Pulmonary rehabilitation (PR) may improve anxiety in patients with idiopathic pulmonary fibrosis (IPF) and depression in patients with sarcoidosis, according to systematic review findings published in Respiratory Medicine.
Because research shows that PR has alleviated anxiety and depression symptoms in patients with chronic obstructive pulmonary disease (COPD), researchers sought to assess the effect of PR on symptoms of anxiety and depression in patients with interstitial lung disease (ILD).
For their systematic review, the researchers performed a search in the MEDLINE, EMBASE, Cochrane, and PsycINFO databases on April 3, 2023, for relevant randomized controlled trials. Primary outcomes were anxiety or depression symptom scores and all-cause discontinuation.
The review included 5 studies (4 from Europe) published from 2016 to 2021. The most frequently reported ILD was IPF (60%) in the studies, which all used aerobic- and strength-based PR. Control protocols mostly involved routine medical care. The studies included 281 patients (mean age, 63.1 years; 39.8% female), with 54.8% randomly assigned to a PR intervention.
Among patients with IPF, depression and anxiety were evaluated in 3 studies (n=115). In 1 study, the authors reported nonstatistically significant differences in anxiety per the Hospital Anxiety and Depression Scale (HADS) at 15 weeks with PR, and patients with clinically significant baseline anxiety symptoms had clinically significant improvement. The second study found that the prevalence of clinically significant anxiety decreased at 9 weeks in the PR group but returned at 6 months. The third study found that differences in score changes between the 2 treatment groups were not clinically significant.
Nonstatistically significant differences in depression per HADS were reported at 15 weeks in the PR group in 1 study of patients with IPF; these changes were clinically significant in those with COPD. Another study reported that the prevalence of clinically significant depression increased at 9 weeks and at 6 months in the PR group.
Depression and anxiety were assessed in 2 studies (n=56) in patients with sarcoidosis. In 1 study, the PR group had clinically significantly increased anxiety scores at 6 months but not 12 months in the borderline anxiety range. Another study found that the PR group had statistically significant within-group and between-group decreases in HADS anxiety scores vs the control group at 12 weeks, but they were not clinically significant.
Regarding depression in patients with sarcoidosis, 1 study reported clinically but not statistically significant improvement in depressive symptoms in the PR group at 6 and 12 months vs the control group. The second study found that the PR group had clinically significant improvement in median HADS depression scores but not statistically significant decreases vs the control group.
Among several limitations, methodologic heterogeneity precluded formal meta-analyses, and the small number of studies with low sample sizes and low levels of clinically significant anxiety and depression limited the ability to identify meaningful changes from PR. Also, all studies had a high risk of bias.
“Although studies were not powered to detect statistically-significant changes, we observed clinically significant improvements for anxiety in IPF, and for depression in stage III-IV sarcoidosis,” said review authors. “Our review suggests that PR may improve symptoms of anxiety in IPF and depression in sarcoidosis, with low dropout rates suggesting it is a safe intervention,” concluded the investigators.
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Luu B, Gupta A, Fabiano N, et al. Influence of pulmonary rehabilitation on symptoms of anxiety and depression in interstitial lung disease: a systematic review of randomized controlled trials. Respir Med. Published online October 19, 2023. doi:10.1016/j.rmed.2023.107433
This article originally appeared on Pulmonology Advisor