Comparative efficacy of different types of structured exercise interventions for idiopathic pulmonary fibrosis: a...

Exercise interventions have demonstrated favorable effects for patients with idiopathic pulmonary fibrosis, but the optimal exercise regimen remains unclear. To address this, we conducted a meta-analysis.

Investigate the effects of different types of structured exercise interventions on patients with idiopathic pulmonary fibrosis and evaluate the quality of evidence for study outcomes using the GRADE system.

Search databases including PubMed, Embase, Web of Science, The Cochrane Library, and Scopus to collect randomized controlled trials (RCTs) on exercise interventions for idiopathic pulmonary fibrosis published from the inception of each database through December 2025. Analyses were performed using RevMan5.4.1and R4.4.2 software.

A total of 11 studies involving 503 patients were included. Meta-analysis results showed that exercise interventions significantly improved the 6-min walk distance (MD = 38.62 m, 95% CI: [25.72, 51.51], P < 0.00001) in exercise endurance, with mind-body integrated training showing potentially greater benefit. Regarding pulmonary function, mind-body integrated training significantly improved forced vital capacity (SMD = 0.76, 95% CI: [0.32, 1.20], P = 0.0008) and carbon monoxide diffusion capacity (SMD = 0.76, 95% CI: [0.42, 1.10], P < 0.0001). In contrast, structured multi-component training did not demonstrate consistent benefits across all pulmonary function measures. Regarding quality of life, mind-body integrated training demonstrated significant improvements across all dimensions and the total score of the St. George's Respiratory Questionnaire, showing comprehensive efficacy; structured training proved effective only in certain dimensions. For dyspnea symptoms, mind-body integrated training exhibited significant improvement (SMD = -0.63, 95% CI: [-1.00, -0.27], P = 0.0006), whereas the effect of structured training was unclear and highly heterogeneous. Neither training approach demonstrated significant benefits for health status or psychological emotion wellbeing. Safety analysis was limited by incomplete adverse event reporting across studies; only one study provided detailed safety data, which showed no significant increase in adverse event risk with supervised exercise. GRADE evidence quality assessment revealed moderate-quality evidence for measures such as 6-min walk distance and carbon monoxide diffusion capacity, while most pulmonary function and quality of life indicators had low-quality evidence.

Structured exercise interventions, including mind-body integrated training, can improve exercise endurance, selected pulmonary function measures, quality of life, and dyspnea symptoms in patients with idiopathic pulmonary fibrosis, but No firm conclusion on overall safety could be drawn. However, the evidence strength for most outcomes remains limited due to the risk of bias and heterogeneity in existing studies. Future high-quality research is needed to further validate the long-term benefits of different exercise modalities.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251253143, CRD420251253143.