The NIH Exercise Therapy for Advanced Lung Disease Trials: Response and Adaptation to Aerobic Exercise in Patients With Interstitial Lung Disease
Interstitial lung disease (ILD) is the result of over 200 etiological pathways arising from several different insults to the lung parenchyma: inhaled substances, drug side effects, connective tissue disease, infection, and malignancy. The disease can also be of idiopathic origin. If prolonged, the resulting inflammation causes permanent and progressive fibrotic reorganization of the parenchyma and small airways, which reduces the distensibility of the lung and impedes O2 and CO2 exchange.
This study is a randomized controlled trial to determine the safety and efficacy of aerobic exercise for patients who have interstitial lung disease (ILD) uncomplicated by pulmonary hypertension. In an uncontrolled study, we observed more efficient cardiorespiratory function, increased physical work capacity, and improved health-related quality of life following aerobic exercise in this study population. Serious adverse events resulting from aerobic exercise training were not observed and our work to date has established plausibility for the efficacy of aerobic exercise training and its safety for patients with ILD.
|Interstitial Lung Disease Idiopathic Pulmonary Fibrosis Interstitial Pneumonitis Desquamative Interstitial Pneumonia||Other: Aerobic Exercise Training Other: Education||Phase 2|
|Study Design:||Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Official Title:||The NIH Exercise Therapy for Advanced Lung Disease Trials: Response and Adaptation to Aerobic Exercise in Patients With Interstitial Lung Disease|
- 6MWT distance (most frequently used measured of physical performance for evaluating patients with ILD and other advanced lung diseases). [ Time Frame: 0 weeks and after 10 weekds of exercise training ]
- Peak work rate on a treadmill cardiopulmonary exercise test and performance and perceived fatigability. [ Time Frame: 0 weeks, after 10 weeks of exercise training In Group 1, and after 10 weeks of education in Group 2 ]
- Cardiorespiratory capacity, including AT-time and muscle oxygenation capacity. [ Time Frame: 0 weeks, after 10 weeks of exercise training In Group 1, and after 10 weeks of education in Group 2 ]
- Fatigue severity, participation in physical activities, health-related quality of life scores, and changes in mood. [ Time Frame: 0 weeks, after 10 weeks of exercise training In Group 1, and after 10 weeks of education in Group 2 ]
- Frequency and type of exercise continued after study participation; rate of hospitalization; acceptance onto lung transplant lists; and patient mortality. Participates will be followed monthly over one year after completion of exercise. [ Time Frame: 1 month post training and monthly up to 12 months post training ]
|Study Start Date:||November 26, 2013|
|Estimated Study Completion Date:||December 31, 2021|
|Estimated Primary Completion Date:||December 31, 2020 (Final data collection date for primary outcome measure)|
Active Comparator: Group 1
10 weeks of education and exercisse concurrently
|Other: Aerobic Exercise Training Other: Education|
Active Comparator: Group 2
10 weeks of education followed by 10 weeks of exercise
|Other: Aerobic Exercise Training Other: Education|
There are two primary treatment conditions. Patients with ILD are be randomized to either an intervention consisting of aerobic exercise training plus patient education or a control condition that includes patient education only. Aerobic exercise training will consist of a 10-week regimen of supervised treadmill walking three times a week. The duration of the exercise sessions will progress from 30 minutes to 45 minutes per session over the 10 weeks, as tolerated. The intensity of the exercise will be determined based on results of a cardiopulmonary exercise test. Those randomized to control will not initially engage in aerobic exercise training. There will, however, be a secondary study: a crossover design in which subjects in the control group will complete the aerobic exercise regimen.
- Participants must be between the ages of 21 and 80 and live within a reasonable travel distance from the greater Washington D.C. area
- All pre and post testing will be conducted at the NIH Clinical Center in Bethesda, Maryland. Each testing session will last about 6 hours and will consist of a medical history and examination; six questionnaires on health, fatigue, activity, and mood; electrocardiogram, transthoracic echocardiogram, pulmonary function tests, six-minute walk test (6MWT); and urine pregnancy test (if applicable). Other required tests are:
- A maximum treadmill test: The exercise begins at an easy level and gradually increases until the participant says he or she can no longer continue or the investigator decides it is not safe to continue. Participants are fitted with a mask, electrodes and light sensors to measure how well the heart is working and how well the muscles use oxygen.
- An arterial occlusion muscle oxygenation capacity test:: During seated rest, a light sensor that measures the oxygen level in the muscle is placed on the calf while a pressure cuff will then be placed around the thigh. The cuff is rapidly inflated and held at a high pressure for up to 10 minutes and then deflated.
- A blood sample for complete blood count and Nt-ProBNP (a hormone that indicates damage to heart muscle).
- Aerobic exercise training and education may take place at either the NIH Clinical Center in Bethesda, Maryland, or the Pulmonary Rehabilitation Program at INOVA Fairfax Hospital in Falls Church, Virginia.
Please refer to this study by its ClinicalTrials.gov identifier: NCT02019641
|Contact: Anne B Quinn, C.R.N.P.||(301) firstname.lastname@example.org|
|Contact: Leighton Chan, M.D.||(301) email@example.com|
|United States, Maryland|
|National Institutes of Health Clinical Center, 9000 Rockville Pike||Recruiting|
|Bethesda, Maryland, United States, 20892|
|Contact: For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL) 800-411-1222 ext TTY8664111010 firstname.lastname@example.org|
|United States, Virginia|
|INOVA Fairfax Hospital||Recruiting|
|Falls Church, Virginia, United States, 22042|
|Principal Investigator:||Leighton Chan, M.D.||National Institutes of Health Clinical Center (CC)|