Utilisation of cardiopulmonary exercise testing for tailored pulmonary rehabilitation in people with interstitial lung diseases: A systematic review.

The review included only 11 studies with 321 participants, and the studies used different designs, interstitial lung disease subtypes, interventions and outcome reporting. Four studies had no control group, and the control groups that were used varied, including usual medical management, matched people without interstitial lung disease, and study dropouts. The authors did not pool the results or rate the certainty of evidence because the studies were too heterogeneous. Quality appraisal found gaps: five cohort studies had inadequate follow-up, two had inaccurate exposure or outcome measurement, and two randomised trials had inadequate methodology. Exercise reporting was incomplete: baseline exercise experience was not described in 10 studies, motivational strategies in 7 studies, and non-exercise components in 5 studies. The tests were not confirmed as true maximal efforts in any study, so 'maximal oxygen uptake' may reflect the authors' interpretation rather than a verified maximum. The programmes combined several treatments, so any improvement cannot be credited to cardiopulmonary exercise test-based prescription alone. Only English full-text articles were searched, and no grey literature, theses or dissertations were included. The included studies were selected for cardiopulmonary exercise test outcomes, not for patient-reported function or quality of life.

The study was funded by the National Institute for Health and Care Research and the Exeter Biomedical Research Centre. The authors state the funder had no role in the design. The authors declared no potential conflicts of interest.

Do not read the improvements in exercise test measures as proof that cardiopulmonary exercise test-based pulmonary rehabilitation works for people with interstitial lung disease. Four studies had no control group, the programmes combined several treatments, and the review could not combine the results because the studies were too different.