India. 2020;37:359-78.\u003c/li\u003e\n\u003cli\u003eElganady AA, El Hoshy MS, Eshmawey HA, Mohamed MM. Value of pulmonary rehabilitation in interstitial lung diseases. Egypt J Chest Dis Tuberc. 2020;69.\u003c/li\u003e\n\u003cli\u003eAntoine MH, Mlika M. Interstitial lung disease. StatPearls [internet]: StatPearls Publishing; 2023.\u003c/li\u003e\n\u003cli\u003eAlthobiani MA, Russell AM, Jacob J, Ranjan Y, Folarin AA, Hurst JR, et al. Interstitial lung disease: a review of classification, etiology, epidemiology, clinical diagnosis, pharmacological and non-pharmacological treatment. Front Med (Lausanne). 2024;11:1296890.\u003c/li\u003e\n\u003cli\u003eRaghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, et al. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2018;198:e44-e68.\u003c/li\u003e\n\u003cli\u003eGali\u0026egrave; N, Palazzini M, Manes A. Confirmation of survival prediction based on 2022 ESC/ERS pulmonary hypertension guidelines new haemodynamic thresholds. Eur Heart J. 2023;44:4692-5.\u003c/li\u003e\n\u003cli\u003eKacprzak A, Tomkowski W, Szturmowicz M. Pulmonary Hypertension in the Course of Interstitial Lung Diseases-A Personalised Approach Is Needed to Identify a Dominant Cause and Provide an Effective Therapy. Diagnostics (Basel). 2023;13.\u003c/li\u003e\n\u003cli\u003eSpruit MA, Singh SJ, 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:e13-64.\u003c/li\u003e\n\u003cli\u003eTorres S\u0026aacute;nchez I, Meg\u0026iacute;as Salmer\u0026oacute;n Y, L\u0026oacute;pez L\u0026oacute;pez L, Ortiz Rubio A, Rodr\u0026iacute;guez Torres J, Valenza MC. Videogames in the Treatment of Obstructive Respiratory Diseases: A Systematic Review. Games Health J. 2019;8:237-49.\u003c/li\u003e\n\u003cli\u003eVainshelboim B, Myers J. Resistance Training for Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis. Transl Med Exerc Prescr. 2021:62-9.\u003c/li\u003e\n\u003cli\u003eFan J, Chang Y, Cheng S, Liang B, Qu D. Effect of breathing exercises on patients with interstitial lung disease: A systematic review and meta-analysis. Qual Life Res. 2024;33:2335-47.\u003c/li\u003e\n\u003cli\u003eShen Q, Guo T, Song M, Guo W, Zhang Y, Duan W, et al. Pain is a common problem in patients with ILD. Respir Res. 2020;21:297.\u003c/li\u003e\n\u003cli\u003eHolland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44:1428-46.\u003c/li\u003e\n\u003cli\u003eKataoka 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;78:784-91.\u003c/li\u003e\n\u003cli\u003eVainshelboim B, Fox BD, Oliveira J, Kramer MR. Exercise training in idiopathic pulmonary fibrosis. Expert Rev Respir Med. 2016;10:69-77.\u003c/li\u003e\n\u003cli\u003eMendes RG, Castello-Sim\u0026otilde;es V, Trimer R, Garcia-Ara\u0026uacute;jo AS, Gon\u0026ccedil;alves Da Silva AL, Dixit S, et al. Exercise-Based Pulmonary Rehabilitation for Interstitial Lung Diseases: A Review of Components, Prescription, Efficacy, and Safety. Front Rehabil Sci. 2021;2:744102.\u003c/li\u003e\n\u003cli\u003eEaton LG, Doherty KL, Widrick RM. A review of research and methods used to establish art therapy as an effective treatment method for traumatized children. The Arts in Psychotherapy. 2007;34:256-62.\u003c/li\u003e\n\u003cli\u003eDowman LM, McDonald CF, Hill CJ, Lee AL, Barker K, Boote C, et al. The evidence of benefits of exercise training in interstitial lung disease: a randomised controlled trial. Thorax. 2017;72:610-9.\u003c/li\u003e\n\u003cli\u003eWickerson LM. Oxygenation during Exercise in Individuals with Interstitial Lung Disease: University of Toronto (Canada); 2019.\u003c/li\u003e\n\u003cli\u003eJarosch 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.\u003c/li\u003e\n\u003cli\u003eOzalevli S, Karaali HK, Ilgin D, Ucan ES. Effect of home-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Multidiscip Respir Med. 2010;5:31-7.\u003c/li\u003e\n\u003cli\u003eMart\u0026iacute; JD, McWilliams D, Gimeno-Santos E. Physical Therapy and Rehabilitation in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit. Semin Respir Crit Care Med. 2020;41:886-98.\u003c/li\u003e\n\u003cli\u003eMochizuki T, Yano K, Ikari K, Okazaki K. Effectiveness of locomotion training in patients with rheumatoid arthritis: a prospective clinical trial. J Phys Ther Sci. 2023;35:810-6.\u003c/li\u003e\n\u003cli\u003eLaveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, et al. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J. 2019;53. