• Leona M Dowman, Baruch Vainshelboim, and Anne E Holland.
• Respiratory Research@Alfred, Central Clinical School, Monash University, VIC, Australia; Institute for Breathing and Sleep, VIC, Australia; Department of Respiratory and Sleep Medicine, Austin Health, VIC, Australia; Department of Physiotherapy, Austin Health, VIC, Australia. Electronic address: Leona.dowman@monash.edu.
• Chest. 2025 Jan 11.

BackgroundPulmonary rehabilitation (PR) is a beneficial intervention for people with interstitial lung disease (ILD), however the effect of PR on survival is unclear. This study compared the survival outcomes in people with ILD who were allocated to PR versus those who were allocated to control in two published randomised controlled trials (RCTs).Research QuestionDoes participation in PR impact survival among people with ILD?Study Design And MethodsThe combined data from the two previous RCTs of PR in ILD were included. Time from start of PR until date of death, lung transplantation or censoring was calculated. Kaplan-Meir and Cox proportional hazard regression analysis were used to assess the impact of PR on survival. Baseline variables of age at time of PR, gender, FVC, 6-minute walk distance (6MWD), exertional nadir SpO2 and diagnosis of idiopathic pulmonary fibrosis (IPF) were included as covariates.ResultsOf the 182 participants with ILD (87 IPF, 109 males, mean (SD) age 69(10), FVC%pred 76(19), TLCO%pred 48(16)), death occurred in 62%, 6% were transplanted, 20% were alive and 12% were lost to follow-up. Median survival for those who completed PR was 6.1 years (95% CI 4.4 to 7.9) compared to 4.7 years (95%CI 3.4 to 6.0) for those in the control group, however this was not significantly different (log rank p=0.7). After adjusting for baseline variables, at 5 years, completion of PR was associated a 44% lower risk of mortality (HR 0.56 (0.36-0.88), p=0.01). At 10 years, no difference in survival was observed between the PR and control group.InterpretationParticipation in PR among people with ILD may impact survival at 5 years. Along with clinical improvements following PR, the potential for a survival benefit further strengthens the importance of PR in the standard care of people with ILD.Copyright © 2025. Published by Elsevier Inc.

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