Roy, M.

Abstract Rationale: Fibrotic interstitial lung diseases (f-ILDs) often lead to increased dyspnea and decreased physical activity, negatively impacting patient quality of life. While center-based pulmonary rehabilitation (PR) provides known benefits, access and adherence may be limited. This study investigates the implementation of a home-based pulmonary rehabilitation program with telephonic health coaching to improve physical activity and respiratory-related quality of life (RR-QOL) over 12 weeks. Methods: This prospective, single-center, non-randomized study enrolled patients with various f-ILD subtypes and severities over two years. Participants engaged in video-based exercises (25 minutes/day, 6 days per week) with weekly telephonic health coaching. Primary outcomes included changes in average daily steps, dyspnea (modified Medical Research Council (mMRC)), and self-reported RR-QOL (Chronic Respiratory Questionnaire (CRQ)- Physical and Emotional Summary domain scores). Minimal Clinically Important Differences (MCID) for study endpoints were defined as ≥600 steps per day, 1-point change in mMRC, and 0.5-point change in CRQ Physical and Emotional Summary scores, used to stratify patient responses to intervention as improved, stable, or worsened. Pre- and post-intervention summary results were compared using paired two-sample t-tests. The percentage of patients reaching MCID thresholds for improvement in primary endpoints was also reported. Results: 88 patients completed the program (mean age 70.2 years, 54% male, and mean FVC 66.9%). Mean CRQ Physical Summary scores improved from baseline 4.09 to 4.35 (mean improvement of 0.26 with 95% CI [0.06, 0.46]). 35% of patients achieved MCID change in the CRQ Physical Summary score, 34% in the CRQ Emotional score, and 22% in mMRC. Although 24% of patients increased their daily steps by 600 or more, average daily steps declined from 7,594 to 7,103 (mean decrease of 492 with 95% CI [101, 883]). When stratified by outcome responses to intervention (improved, stable, or worsened), lower baseline DLCO% was associated with decreased CRQ Physical Summary Scores and daily steps. Conclusion: Home-based PR may improve self-reported quality of life in f-ILD patients, as evidenced by improved CRQ Physical Summary scores. DLCO% may be associated with poorer response to PR intervention, as lower values were associated with declines in CRQ Physical Summary scores and daily steps. These findings support the potential utility of home-based rehabilitation and customizing individual strategies according to baseline characteristics and background disease progression.