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-bronchology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Bronchology](https://ejb.springeropen.com/)","snPcode":"43168","submissionUrl":"https://submission.nature.com/new-submission/43168/3","title":"The Egyptian Journal of Bronchology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pulmonary Rehabilitation, Peripheral Muscle Strength, Indurance, Interstitial Lung Diseases","lastPublishedDoi":"10.21203/rs.3.rs-7595287/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7595287/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe treatment of Interstitial Lung Disease (ILD) typically adheres to a sequence of therapeutic protocols \u0026amp; according to assessment procedures. Efforts must focus on symptom alleviation, including incorporating treatments like pulmonary rehabilitation (PR) \u0026amp; psychosocial support to enhance case wellbeing. We aimed to determine whether PR in interstitial lung diseases cases has an advantageous influence on symptoms, exercise capacity, \u0026amp; quality of life (QOL).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis Cross-sectional analytic research was done on 60 ILD patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years old, in both sexes. All patients were subjected to complete history taking, McGill QOL Questionnaire, Hamilton Depression Rating Scale, dyspnea assessment using the modified Medical Research Council scale, BMI, six-minute walk test, spirometry, oxygen saturation and ABG, echocardiography, and high-resolution CT chest. Participants underwent a supervised PR program (2 sessions/week for 8 weeks) following ATS/ERS guidelines, including: Health education (20 minutes) [Medication education, exacerbation review, and rehabilitation importance], exercise training [Warm-up (5\u0026ndash;10 min), endurance training, resistance training, respiratory muscle training, and cool-down (5\u0026ndash;10 min)], and evaluation of peripheral and respiratory muscle strength.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSpirometry results showed a significant increase in FVC (p\u0026thinsp;=\u0026thinsp;0.04), indicating improved lung capacity. Psychological well-being, as measured by the Hamilton Depression Rating Scale (HDRS), improved significantly, with scores decreasing (p\u0026thinsp;=\u0026thinsp;0.004). Additionally, the MQOL total score increased markedly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reflecting a significant enhancement in perceived quality of life. The categorical distribution of MQOL also showed significant improvement (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). According to comparison between pre- and post- program, there was statistically significant difference regarding mMRC dyspnea scale Pre \u0026amp; Post-test, Heart rate Pre \u0026amp; Post-test, \u0026amp;O2 saturation Pre \u0026amp; Post-test (P\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003ePR in cases with interstitial lung diseases demonstrated significant benefits by alleviating symptoms such as dyspnea, enhancing QOL, psychological wellbeing, improving exercise capacity, aerobic capacity, respiratory mechanics, \u0026amp; muscle strength.\u003c/p\u003e","manuscriptTitle":"Effect of Pulmonary Rehabilitation on Patients with Interstitial Lung Disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-01 14:52:01","doi":"10.21203/rs.3.rs-7595287/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-28T20:36:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-27T13:06:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87292693295291585378200380344461195809","date":"2025-10-18T22:04:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-28T18:09:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162629535973446748714593912640137722064","date":"2025-09-19T15:35:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-19T15:24:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T04:22:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-15T13:25:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Bronchology","date":"2025-09-12T00:11:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-bronchology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Bronchology](https://ejb.springeropen.com/)","snPcode":"43168","submissionUrl":"https://submission.nature.com/new-submission/43168/3","title":"The Egyptian Journal of Bronchology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1b3b724a-ba01-422d-9569-e466ed9bc179","owner":[],"postedDate":"October 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-20T05:53:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-01 14:52:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7595287","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7595287","identity":"rs-7595287","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}