Rehabilitation in non-COPD: mechanisms of exercise limitation and pulmonary rehabilitation for patients with pulmonary fibrosis/restrictive lung disease.

The standard of care in the treatment of chronic lung disease includes pulmonary rehabilitation (PR). While evidence of the effectiveness of PR in chronic obstructive lung disease (COPD) is robust, that for pulmonary fibrosis and other non-fibrotic restrictive lung diseases is less extensive. However, PR has been shown to improve functional exercise capacity and health-related quality of life in non-COPD patients, primarily those with interstitial lung diseases. This review examines mechanisms of exercise limitation in non-COPD patients and discusses how they might affect both the application of and outcome measures of PR. We also review the assessment of exercise performance, dyspnea, and quality of life as well as special protocols, safety considerations, and special techniques in PR as applied to patients with pulmonary fibrosis or restrictive lung disease. At present, there are no evidence-based guidelines for PR in non-COPD patients whereas PR is firmly recommended in COPD management. More research is needed to strengthen the evidence for the use of PR in non-COPD patients. Meanwhile, the available data, summarized in this review, support the inclusion of PR in the management of all patients with chronic lung disease including pulmonary fibrosis and restrictive lung disease.