Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle, WA.
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA.
Chest. 2024 Nov;166(5):1108-1123. doi: 10.1016/j.chest.2024.06.3803. Epub 2024 Jul 16.
Little research is available to provide practical guidance to health care providers for exercise preparticipation screening and referral of patients with interstitial lung diseases (ILDs), including lymphangioleiomyomatosis (LAM), to participate in remote, unsupervised exercise programs.
What exercise preparticipation screening steps are essential to determine whether a patient with LAM is medically appropriate to participate in a remote, unsupervised exercise program?
Sixteen experts in LAM and ILD participated in a two-round modified Delphi study, ranking their level of agreement for 10 statements related to unsupervised exercise training in LAM, with an a priori definition of consensus. Additionally, 60 patients with LAM completed a survey of the perceived risks and benefits of remote exercise training in LAM.
Seven of the 10 statements reached consensus among experts. Experts agreed that an in-person clinical exercise test is indicated to screen for exercise-induced hypoxemia and prescribe supplemental oxygen therapy as indicated prior to initiating a remote exercise program. Patients with recent pneumothorax should wait to start an exercise program for at least 4 weeks until after resolution of pneumothorax and clearance by a physician. Patients with high cardiovascular risk for event during exercise, severe resting pulmonary hypertension, or risk for falls may be more appropriate for referral to a rehabilitation center. A LAM-specific remote exercise preparticipation screening tool was developed from the consensus statements and agreed upon by the panelists.
A modified Delphi study approach was useful to develop disease-specific recommendations for safety and preparticipation screening prior to unsupervised, remotely administered exercise in LAM. The primary product of this study is a clinical decision aid for providers to use when medically screening patients prior to participation in the newly launched LAMFit remote exercise program.
几乎没有研究为医疗保健提供者提供实践指导，以对患有间质性肺疾病（ILD）的患者，包括淋巴管平滑肌瘤病（LAM）进行运动预参与筛查和转诊，以便参与远程、非监督的运动项目。
确定 LAM 患者是否适合参加远程、非监督的运动项目，需要进行哪些运动预参与筛查步骤？
16 名 LAM 和ILD 专家参与了两轮改良 Delphi 研究，对与 LAM 非监督运动训练相关的 10 个陈述进行了他们的一致性程度的排名，并有事先定义的共识。此外，60 名 LAM 患者完成了一份关于远程运动训练在 LAM 中的风险和益处的调查。
专家们对 10 个陈述中的 7 个达成了共识。专家们一致认为，应进行面对面的临床运动测试，以筛查运动诱导性低氧血症，并在开始远程运动计划之前根据需要开具补充氧气治疗。最近发生气胸的患者应至少等待 4 周，直到气胸解决并经医生批准后再开始运动计划。对于运动中发生心血管事件风险高、严重静息肺动脉高压或有跌倒风险的患者，可能更适合转诊到康复中心。从共识陈述中开发了一个专门针对 LAM 的远程运动预参与筛查工具，并得到了小组成员的认可。
改良 Delphi 研究方法可用于制定特定疾病的建议，以确保在 LAM 中进行无人监督、远程管理的运动前的安全性和预参与筛查。本研究的主要成果是为提供者提供的一种临床决策辅助工具，以便在患者参与新启动的 LAMFit 远程运动计划之前对其进行医学筛查。
