Roy, M.J.

Abstract Rationale: Patients with fibrotic interstitial lung (f-ILD) disease often have decreased physical activity (PA) due to high symptom burden, with shortness of breath, cough, anxiety, and fatigue affecting health-related quality of life (HR-QOL). Previously undiagnosed anxiety and depression has been described in f-ILD though contributing factors remain unknown. We hypothesize that significant rates of disease-related anxiety and depression may be detected but not persist, representing situational or short-term responses to disease burden. We also hypothesize that real-world PA is an important contributor to or reflection of HR-QOL and associated with selected patient-reported outcome measures (PROMs). Methods: This was a single-center prospective observational cohort enrolling adult patients with established f-ILD. PROM questionnaires were sent electronically to patients at study enrollment and 3 months. These included the Modified Medical Research Council (mMRC), Fatigue Severity Scale (FSS), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Self-Management Ability Scale-30 (SMAS-30), and abbreviated Prolife of Mood States (POMS). PA was defined as mean number of steps per day over a 7-day period as measured by at-home Actigraphy, obtained at enrollment and 3 months (within 2 weeks of completing PROM questionnaires). Results: Forty five patients were included (mean age 69, female 49 %, non-IPF f-ILD 78%, mean forced vital capacity 77%). Baseline GAD-7 anxiety scores were ‘moderate’ in 45% and ‘severe’ in 5%. PHQ-9 depression scores were ‘moderately severe’ in 30% and ‘severe’ in 5%. Mean GAD-7 and PHQ scores were no different at baseline and three months (GAD7 10.18 vs 10, P = 0.653; PHQ-9 12.82 vs 13.32, P = 0.294). mMRC, FSS, and SMAS-30 scores were associated with daily step activity. A one-point increase in mMRC or FSS (greater dyspnea or fatigue) was associated with a decrease in daily steps of 1400 [CI: (-2000, -600), ] or 90 steps [CI: (-160, -15))], respectively. A one-point increase in SMAS-30 (greater self-management) was associated with an increase of 108 steps per day [CI: (25, 190-0.38) ]. Anxiety, depression, and mood did not appear to be associated with step activity GAD-7-4.5 (P = 0.982), PHQ-9-211.5 (P = 0.13), POMS -36.5 (P = 0.096). Conclusions: Clinical symptoms of anxiety and depression are prevalent in patients with f-ILD and do not appear diminished or improved in the short term. Dyspnea, fatigue, and self-management ability are associated with real-world measures of physical activity.