Unsupervised Exercise in Interstitial Lung Disease: A Delphi Study to Develop a Consensus Preparticipation Screening...

Area of Science:

• Pulmonary Medicine
• Exercise Physiology
• Rehabilitation

Background:

• Limited guidance exists for healthcare providers on exercise preparticipation screening for interstitial lung diseases (ILDs), specifically lymphangioleiomyomatosis (LAM).
• Patients with LAM often face challenges in safely participating in remote, unsupervised exercise programs.

Purpose of the Study:

• To establish essential exercise preparticipation screening steps for patients with LAM.
• To determine medical appropriateness for remote, unsupervised exercise programs in LAM patients.

Main Methods:

• A modified Delphi study involving 16 LAM and ILD experts was conducted in two rounds.
• Experts ranked agreement on statements regarding unsupervised exercise training in LAM.
• A survey assessed perceived risks and benefits of remote exercise training among 60 LAM patients.

Main Results:

• Consensus was reached on 7 out of 10 statements regarding exercise screening for LAM.
• An in-person clinical exercise test is recommended to screen for exercise-induced hypoxemia and guide oxygen therapy.
• Patients with recent pneumothorax, high cardiovascular risk, severe pulmonary hypertension, or fall risk require specific considerations or referral.

Conclusions:

• A modified Delphi study effectively developed disease-specific recommendations for safe preparticipation screening for remote exercise in LAM.
• A LAM-specific screening tool was created as a clinical decision aid for providers.
• These recommendations support the safe initiation of the LAMFit remote exercise program.