• Claire E Child, Lawrence A Ho, Daniel Lachant, Nishant Gupta, Joel Moss, Amanda Jones, Rachana Krishna, Anne E Holland, MeiLan K Han, Cormac McCarthy, Ali Ataya, Misbah Baqir, Daniel F Dilling, Jeff Swigris, Erik R Swenson, and Mary Beth Brown.
• Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle, WA.
• Chest. 2024 Nov 1; 166 (5): 110811231108-1123.

BackgroundLittle research is available to provide practical guidance to health care providers for exercise preparticipation screening and referral of patients with interstitial lung diseases (ILDs), including lymphangioleiomyomatosis (LAM), to participate in remote, unsupervised exercise programs.Research QuestionWhat exercise preparticipation screening steps are essential to determine whether a patient with LAM is medically appropriate to participate in a remote, unsupervised exercise program?Study Design And MethodsSixteen experts in LAM and ILD participated in a two-round modified Delphi study, ranking their level of agreement for 10 statements related to unsupervised exercise training in LAM, with an a priori definition of consensus. Additionally, 60 patients with LAM completed a survey of the perceived risks and benefits of remote exercise training in LAM.ResultsSeven of the 10 statements reached consensus among experts. Experts agreed that an in-person clinical exercise test is indicated to screen for exercise-induced hypoxemia and prescribe supplemental oxygen therapy as indicated prior to initiating a remote exercise program. Patients with recent pneumothorax should wait to start an exercise program for at least 4 weeks until after resolution of pneumothorax and clearance by a physician. Patients with high cardiovascular risk for event during exercise, severe resting pulmonary hypertension, or risk for falls may be more appropriate for referral to a rehabilitation center. A LAM-specific remote exercise preparticipation screening tool was developed from the consensus statements and agreed upon by the panelists.InterpretationA modified Delphi study approach was useful to develop disease-specific recommendations for safety and preparticipation screening prior to unsupervised, remotely administered exercise in LAM. The primary product of this study is a clinical decision aid for providers to use when medically screening patients prior to participation in the newly launched LAMFit remote exercise program.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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